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Breakthrough Helps Predicts Risk of Invasive Breast Cancer


The most common form of non-invasive breast cancer is ductal carcinoma in situ (DCIS). Scientist may now have discovered a way to predict if a woman with DCISis at risk of developing more invasive tumors.

The research comes from the University of California, San Francisco and the San Francisco Veterans Affairs Medical Center. The results of their study is published online by the “Journal of the National Cancer Institute.’’

Karla Kerlikowske, MD and colleagues followed the medical histories of 1,162 women aged 40 years and older who were diagnosed with DCIS and treated with lumpectomy. They found that two factors were predictors of risk of developing invasive cancer within eight years after a diagnosis of DCIS -- the method by which it was detected and the expression of several biomarkers.

The researchers found that a breast lump that is diagnosed as DCIS was more predictive of a high risk of subsequent invasive cancer than DCIS diagnosed by mammography.

The researchers also found that different combinations of biomarkers measured on the initial DCIS tissue were associated with varying levels of risk of invasive cancer or DCIS. These biomarkers include 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.

DCIS rarely leads to death from breast cancer. It is estimated approximately 11% women treated by lumpectomy go on to develop invasive cancer within eight years of the initial diagnosis of DCIS, and only 1 to 2% of women die of breast cancer within 10 years of diagnosis.

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Historically, it has been difficult to present women diagnosed with DCIS with an accurate perception of their risk of later developing invasive cancer. This new information has the potential to help clarify the risk.

Currently, approximately 35% opt for a lumpectomy, about 25% for a complete mastectomy, 3 to 5% for active surveillance only, and the remainder for lumpectomy plus radiation or hormone treatment or both.

“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.’’

The data shows definite markers that will predict as far as eight years into the future, said Thea D. Tlsty, PhD, one of the principal investigators of the study. She is a professor of pathology and UCSF leader of the Cell Cycling and Signaling Program at the UCSF Helen Diller Family Comprehensive Cancer Center.

“This is an exciting and powerful beginning, to be able to predict which pre-cancers will lie dormant and which will lead to invasive cancers,’’ said Tlsty. “For the first time, we’ve identified that group of patients who have the lowest risk and the group at highest risk of developing invasive cancer. It’s a big step forward.’’

“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.


Biomarker Expression and Risk of Subsequent Tumors After Initial Ductal Carcinoma In Situ Diagnosis; Karla Kerlikowske, Annette M. Molinaro, Mona L. Gauthier, Hal K. Berman, Fred Waldman, James Bennington, Henry Sanchez, Cynthia Jimenez, Kim Stewart, Karen Chew, Britt-Marie Ljung, Thea D. Tlsty; Journal of the National Cancer Institute, doi:10.1093/jnci/djq101
This page is updated on May 18, 2013