Ductal carcinoma in situ: Trends in treatment over time in the US

National Cancer Institute, CTEP, Bethesda, MD, USA.
Breast Cancer Research and Treatment (Impact Factor: 3.94). 10/2010; 127(1):251-7. DOI: 10.1007/s10549-010-1198-z
Source: PubMed


To describe therapy and changes in therapy over time for women diagnosed with ductal carcinoma in situ (DCIS) and treated in the community setting. Women aged 20 or older diagnosed with DCIS in this study were sampled from the population-based Surveillance, Epidemiology and End Results Program. A total of 770, 1055, 480, and 404 women with DCIS were selected in 1991, 1995, 2000, or 2005, respectively. Most women do not have nodal sampling, but between 2000 and 2005 there was an increase in the use of sentinel node biopsy, 9 and 22%, respectively. Of the DCIS patients, 80% had no or unknown HER-2 assays, 12% were postitive, 7% negative, and 1% equivocal. After adjusting for tumor size, age, race, marital status, and insurance there has been a decrease in mastectomy since 1991. Of women with DCIS 36% were given tamoxifen in 2000; in 2005 this decreased to about 21%. However, in 2005 we see the use of aromatase inhibitors in nearly 4% of patients. HER-2 testing is increasingly performed for women with DCIS. Despite positive HER-2 tests no women received trastuzumab as of 2005. Despite the lack of clinical trials evidence, aromatase inhibitors are being prescribed for women with DCIS.

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    • "The frequency of such upstaging varies in different sets of patients and is usually between 15% and 40%, with a median value of 26.0% [1]. Though the incidence of nodal metastases in pure DCIS is rare (3.7% in a meta-analysis [2]), the role of sentinel lymph node biopsy (SLNB) has been debated, because of the possibility of invasion in the definitive surgical specimen, and there are substantial differences regarding its indication worldwide [3, 4]. SLNB is not considered a demanding procedure, but there are still some associated costs and inconvenience for the patient. "
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    ABSTRACT: Objectives . The aim of the study was to develop a clinical prediction model for assessing the probability of having invasive cancer in the definitive surgical resection specimen in patients with biopsy diagnosis of ductal carcinoma in situ (DCIS) of the breast, to facilitate decision making regarding axillary surgery. Methods . In 349 women with DCIS, predictors of invasion in the definitive resection specimen were identified. A model to predict the probability of invasion was developed and subsequently simplified to divide patients into two risk categories. The model’s performance was validated on another patient population. Results . Multivariate logistic regression revealed four independent predictors of invasion: (i) suspicious (micro)invasion in the biopsy specimen; (ii) visibility of the lesion on ultrasonography; (iii) size of the lesion on mammography >30 mm; (iv) clinical palpability of the lesion. The actual frequency of invasion in the high-risk patient group in the test and validation population was 52.6% and 48.3%, respectively; in the low-risk group it was 16.8% and 7.1%, respectively. Conclusion . The model proved to have good performance. In patients with a low probability of invasion, an axillary procedure can be omitted without a substantial risk of additional surgery.
    BioMed Research International 07/2014; 2014(9):480840. DOI:10.1155/2014/480840 · 2.71 Impact Factor
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    • "Supplemental radiation is part of adjuvant therapeutic regime [18]. Until now, there has been an absence of common guidelines for the use of hormone therapy or Trastuzumab, a monoclonal antibody, for patients with (human epidermal growth factor) HER 2 positive DCIS [19-22]. Boughey et al. [19] suggested that anti-hormone therapy should be part of adjuvant therapy regime in oestrogen receptor positive DCIS and the use of Trastuzumab for DCIS was seen as an option which needs to be more specified in future. "
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    ABSTRACT: Background Lysine-specific demethylase1 (LSD1) is a nuclear protein which belongs to the aminooxidase-enzymes playing an important role in controlling gene expression. It has also been found highly expressed in several human malignancies including breast carcinoma. Our aim was to detect LSD1 expression also in pre-invasive neoplasias of the breast. In the current study we therefore analysed LSD1 protein expression in ductal carcinoma in situ (DCIS) in comparison to invasive ductal breast cancer (IDC). Methods Using immunohistochemistry we systematically analysed LSD1 expression in low grade DCIS (n = 27), intermediate grade DCIS (n = 30), high grade DCIS (n = 31) and in invasive ductal breast cancer (n = 32). SPSS version 18.0 was used for statistical analysis. Results LSD1 was differentially expressed in DCIS and invasive ductal breast cancer. Interestingly, LSD1 was significantly overexpressed in high grade DCIS versus low grade DCIS. Differences in LSD1 expression levels were also statistically significant between low/intermediate DCIS and invasive ductal breast carcinoma. Conclusions LSD1 is also expressed in pre-invasive neoplasias of the breast. Additionally, there is a gradual increase of LSD1 expression within tumour progression from pre-invasive DCIS to invasive ductal breast carcinoma. Therefore upregulation of LSD1 may be an early tumour promoting event.
    BMC Clinical Pathology 08/2012; 12(1):13. DOI:10.1186/1472-6890-12-13
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    • "This is well evidenced by a recent report on treatment of DCIS in the United States, describing that at the present time 30% of women with DCIS are treated with mastectomy, 40% with conservative surgery plus RT, and 30% with excision alone [8]. Additionally, data on treatment trends for DCIS in the USA have documented a shift in the last 15 years with a decrease of mastectomy in favour of breast conservation plus RT [3]. Breast conservation for DCIS is an issue of particular relevance and interest, because it is well documented that, on the other hand, mastectomy rates are on the rise in the USA as in other parts of the world [9]. "
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    ABSTRACT: Ductal Carcinoma in situ has been diagnosed more frequently in the last few years and now accounts for approximately one-fourth of all treated breast cancers. Traditionally, this disease has been treated with total mastectomy, but conservative surgery has become increasingly used in the absence of unfavourable clinical conditions, if a negative excision margin can be achieved. It is controversial whether subgroups of patients with favourable in situ tumors could be managed by conservative surgery alone, without radiation. As the disease is diagnosed more frequently in younger patients, these issues are very relevant, and much research has focused on this topic in the last two decades. We reviewed randomized trials regarding adjuvant radiation after breast-conservative surgery and compared data with available retrospective studies.
    International Journal of Surgical Oncology 05/2012; 2012(22):296829. DOI:10.1155/2012/296829
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