The researchers found 26 factors that could be linked to invasive breast cancer recurrence after DCIS. Their analysis found that six of those factors were statistically significant, which means the factors were likely linked to a higher risk of invasive breast cancer recurrence rather than it being due to chance. The researchers said that the reason each of the six factors was linked to a higher risk of invasive breast cancer recurrence could be biologically explained. The researchers recommended that these six factors be validated in other studies.
This is one of the first studies to try to identify risk factors for an invasive breast cancer recurrence after a DCIS diagnosis. It also makes sense to talk to your doctor about calculating your personal risk of invasive breast cancer using one of the assessment tools available. If you have a higher-than-average risk of invasive disease, there are a number of lifestyle choices you can make, including:.
Written by: Jamie DePolo , senior editor. Reviewed by: Brian Wojciechowski, M. These analyses have overlooked the fact that, to sustain a rate of detection each year, there would have to be a reservoir of undetected breast carcinomas growing in the population. The authors developed a simple model that makes this clear. In addition, complex phenomena have been suggested to explain why invasive breast disease may grow more rapidly among very young women and more slowly among the very old.
A simple model provides some insight that may simplify the explanation of these observations. Methods: The simple model of breast carcinoma growth assumes that there are three types of breast carcinoma that begin each year in a cohort of women. It assumes that all breast carcinomas begin as DCIS and take 9 years to go from a single cell to an invasive lesion for the slowest growing lesions, 6 years for intermediate growing DCIS lesions, and 3 years for fast-growing DCIS lesions.
This information is needed to determine how to treat the DCIS. The options for treating DCIS are: lumpectomy, lumpectomy and radiation, a combination of those with tamoxifen, or mastectomy. The goal of treating DCIS is prevention.
As long as the precancer is completely removed, it can neither come back nor become invasive. Currently not all doctors are in agreement about the best way to treat DCIS. Most women undergo breast conservation surgery, a lumpectomy. However, if the DCIS is throughout the breast, a mastectomy will probably be necessary. But if the lesions are big greater than 5cm , some experts think they may hide microinvasion and recommend removing the lymph nodes as well.
It is recommended that most women with DCIS receive radiation following a lumpectomy. You can read or download it here.
Since DCIS is not capable of spreading, there is no reason to use chemotherapy. However, if the DCIS is ER-positive you will need to consider whether you want to take tamoxifen for five years to reduce your risk of a recurrence. The decision to take tamoxifen for DCIS is a difficult one for many women, as the benefits from taking it are small and have to be weighed against the risks associated with the drug as well as any side effects you may experience.
Learn more about hormone therapy here. If you have a family history of breast cancer in addition to DCIS and you want to understand more about whether your family history may contribute to your breast cancer risk, you should make an appointment with a genetic counselor to discuss testing for the hereditary breast cancer gene mutations, called BRCA1 and BRCA2, which put women at higher risk for breast and ovarian cancer.
Under the Affordable Care Act, genetic counseling and testing are covered for high-risk women. If you decide to have genetic testing and if you are found to carry a BRCA genetic mutation your doctor may suggest that you consider a bilateral prophylactic mastectomy removal of both breasts. This will reduce the chance of getting breast cancer by about 95 percent.
The surgery is recommended if you have a strong family history of the disease. It is not recommended for women just because they have had a diagnosis of DCIS, however, some women do choose this option. Tamoxifen began to be routinely offered to women for DCIS in , after researchers reported the results of a study that investigated whether adding tamoxifen to DCIS treatment had additional value.
The findings were confirmed with additional follow-up data in The study randomized 1, women who had been treated with surgery followed by radiation for DCIS to tamoxifen or a placebo for five years. After following the women for five years, the researchers found that:.
Choosing whether to take tamoxifen to treat DCIS is obviously a complex issue. The advantages are small, but then so are the risks. Each woman will probably evaluate these risks and benefits differently. Raloxifene brand name Evista is approved for use as a treatment to reduce cancer risk in high-risk women. It is not approved for use as a treatment for DCIS or invasive breast cancer. Sometimes it is offered to postmenopausal women who cannot tolerate the side effects of tamoxifen, but this is not done routinely.
But I—along with most doctors —would not recommend that you wait for a year to be treated. The data that we have about DCIS going on to become invasive cancer comes from women that were misdiagnosed, and they were more likely to have a lower grade DCIS.
Right now, we have no way to definitively say which women with DCIS will go on to have invasive cancer and which will not. One day, we probably will.
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