New method to predict DCIS recurrence

Patients with ductal carcinoma in situ (DCIS) can now benefit from a multi-gene analysis that considers gene patterns to tailor therapy and predict recurrence. The DCIS score, which was published in the Journal of the National Cancer Institute, shows that the expression of 12 genes (calculated from 7 cancer-related genes and 5 reference genes) can help determine if a woman's risk of recurrence in the same breast is low, medium, or high.1 The score will help guide recommended treatment options. Researchers compared data from 327 patients with DCIS treated with surgical removal of their tumor but no radiation from an Eastern Cooperative Oncology Group (ECOG) E5 194 study. Among the factors considered in the score were age, menopause status, tumor size, margin width of the excision, tumor grade, and an analysis of 21 genes, including 7 that predict recurrence. Mastectomy was once the standard treatment for DCIS with recurrence rates at about 1.4%. For patients with DCIS who are treated with lumpectomy, surgery cures 70% of patients, but the remaining 30% develop a recurrence in the same breast. Radiation reduces that recurrence risk by about 50%, whereas adding tamoxifen—which blocks the estrogen receptor—reduces the recurrence risk to between 8% and 10%. The DCIS score will enable physicians to identify patients in the high-risk group who need the full course of therapies and those in the low-risk group for whom additional treatments with radiation and/or tamoxifen may not be necessary. Senior author Sunil Badve, MD, professor of pathology and laboratory medicine at Indiana University School of Medicine in Indianapolis, notes that the score will help safeguard patients and protect them from unnecessary therapy. In an accompanying editorial, Christine Berg, MD, formerly of the National Cancer Institute, writes that the clinical applicability of the assay for all women with DCIS remains to be determined because the research was done on a highly selected patient group. In another editorial, however, Thomas Julian, MD, of Allegheny General Hospital in Pittsburgh, Pennsylvania, writes that the score should complement traditional clinical and pathologic factors used to guide decision-making in the treatment of DCIS.