Treatment and Long-Term Risks for Patients With a Diagnosis of Ductal Carcinoma In Situ

Zee, Kimberly J. Van; Barrio, Andrea V.; Tchou, Julia

doi:10.1001/jamaoncol.2015.4860

Cited by 7 publications

(6 citation statements)

References 4 publications

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“…Another criticism raised against our paper and the message that DCIS could be fatal in its own right was that pathology is an inexact science and that the 3% of women who succumbed to breast cancer probably had cancers with missed foci of micro-invasion, and hence, many invasive breast cancers were misclassified as DCIS [ 26 ]. In the SEER data set, there were 13,489 cases of DCIS with micro-invasion that we excluded from our original analysis.…”

Section: Part 2: the Seer Study: Mortality After Dcismentioning

confidence: 99%

Is invasion a necessary step for metastases in breast cancer?

Narod

Sopik

2018

Breast Cancer Res Treat

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PurposeTo review the empirical evidence to support the conventional (sequential) model of breast cancer progression, which is based on the paradigm that cancer passes through several stages, including an in situ stage prior to an invasive stage, and thereafter (in some cases) disseminates to the lymph nodes and distant organs.MethodsWe review the cancer literature of the last 50 years which relates to the prevention of invasive breast cancer (through radiotherapy or surgery) and reductions in the mortality for breast cancer.ResultsFor both invasive cancers and DCIS, the literature indicates that prevention of in-breast invasive recurrences does not prevent death from breast cancer. Moreover, the presence of residual cancer cells in the breast after breast-conserving surgery does not compromise the cure rate.ConclusionWe propose an alternate (parallel) model of breast cancer wherein there is a small pool of cancer stem cells which have metastatic potential from their inception and which disseminate synchronously through several routes—to the breast stroma, to the lymph nodes and to distant organs. Cancer cells which disseminate to the breast give rise to cells which make up the bulk of the tumour mass but these are not the source of the distant metastases.

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Section: Part 2: the Seer Study: Mortality After Dcismentioning

confidence: 99%

Is invasion a necessary step for metastases in breast cancer?

Narod

Sopik

2018

Breast Cancer Res Treat

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“…Meta-analyses of four randomized clinical trials of radiotherapy for DCIS demonstrated that radiotherapy halves the risk of ipsilateral invasive disease [8], but with fewer than 4000 patients combined, the trials lack sufficient statistical power to assess the risks of second non-breast cancers. A recent observational study reported that despite reducing the risk of invasive disease, radiotherapy for DCIS did not lead to decreased breast cancer-specific mortality 10 years post-diagnosis, contributing to an ongoing discussion regarding the magnitude of the benefit of radiotherapy for DCIS [9][10][11][12][13]. Two small studies have reported the patterns of second non-breast cancers after breast carcinoma in situ (BCIS), but they did not evaluate the effect of radiotherapy [14,15].…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy for ductal carcinoma in situ and risk of second non-breast cancers

Withrow

Morton

Curtis

et al. 2017

Breast Cancer Res Treat

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Radiotherapy was associated with an increased risk of second non-breast cancers. The specific excess of cancers at sites likely in/near the radiotherapy field suggests the findings are unlikely due exclusively to confounding, but further research into factors related to receipt of radiotherapy is needed. Our risk estimates can be used to help assess the balance of the risks and benefits of radiotherapy for DCIS and to inform clinical practice.

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“…Nevertheless, as most evidence supports the notion that true in-situ disease alone in the absence of occult invasion does not have this capability, there is a view that DCIS should not be considered a true cancer as it has a low disease-specific mortality rate. 2,3 Nonetheless, patients are at risk of local recurrence and progression, generally within 10 years. 4,5 Historically, DCIS was relatively rare, presenting as a symptomatic palpable mass with an incidence of only 5.8/100 000 in the 1970s.…”

Section: Definition and Incidencementioning

confidence: 99%

“…However, some consider DCIS to be a genuine cancer with the rare potential to disseminate earlier, 1 albeit with a minimal risk of being life‐threatening. Nevertheless, as most evidence supports the notion that true in‐situ disease alone in the absence of occult invasion does not have this capability, there is a view that DCIS should not be considered a true cancer as it has a low disease‐specific mortality rate 2,3 . Nonetheless, patients are at risk of local recurrence and progression, generally within 10 years 4,5 …”

Section: Definition and Incidencementioning

confidence: 99%

Identifying recurrences and metastasis after ductal carcinoma in situ (DCIS) of the breast

et al. 2022

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Identifying recurrences and metastasis after ductal carcinoma in situ (DCIS) of the breast Ductal carcinoma in situ (DCIS) of the breast is a non-invasive tumour that has the potential to progress to invasive ductal carcinoma (IDC). Thus, it represents a treatment dilemma: alone it does not present a risk to life, however, left untreated it may progress to a life-threatening condition. Current clinico-pathological features cannot accurately predict which patients with DCIS have invasive potential, and therefore clinicians are unable to quantify the risk of progression for an individual patient. This leads to many women being over-treated, while others may not receive sufficient treatment to prevent invasive recurrence. A better understanding of the molecular features of DCIS, both tumour-intrinsic and the microenvironment, could offer the ability to better predict which women need aggressive treatment, and which can avoid therapies carrying significant sideeffects and such as radiotherapy. In this review, we summarise the current knowledge of DCIS, and consider future research directions.

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Treatment and Long-Term Risks for Patients With a Diagnosis of Ductal Carcinoma In Situ

Cited by 7 publications

References 4 publications

Is invasion a necessary step for metastases in breast cancer?

Is invasion a necessary step for metastases in breast cancer?

Radiotherapy for ductal carcinoma in situ and risk of second non-breast cancers

Identifying recurrences and metastasis after ductal carcinoma in situ (DCIS) of the breast

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