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DCIS

Posted 8/19/2013

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  Is it or is it not cancer? What is the proper name for (what is now called) Ductal Carcinoma in Situ (DCIS) or its close cousin Lobular Carcinoma in Situ (LCIS)? A recent report from the NCI suggests that the name should be changed, and "cancer" taken away? ( http://www.nbcnews.com/video/nightly-news/52615855/#52615855). This report focused on over diagnosis, and DCIS was not the only diagnosis that was criticized for its name. Interestingly, virtually all studies looking at women's anxiety after a breast cancer diagnosis have found that women with DCIS are just as anxious as women with an invasive breast caner. That is unfortunate and just not necessary, and, if changing the name would help, I am in favor of it. On the other hand, no one is able yet to confirm which DCIS cells may go on to be invasive and which will happily live in the ducts, causing no harm, forever.

  Stepping back a bit from the name controversy, it is helpful to understand more about DCIS. This is an excellent article from CancerNetworks.com that will tell you all you need to know.

Ductal Carcinoma In Situ of the Breast: ‘Making the Punishment Fit the Crime’
By William C. Wood, MD

Many oncologists were heartened by the study recently published in the Journal of the National Cancer Institute showing the ability of the “Ductal Carcinoma in Situ (DCIS) Score” (based on the Oncotype DX breast cancer assay) to help predict the risk of invasive breast cancer in patients with newly diagnosed DCIS. This enthusiastic response, despite the acknowledged limitations of the study, may, as much as anything, be evidence of the difficulty of making treatment decisions for this patient population, and the urgency of the need for truly effective tools.
Contention about the best management of DCIS begins with its common inclusion with invasive breast cancer as “early breast cancer.”[1] Because DCIS is a common but not an obligate precursor of invasive breast cancer, this conflation leads to what is termed “overdiagnosis of breast cancer.”[1] Indeed, DCIS is far more common than invasive breast cancer, being found in 15% of medicolegal autopsies of women 20 to 54 years of age.[2] Because it lacks the ability to invade or metastasize, it is not a true carcinoma until—and if—it later becomes invasive. Invasive breast carcinomas progress to lethality, albeit at various rates, unless controlled, or unless intercurrent disease ends life before they do. DCIS, on the other hand, poses no threat of lethality beyond its risk of progression to an invasive cancer over time. However detected, DCIS can only be diagnosed as in situ or invasive breast cancer after excision and histopathologic examination.
Some patients present with such extensive DCIS that it may already contain areas of invasion, and mastectomy may be felt necessary to control the process in a person with years of expected survival.

Read more:

http://www.cancernetwork.com/breast-cancer/content/article/10165/2152568

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