Is There a Personalized Way to Treat DCIS Breast Cancer?

Is There a More Personalized Way to Treat DCIS Breast Cancer?

dcisAt the 2014 annual meeting of the San Antonio Breast Cancer Symposium, an important report was shared with the largest breast cancer research meeting in the world.

This report came from Ontario Canada that’s called the Ontario Cohort Report which examined the effectiveness of the Oncotype DX Breast Cancer Assay further.

The Ductal Carcinoma In Situ (DCIS) score from the Oncotype DX Breast Cancer Assay was an independent predictor and an important predictor of biologic predictor of the chance of the cancer recurring within the treated breast.

It’s been suggested that this DCIS score can help breast cancer patients tailor their breast cancer treatment. But what we have used historically to make this breast cancer treatment decision is factor such as the age of the patient, the size of the area of the in situ breast cancer, the grade of the cancer which might determine whether radiation therapy is needed when you have breast conservation.

But could this test be the solution to a More accurate and Personalized Way to Treat DCIS Breast Cancer?

Find out from our Medical Director Dr. Jay Harness in the video below.

Transcript

Jay K. Harness: Is there is a more personalized way to treat ductal carcinoma in situ? Let me share with you some breaking news on this subject.

Ductal carcinoma in situ, DCIS, is the cancer still confined inside the ducts of the breast. DCIS can be treated with lumpectomy and if you do treat it with lumpectomy, you typically need radiation therapy and perhaps anti-hormone therapy. The question has been which of the types of ductal carcinoma in situ do we need to treat with radiation therapy and anti-hormone therapy.

What we have used historically to make this decision is the age of the patient, the size of the area of the in situ breast cancer, the grade of the cancer, whether it’s solid cribriform or whatever it may be, whether there is comedonecrosis, all these fancy terms have been combined together as a way of deciding whether radiation therapy is needed when you have breast conservation. Remember that if you leave the breast behind, then there is a chance of a recurrence of the cancer in the breast.

Well, importantly the folks at Genomic Health have developed a while ago an Oncotype DCIS test taking the same type of technology and applying this to the in situ breast cancer the way they have with invasive breast cancer and the Oncotype score has become very much part of the standard of care in evaluating patients with invasive breast cancer. Around four years ago was the first initial report on the DCIS score in a small group of

patients that strongly suggested that a low risk DCIS score may be associated with avoiding radiation therapy. In other words, the radiation therapy was not going to be needed and wasn’t going to add that much. The difficulty with that original report of a few years ago was the group of patients was quite small.

At the 2014 annual meeting of the San Antonio Breast Cancer Symposium, an important report was shared with the largest breast cancer research meeting in the world. This report came from Ontario Canada that’s called the Ontario Cohort Report. This was a much larger group of patients around 571 patients were treated with lumpectomy alone and no radiation therapy.

What was done then was to look at those 571 patients and look at their DCIS score of low risk, intermediate risk, and high risk and then looking at what the recurrence rate was of the cancer within the breast. Now little over 60% of the patients in this Cohort Study had a DCIS score in the low risk range and the chance that they are going to have a recurrence in their breast was very low.

In other words what came out of this study also looking at the age of the patient, the size of the area of the DCIS, the grade of the DCIS, and the other anatomic and clinical factors that we normally use, what we found was and what the authors reported was that the DCIS score was an independent predictor and an important predictor of biologic predictor of the chance of the cancer reoccurring within the treated breast, so what’s the bottom line of this study, we now have an additional tool to evaluate whether patients need follow-up radiation therapy after lumpectomy and been treated for ductal carcinoma in situ.

I believe that the importance of the study is going to grow enormously. If you have been diagnosed with ductal carcinoma in situ, I believe it’s highly appropriate now to ask what is your DCIS score and how does that DCIS score play into making additional treatment decisions about your cancer.

 

Dr. Jay Harness is a surgeon specializing in complete breast health, breast cancer surgery, oncoplastic reconstruction, genetic screening, risk assessment and counseling, management of breast health issues and breast cancer treatment in Orange County, California. Dr. Harness completed his general surgery residency at University of Michigan Hospitals and Health Centers.