DCIS & Neoadjuvant treatment - moving discussion to a new thread

[sarah]

Hello Lizabeth, thank you for your post. I am actually not angry because I am so happy with the life I have now. I jsut wish to warn others to fight and to be careful. My theme song during chemo when I thought I was dying (the recurrence) was the Eagles song "get over it" and that's my attitude, enjoy each day as a gift and the past is just that, past. I was lucky but I could have been dead. Just don't want others to have to deal with that risk. I am not at all angry but thanks for caring. I love California and am so sorry you are all suffering from the effects of radiation on your food, etc - who would have thought the japanese would have been so careless. take iodine or whatever to protect yourselves. It will get over here also I'm sure. But we had the Russians mess already.
health and happiness
sarah

['lizbeth]

LMAO. Okay Okay. I did check and see about the clinical trials of Herceptin and DCIS. You never know - you might have been the catalyst that started the ball rolling on this years ago. You probably traumatized that doctor for life.

So many Americans retiring to France - it must be a wonderful place to live.

I'm not worried about the Japanese radiation. I had to start taking iodine (Kelp) several years ago for mastalgia. I've got bottles of it. With the stockpile of nuclear weapons maybe we should all have a bottle of Kelp in the pantry, eh?

Geez - and I was silly enough to be concerned about breast cancer.

[sarah]

Lizbeth, do you mean if you have DCIS, you don't get Herceptin if you're HER2+??? I thought Herceptin was automatic now with HER2, am I mistaken???? California is generally ahead of the curve.

['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.

['lizbeth]

I read further into the guidelines and found with breast conserving therapy a study of 215 patients showed an 8 year recurrence rate of 0% for low risk DICS, 21.5% for intermediate risk DCIS and 32.1% for high-risk DCIS.

A different study showed a 94% disease free survival rates with low risk DCIS, and 83% for both intermediate and high-risk DCIS over 10 years.

Later in the guidelines it states half of the local recurrences will be Invasive Ductal Carcinoma.

I did not see data on DCIS treated with mastectomy for recurrence rates in the guidelines.

Based on these numbers - if the goal to reduce recurrence perhaps Herceptin could make it into the guidelines. The studies will be worth watching.

I saw that IDC was found in 25% of the DCIS biopsies.

I think Sarah's decision for mastectomy was prudent, and not extreme - especially with intermediate and high risk DCIS.