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Old 09-19-2006, 11:12 AM   #1
Lani
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intriguing study--how many of you had DCIS as well as infiltrating ductal carcinoma?

...or DCIS prior to infiltrating ductal carcinoma?

Needs to be looked at with larger number of patients--thought-provoking!


Presence of HER2/neu Predicts Development of Invasive Disease in Ductal Carcinoma in Situ: Presented at IAP

By Alison Palkhivala

MONTREAL, CANADA -- September 18, 2006 -- The presence of the pathological marker HER2/neu in patients with ductal carcinoma in situ (DCIS) may predict which patients will go on to develop invasive breast cancer, according to research presented here at the 26th International Congress of the International Academy of Pathology (IAP).

Based on this evidence, patients with DCIS who are HER2/neu-positive might benefit from a biologic agent such as trastuzumab, which specifically targets the HER2/neu receptor, while those without this marker may be fine with a less aggressive therapeutic approach than is currently recommended for DCIS, the researchers concluded.

"Most patients with DCIS … will not die of their disease; it's a highly curable disease," said Sharon Nofech-Mozes, MD, clinical fellow, Sunnybrook and Women's College Hospital, Toronto, Ontario, Canada. "Yet, with no further treatment rather than surgical resection, 25% [of these cancers] will recur, and about half of them will recur as invasive cancer."

All patients with DCIS are now subjected to 6 weeks of radiotherapy after they undergo breast resection. "If you go back and do the math, you realize that most of these patients would never have recurred, so they are subjected to 6 weeks of radiation unnecessarily," Dr. Nofech-Mozes said.

To identify novel pathological markers assessed using immunohistochemistry that could be used to determine which patients with DCIS are at high risk for invasive disease, Dr. Nofech-Mozes and colleagues reviewed 133 cases of pure DCIS treated with breast conserving surgery between 1982 and 2000.

"The idea was to identify a high risk group of patients who will actually benefit from the addition of radiotherapy and spare the radiotherapy for the majority of patients who are now getting it," she explained.

Patients were followed for a median of 8.91 years to determine who would develop invasive disease, and the investigators then assessed which pathological markers were most predictive of outcome.

In her poster presentation today, Dr. Nofech-Mozes said that in the area of DCIS, this study represents a large sample size. The follow-up period was also long enough to capture the majority of cases of invasive carcinoma that would occur in this cohort of patients, she said.

Among the 9 pathological markers they investigated, the researchers found the presence of 1 to be predictive of invasive disease: HER2/neu.

"This is the same marker that is targeted by herceptin [trastuzumab]," she said.

She also said that if the findings of this study are true, then each patient with DCIS should be tested for HER2/neu routinely. "It may be that these patients should be targeted with molecular therapy like Herceptin somewhere down the road. But this must be confirmed in a larger study."


[Presentation title: Molecular Markers for Invasive Recurrence in DCIS. Poster 72]
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Old 09-19-2006, 11:37 AM   #2
Margerie
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I had multi-focal DCIS as well as multi-focal IDC at diagnosis.

Mammo 3 years before, age 35, showed no abnormalitites.

Good trend here. I would hate to think of going thru radiation for no benefit.
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Old 09-19-2006, 02:37 PM   #3
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By coincidence, I was reading an older article (2002) today that addresses a similar subject. The abstract can be found at http://cancerres.aacrjournals.org/cg...act/62/22/6667 with a free link to the full article at that site. The objective of the study was to determine whether measuring activated (physphorylated) her2 in DCIS provided better prognostic information than simply measuring the amount of her2 expressed. They found that there was a higher percentage of activated her2 in DCIS than in IDC, a result they described as "paradoxical," and went on to say:

"This suggests that Her-2/neu signaling activity is a very important component of the biology of DCIS itself and possibly plays a criticial role in tumerogenesis. As a tumor advances to a more abnormal, invasive phenotype, other biological changes may occur that supplant the requirement for continued Her-2/neu signaling; this may explain the low response rate in the treatment of Her-2/neu overexpressing advanced breast cancer patients with single agent trastuzumab (Herceptin), the therapeutic anti-Her-2/neu antibody. Such anti-Her-2/neu-targeted therapy could be more efficacious at treating DCIS than invasive carcinoma, although it would be a difficult clinical area to explore because one would not want to compromise the nearly 100% cure rate achieved surgically. However, this may bode well for the incorporation of anti-Her-2/neu-targeted therapy into the adjuvant treatment of early stage breast cancer."
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Old 09-19-2006, 09:00 PM   #4
Lani
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?In the Journal of Medical Hypotheses a few weeks ago

they postulated treating DCIS with intraductal (injected through the nipple) Herceptin to prevent intraductal carcinoma in situ from becoming infiltrating ductal. Tried to copy and paste parts of it (it is not free) but couldn't

Had sent it to Jean--perhaps she can
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Old 09-19-2006, 09:01 PM   #5
Lani
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?In the Journal of Medical Hypotheses a few weeks ago

they postulated treating DCIS with intraductal (injected through the nipple) Herceptin to prevent intraductal carcinoma in situ from becoming infiltrating ductal. Tried to copy and paste parts of it (it is not free) but couldn't.Sorry!
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Old 09-20-2006, 08:44 AM   #6
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I did not find out about the DCIS until lumpectomy for the IDC. I was 12 months from last mammo and 2 months from last complete physical exam. I also did very frequent self exams. My PCP said she felt nothing. I think this testifies to the aggressiveness of HER2+ breast cancer.
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Old 09-21-2006, 11:36 AM   #7
Montana
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I had both DCIS (high grade with necrosis) and IDC. A few calcifications were evident on a mamogram approximately 20 months before diagnosis.
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Old 09-24-2006, 05:02 PM   #8
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my diagnosis was multifocal IDC (2 tumors = 1.05mm) plus extensive DCIS, high-grade. I had skipped a few years since mammograms. Previously had microcalcifications


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Old 09-25-2006, 12:16 PM   #9
Christine MH-UK
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I had both

It was DCIS with infiltrating right next to it.
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Old 09-25-2006, 05:19 PM   #10
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I did an informal survey at a different breast cancer website to find out how common it was, and well over half of those with IDC had DCIS as well among that general bc population.

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IDC and DCIS
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