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Ductal Carcinoma In Situ

By Linda Fugate PhD
 
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The name may be worse than the actual disease, according to a conference statement produced by the National Institutes of Health. Ductal carcinoma in situ (DCIS) is a form of breast cancer that originates in the milk ducts. The “in situ” part means that the abnormal growth is confined to the area bounded by the duct. Dr. Carmen J. Allegra of the University of Florida and colleagues on the Consensus Development Panel noted that both patients and physicians have strongly negative reactions to any diagnosis of cancer. “It is also important for the medical community to consider eliminating the term 'carcinoma' in this disease, as DCIS is by definition not invasive – a classic hallmark of cancer.”

By analogy, the name “polyp” sounds much less frightening than “colon cancer”. Both polyps and DCIS can develop into invasive cancer if not treated promptly. However, early detection and removal of both offer complete cure for most patients.

Allegra noted that some women choose mastectomy to remove both breasts when DCIS is diagnosed in only one breast. However, “no clear data exist to suggest that this improves outcomes.” Local excision (lumpectomy) with radiation is just as good as mastectomy in terms of long-term survival. However, patients who choose mastectomy have only a 1 percent rate of developing breast cancer again, compared to 12 percent of those who choose breast-conserving initial treatment.

“It is important to stress that DCIS has a high probability of long-term disease-free survival and that all current therapies have short- and long-term side effects,” Allegra added. Thus, she recommended more research on which patients are likely to experience recurrence.

Dr. Karla Kerlikowske and colleagues at the San Francisco Veterans Affairs Medical Center performed a study of 1,160 women who were diagnosed with DCIS and treated with lumpectomy alone between 1983 and 1994. They found that the 8-year risk of invasive cancer was significantly higher for DCIS lesions that were detected by palpation (the woman or her doctor could feel a lump) and that were positive for all three of the biomarkers designated p16, COX-2, and Ki67.

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