Dr Flanagan on Debates About Genomic Assays for DCIS Treatment Decision-Making

“In breast cancer, we always have to be talking with each other and learning new things.”

Meghan R. Flanagan, MD, MPH, a physician at Fred Hutchinson Cancer Center and an assistant professor of surgery at the University of Washington School of Medicine, highlighted details of a breast cancer multidisciplinary tumor board discussion that was presented at the 43rd Annual Miami Breast Cancer Conference.

This discussion explored radiation treatment strategies for patients with ductal carcinoma in situ (DCIS). During the session, one of the cases presented by fellows centered on the management of DCIS and sparked a debate among the attendees, Flanagan began. Despite the case being a relatively common clinical scenario, the discussion revealed a wide spectrum of opinions regarding the most appropriate radiation protocols, she said.

A theme of the debate was the use of genomic scores to guide treatment decisions, according to Flanagan. She noted that although several colleagues were strong proponents of using these assays to determine radiation necessity, her own institution does not currently incorporate these scores into standard practice. This divergence in clinical approach served as an example of how management strategies for breast cancer can vary significantly across different health care settings, she explained. Flanagan observed that the presence of national and international experts—including surgeons, medical oncologists, and radiation oncologists—offered a unique opportunity to witness these varying professional philosophies firsthand.

Flanagan shared that the outcome of this tumor board reinforced the critical importance of ongoing multidisciplinary communication and the necessity of remaining open to new information. She emphasized that the lack of a single, uniform answer for a common case highlights the complexity of modern oncology. For Flanagan, the true value of these discussions lies in the ability to bring new insights back to one’s local practice. Following the session, she engaged her institution’s radiation oncologists in a dialogue regarding genomic assays for DCIS to better understand why their specific practice patterns differ from those of other leading experts, she concluded.