['lizbeth]

Sarah,

It is my understanding that all US oncologists follow the NCCN Clinical Practice Guidelines. To stray from the guidelines means prescribing "off label" -using a drug for a purpose other than the FDA approval.

I double-checked on nccn.org and did not see Herceptin in the guidelines for Her2 3+ with DCIS.

California is generally ahead of the curve on clinical trials, but must comply with the same standard guidelines as the remainder of the country.

Here is a snippet of the guidelines:

Although HER2 status is of prognostic significance in invasive cancer, its importance in DCIS has not been elucidated. To date studies have either found unclear or weak evidence of HER2 status as a prognostic indicator in DCIS.

The NCCN Panel concluded that knowledge of the HER2 status of DCIS does not alter the management strategy, and routinely should not be determined.

From page 77 version 3.2013 Breast Cancer DCIS guidelines


Currently California has no plans to secede from the Union - so I guess we are following the same guidelines as everyone else. Those folks over in Texas, now that is a different story. There was a petition circulating not too many years ago to put secession from the Union to a state vote.


There are studies with Herceptin and DCIS, but if the numbers are not statistically significant it doesn't stand a chance of making it into the guidelines.



I do see an NCCN consensus that MRI should be optional for DCIS based on a study that showed 93 were diagnosed with DCIS using mammogram, but 153 were diagnosed with MRI out of 193 with pure DCIS.