Bio markers predict invasive cancer?

MY DCIS was found on mammo- microcalcifications. I'm scheduled for a lumpectomy this coming Monday. I'm also having intraoperative radiation therapy (IORT) during lumpectomy.

I think I will call my surgeon Monday!

I agree with dsj:  the study is a retroactive study in that they looked at data collected on women treated  from 1983 to 1994 with only a lumpectomy.  They used this data to see which of the women had a recurrence.  From that they were able to show that women with a certain "formula" of biomarkers were more likely to recur.  They even state that it is too early to form any concrete conclusions at this point, however, I still think it would be a good idea to gather the info from the sample.  This research may lead to future predictions for untreated DCIS as well as those of us who have had a BMX.  Recurrance following mastectomy is thought to be from cells left behind from the surgeon or an invasive component that was not identified.  Even with a 1 - 2% recurrance rate, you still worry.  Personally I would have liked to have this information so that I could either a:  not worry as much or b:  make sure I had appropriate follow up care.  I don't know if it is too late now that all of my samples are engulfed in parafin archived away in the lab.  Just assuming it would be easier and more cost effective to do it at the time of initial lab tests.  

ebarry, the problem with HER2 testing for DCIS patients is that a lot of us will turn out to be HER2+.  And then what?  The fact is that a much higher percent of DCIS patients are HER2+ (about 40%) versus those who have IDC (about 20% are HER2+).  No one knows yet why that is.  And whether HER2 status is an indicator of aggressiveness and future invasion isn't known yet either.  The study that you linked from last year is the most recent study on this, and it did show that those who were HER2+ had a higher risk of invasion, but there have been other studies that have shown just the opposite.  All these studies are small, so at this point there really is no definitive answer, just conflicting information.  Even the author of the study that you linked isn't saying anything definitive:  "If HER2 is associated with invasion or plays a role in the development of invasive disease, then maybe targeting it early can keep people from moving from DCIS to invasive cancer."  It sounds like it's just a hypothesis at this point, not a known or certain fact.

Here are other studies on HER2 status and DCIS:

http://cebp.aacrjournals.org/content/11/6/587.full   This one found that "HER-2/neu gene amplification was less common in DCIS associated with invasive breast cancer (cases) than DCIS alone (controls). "

http://journals.lww.com/oncology-times/Fulltext/2007/04250/Importance_of_HER_2_Neu_Positivity_as_Predictor_of.16.aspx  This article reviews two research studies on HER2 status & DCIS that each came to different conclusions. "The first suggested that HER-2/neu overexpression was a predictor of invasive recurrence, and the second study said it was not predictive of outcome."

So it's fifty/fifty at this point - half the studies say that HER2+ status is an indicator of future invasion, and half say it's not. With this information, or more to the point, lack of information, in the end we all have to do what we are comfortable with.  In my case, I don't know my HER2 status. I'm glad. I'm not comfortable that medical science knows much at all about what it means and what should be done (if anything at all) for those who have HER2+ DCIS.  So knowing my HER2 status would only confuse me and possibly concern me.

When you say  you have a 50% chance of recurrence, what do you mean?  If someone diagnosed with DCIS has a recurrence, there's a 50% chance that recurrence will be invasive. But it's 50% of what your own risk is.  So if your risk of recurrence is, for example, 5%, your risk of invasive cancer is 2.5%

 An overall 50% chance of recurrence is very, very high.  If you indeed have an overall 50% chance I would imagine the BS would have urged a mastectomy from the start. 

Rate for recurrence in lumpectomy with radiation is 11%, without radiation 22%, depending upon risk factors.  Half of that can be invasive.  So realistically, your max risk is 11% or less for having it come back and it is invasive.  This statistic is from this webpage:  http://www.cancer.gov/clinicaltrials/results/DCIS0309.  Sorry that you thought that ebarry!  Boy I would have been beside myself!  The recurrance rate following a mastectomy is 1 to 2%. 

ebarry, when the radiation oncologist said to you that "most women who had rads only had a 5% advantage over someone who didn't have rads." he probably was thinking in terms of all women with DCIS (all diagnoses) and an average recurrence risk, pre-radiation, of about 10%.  Rads cut recurrence risk by 50% - lots of studies have shown that - so if the starting risk is 10%, then those who take rads will reduce their risk by 50%, i.e. by 5 points to 5%.  But, if someone has a 30% risk of recurrence prior to radiation, then rads will reduce this risk by 15 points to 15%.   

In terms of your risk, only your doctor can tell you what it is.  Based on what you've said about your pathology - the fact that your DCIS was high grade, the fact that you had a recurrence after initially having good margins & that you've mentioned that in some places in your pathology there were 3mm spaces between areas of DCIS (both of which suggest that your DCIS "skips" and/or was multifocal) and the fact that you had at least one margin that was no greater than 3mm (which is considered by many surgeons to about the smallest "acceptable" margin) - I would guess that your recurrence risk is quite high, probably in the 30% - 40% range.  That's not to scare you but just my assessment based on everything I've read.  But remember that this is just the guess of patient with no medical background, so I could easily be wrong.  If you are worried, you really need to get a professional opinion about this - preferrably from an oncologist.  And keep in mind that even if I'm right, the odds are still probably greater than you won't have a recurrence than that you will.

mom3band1g, your pathology sounds like mine.  I had a lot of DCIS, just like you.  Most of it was grade 3 with comedonecrosis but around the edges there was some grade 2 without comedonecrosis.  My microinvasion was right in the middle, in the area where the pathology was most aggressive.  From what you've said my guess is that most of the DCIS near your margins was probably not as aggressive as the DCIS in your lump.  That would be good.  And in any case, you are having radiation, which will cut your risk in half.  Yes, it's normal to worry - it actually would be strange if you didn't worry - but it should fade in time.  For most of us, it does.