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. The lowest risk group consisted of women who had DCIS detected by mammography and negative for all three biomarkers. This group had approximately the same risk of invasive breast cancer as an average 60-year-old woman.
“Many women who have been diagnosed with DCIS have an inaccurate perception of their risk of subsequent invasive cancer,” Kerlikowske reported. Her research provides more tools for estimating this risk.
References:
1. Allegra CJ et al, “National Institutes of Health State-of-the-Science Conference Statement: Diagnosis and management of ductal carcinoma in situ September 22-24, 2009”, J Natl Cancer Inst. 2010; 102: 161-169. http://www.ncbi.nlm.nih.gov/pubmed/20071686
2. Kerlikowske K et al, “Biomarker expression and risk of subsequent tumors after initial ductal carcinoma in situ diagnosis”, J Natl Cancer Inst. 2010; 102: 627-637.
http://www.ncbi.nlm.nih.gov/pubmed/20427430
Reviewed July 13, 2011
by Michele Blacksberg R.N.
Edited by Alison Stanton
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.