Biomarker expression and DCIS

Kitchenwitch

Does anyone know anything about biomarker expression and DCIS tumors or lesions? I came across this and found it interesting (though I probably understood only a fraction of it). It seems to indicate that grade alone is not predictive of the future behavior of DCIS. I know it seems so likely that the higher the grade, the more likely it will progress to invasive cancer, but is that really the whole picture?

IronJawedBCAngel

Read this study on Komen when it was first released.  They learn more and more about individual cancer cells each and every day.  Some studies will lead to more targeted therapy for each individual cancer diagnosis.  I asked my oncologist and it will be some time yet before pathology labs start any testing for these biomarkers en mass.  He did believe some of the large cancer centers will eventually begin testing for these.  It is exciting to me that our research dollars are drawing us closer to the day when we will be able to determine exactly who is at risk for DCIS to become invasive, or an invasive cancer to become metastatic. As mine was Grade 3, I found this study very interesting.

Beesie

Yes, I've seen this before.  Although we know that high grade DCIS and DCIS with comedonecrosis is more likely than low grade DCIS to become invasive, it's well understood that these aren't the only factors that indicate a likelihood of progression. The fact is that while it's more common to find Grade 3 DCIS that has become invasive, there are also cases where Grade 1 DCIS has become invasive. So grade is certainly not the definitive answer. Biomarkers are where the focus of research is now, in trying to better understand what makes some cases of DCIS high risk and what makes other cases of DCIS low risk. 

The research in this area is promising but is still preliminary - the studies done to-date have not been large enough to be conclusive or change treatment guidelines.  This in fact is part of the reason why I get so frustrated when I read articles about possibly changing the definition of DCIS so that it's classified as a pre-cancer rather than a cancer. There is so much we still don't know. However once the work on biomarker expression is more definitive, if clear conclusions can be drawn and treatment guidelines can be safely changed, at that point I could see that DCIS might be split, with some of what's currently called DCIS being moved into a pre-cancer category under a different name, while the rest of DCIS - the DCIS that truly is pre-invasive cancer - remains DCIS and remains classified as Stage 0 breast cancer.