Experts Say DCIS Requires Focus on Genomics and Microenvironment

Meir Rinde
Published: Tuesday, May 21, 2019
Norman Wolmark, MD

Norman Wolmark, MD

Identifying patients with ductal carcinoma in situ (DCIS) who are more likely to develop invasive breast cancer remains a challenge, despite decades of research and the development of stratification methods to predict progression and recurrence, experts say. Two major areas of study are the appropriate use of active surveillance and the use of biomarkers observed in the DCIS microenvironment to determine risk.

Most patients with DCIS are treated with surgery, often combined with radiation and hormone therapy. This results in some patients being treated for low-grade precancerous lesions that probably would not develop into invasive cancers.1 At the same time, long-term follow-up of women with minimally treated DCIS showed that invasive cancers and distant metastases are significant concerns, and management of the condition remains controversial.2

Norman Wolmark, MD, chairman of the National Surgical Adjuvant Breast and Bowel Project (NSABP), laments that DCIS risk is often categorized somewhat arbitrarily. Favorable-risk patients are variously defined by characteristics such as a favorable pattern of microcalcifications, low nuclear grade, estrogen receptor (ER) positivity, and mature age, he said. High-risk patients are said to be ER negative, HER2 positive, of high nuclear grade, and/ or younger and to require aggressive treatment.

Wolmark, who discussed DCIS during a presentation at the 36th Annual Miami Breast Conference® (MBCC), said in his conference abstract that the debate over the treatment of DCIS has been “driven largely by social media, the nonmedical press, and big data mining.”

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