By Julia Janzen, BS, LPN, CRC, Mid-Illinois Hematology & Oncology
DCIS, which stands for ductal carcinoma in situ, is the earliest form of breast cancer. It is most often diagnosed as the result of an abnormal mammogram. This cancer forms inside the milk ducts and has not spread any further into other breast tissues—meaning that it is non-invasive. However, if left untreated, DCIS could very likely become invasive. DCIS is typically treated very effectively by removal of the tumor (lumpectomy) followed by radiation therapy and/or hormonal therapy.
Individuals with DCIS do have a greater chance of developing breast cancer again in the future. The cancer may recur as DCIS or as invasive carcinoma in either the same breast or the other breast. The purpose of radiation therapy and/or hormonal therapy is to greatly reduce this risk to prevent any recurrence. When determining the best treatment option, it is important that the disease is not overtreated—for example, having a mastectomy for early stage DCIS, or undertreated—for example, watchful monitoring or lumpectomy alone.
However, there are some individuals that are not able or willing to undergo the proven, typical treatment options. And sometimes the cancer is not diagnosed until it has become invasive. For certain situations, there is a genomic test available called the Oncotype DX test that can help determine the probability of breast cancer recurring. A genomic test is not the same as a genetic test. A genomic test analyzes a sample of the tumor, while a genetic test analyzes the DNA of a person’s blood or saliva.
The Oncotype DX test can offer some insight as to how the cancer is likely to respond to certain types of treatments and may therefore be a useful tool to help determine the best treatment options. The eligibility requirements for the Oncotype DX test include:
• Recent diagnosis of stage I, II, IIIa invasive breast cancer
• Tumor is estrogen receptor positive
• Tumor is HER2 negative
• Recent diagnosis of DCIS
• Treatment includes lumpectomy for DCIS patients
The test provides a recurrence score, which is a number between 0 and 100. Interpreting the score should be done by you and your doctor.
• Recurrence Score lower than 39
∙ DCIS has a low risk of recurrence.
∙ Benefits of radiation therapy are small, will not outweigh the risks of side effects.
• Recurrence Score between 39 and 54
∙ DCIS has an intermediate risk of recurrence.
∙ Benefits of radiation therapy may or may not outweigh the risks of side effects.
• Recurrence Score greater than 54
∙ DCIS has a high risk of recurrence.
∙ Benefits of radiation therapy are likely to be greater than the risks of side effects.
Breast cancer treatment decisions should always be approached in a multidisciplinary way so that all options can be reviewed and an educated decision can be made. There is no one “right” treatment that is best for every individual. The Oncotype DX recurrence score may be helpful in determining the best treatment option, but it should not be the only or primary consideration. The size, grade, and hormone receptors of the tumor as well as the age of the patient and their medical history are all important pieces of information that can make a difference.
Thankfully, breast cancer is rarely fatal—especially when caught in the early stages. Speaking with a medical oncologist, radiation oncologist, and a breast health navigator can be key when determining which treatment is right for you.
For more information, you may contact Mid-Illinois Hematology & Oncology Associates, Ltd. at 309-452-9701 or online at www.mihoaonline.org. They are an independent QOPI Certified practice located inside the Community Cancer Center at 407 E. Vernon Ave. in Normal. They are also currently enrolling patients in trials for breast cancer. If interested, please contact Julia at 309-451-2207 or julia.janzen@mihoaonline.org.
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