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Two recent articles report on a new study that suggests that, because of a series of tests, many women diagnosed with DCIS may be able to forgo some of the usual treatments.
The study also reports that if DCIS was discovered because of a lump rather than imaging it was more likely to need treatment. If, upon biopsy, the DCIS was found to be estrogen positive it was more likely to need treatment. The fact that finding it with a lump makes treatment more likely to be necessary seems logical. I’m sure that stage, grade, and type are also taken into consideration.
A potential downside that I see is that many expensive tests may be required to get the information to help make the treatment decisions. The tests are listed in the Science Daily article and they are: “biomarkers including estrogen receptor, progesterone receptor, Ki67 antigen, p53, p16, epidermal growth factor receptor-2, and cyclooxygenase-2. Women who express high levels of p16, cyclooxygenase-2 and Ki67 were more likely to develop invasive cancer after their initial DCIS diagnosis.“ I wonder if some of the single tiny DCIS spots that are found with today’s super-sensitive detection methods would produce enough tissue for multiple tests.
I tried to find out how many of these tests are included in the Oncotype DX test which looks at 20 different genetic factors and helps women with Stage 1 invasive breast cancer make the decision about chemotherapy. I was unable to discover exactly which things it tests. I believe it to cost around $4,000. Of course, estrogen and progesterone receptors have been tested for years and are routinely tested in breast cancer biopsies.
I am happy that so many articles are being published about the possible over-treatment of DCIS. I also hope that we will not “over-test.” That being said, I do understand the urge that women have to get every bit of information about their situation possible in order to make the wisest treatment decisions. If the Oncotype DX test had been available when my stage I breast cancer was discovered seven years ago, it would undoubtedly have helped me in making my chemotherapy decision. All I could do then was look at the statistics, try to unravel what the statistics really meant, and then make my decision and hope for the best. Today there are many new tests and treatments, but the uncertainties remain and carefully weighing useful evidence is still a wise strategy.
“For the first time, scientists have discovered a way to predict whether women with ductal carcinoma in situ (DCIS) — the most common form of non-invasive breast cancer — are at risk of developing more invasive tumors in later years.
As a result of the finding, women with DCIS will have the opportunity to be more selective about their treatment, according to the scientists.
“Women will have much more information, so they can better know their risk of developing invasive cancer,” said lead author Karla Kerlikowske, MD. “It will lead to a more personalized approach to treatment. As many as 44 percent of patients with DCIS may not require any further treatment, and can rely instead on surveillance…”
Because of the research, physicians will now be able to predict whether a DCIS patient treated by lumpectomy only will subsequently develop invasive cancer, DCIS, or be at very low risk of developing further tumors…
DCIS rarely leads to death from breast cancer — approximately 11 out of 100 women treated by lumpectomy only go on to develop invasive cancer within eight years of the initial diagnosis of DCIS, and only 1 to 2 percent of women die of breast cancer within 10 years of diagnosis. Yet, women diagnosed with DCIS have historically had an inaccurate perception of their risk of later developing invasive cancer, and as a result have chosen fairly aggressive courses of treatment, said Tlsty.
Currently, approximately 35 percent opt for a lumpectomy, about 25 percent for a complete mastectomy, 3 to 5 percent for active surveillance only, and the remainder for lumpectomy plus radiation or hormone treatment or both.
“Women choose their treatment based on their level of concern of developing invasive cancer,” said Kerlikowske. “DCIS is non-invasive so women do not die of it. Their real concern arises if they develop invasive cancer and the cancer spreads.”
According to the study, the group of patients with the lowest risk has only a 2 percent chance of developing invasive cancer at 5 years and a 4 percent chance at 8 years…”
“Conclusion-Biomarkers can identify which women who were initially diagnosed with DCIS are at high or low risk of subsequent invasive cancer, whereas histopathology information cannot…”