Overall survival improved when DCIS accompanies IDC
I was just googling around during my insomnia about my high grade DCIS in correlation to my grade 2 IDC. Was thinking that everyone with IDC at one time must've had DCIS, and just wanted to find out more. Found this instead, which to me, makes no sense. !! Interesting read, nonetheless. I'd love to hear thoughts on why this could be a thing???
Overall survival is improved when DCIS accompanies invasive breast cancer: https://www.nature.com/articles/s41598-019-46309-2
Comments
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Says "page not found"
I had DCIS with my IDC.
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oh no! So, I just pasted the link in to my original post (instead of trying to link the text). I think it works now!
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I was actually thinking along these lines before I read this:
"It has been hypothesized that tumors present as combined IDC + DCIS when the progression from pre-invasive DCIS to IDC is delayed – a sign of reduced biological aggressiveness6. In contrast, tumors presenting as IDC alone may have achieved invasive potential early in the process of carcinogenesis, leaving little or no evidence of the pre-invasive state"
This would be great to post over on Lumpie's research-outside-BCO thread.
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Ingerp, that's an interesting quote.
Since most IDC starts as DCIS, I have often wondered (and questioned many times on this board) what factors in a tumor cause some cancers to start as DCIS but develop mostly as IDC, whereas other tumors develop primarily as DCIS yet still have a small amount of IDC.
We see so many diagnoses here that are primarily IDC but have just a small amount of DCIS, and other diagnoses (like mine 14 years ago) that have large amounts of DCIS (>7cm in my case) and just a tiny amount of IDC (1mm for me). I have assumed, as the quote seems to indicate, that the progress of evolution from DCIS to IDC happens almost immediately in the cases where the tumor is mostly IDC, whereas the development to IDC happens much later in the tumors that are mostly DCIS.
I've always thought that if we understood the biological differences in these tumors, we might understand more about what makes a cancer aggressive, and we'd likely be able to better identify which cases of DCIS require the big guns and which don't. While I've seen dozens of studies that look into the biology of DCIS tumors, trying to pin-point which factors cause the tumor to evolve from DCIS to IDC, I have yet to see a study that compares the genetics of tumors that are '95% IDC / 5% DCIS' to those that are '5% IDC / 95% DCIS'.
The chart in this study which compares patient and tumor characteristics between 'IDC with no DCIS' to 'IDC with DCIS' doesn't quite do what I'd like to see, but it's an interesting start. It shows that tumors that are ER- or PR- are more likely to develop into IDC quickly rather than develop as DCIS before eventually evolving to become IDC. Interesting that HER2+ has a tendancy to remain DCIS longer. This is consistent with the fact that ~40% of DCIS cases are HER2+ versus only ~20% of IDC cases.
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Fascinating! Thanks for posting.
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Beesie: does most IDC start off as DCIS? When I asked my MO how come they did not find my cancer when it was DCIS, she said that not all IDC is from DCIS, which I thought was strange.
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Elephant, I've read that something like 80%-90% of IDC starts as DCIS. I don't how the other 10%-20% starts, since it is "invasive DUCTAL carcinoma", after all.
The hypothesis in this study is that sometimes the cells that start as DCIS evolve almost immediately to become IDC. To my understanding, it is the same cell that was once DCIS that undergoes a molecular change to become IDC. So what seems to happen in some cases is that if there are very few DCIS cells and they all evolve to become IDC, then even though the cancer started as DCIS, no DCIS cells remain. They've all converted to IDC.
I see it this way:
Case A: 10 DCIS cells develop in the duct. All 10 cells undergo the molecular change to become IDC, all 10 cells break through the duct wall and move into the open breast tissue, and from there, the number of cells multiplies and the cancer grows. The final pathology finds IDC but no DCIS, since all the DCIS cells have become IDC.
Case B: 10 DCIS cells develop in the duct. These cells multiply within the duct and the amount of DCIS grows. At one point, a small number of these DCIS cells undergo the molecular change to become IDC, and then break through the duct wall and move into the open breast tissue. Those new IDC cells may or may not continue to multiply in the open breast tissue. The final pathology finds IDC in the open breast tissue, and DCIS in the duct.
From BCO:
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So the fact that I am HER2+ and ER+ is a sign of increased aggressiveness, while the fact that I had DCIS present now is a sign of decreased aggressiveness. So, do I still contribute to my 401(K)? Or...... not? LOL 🤷🏽
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ER+ and PR+ are not signs of aggressiveness; ER- and PR- are.
Within IDC, HER2+ is, but within DCIS, it's not (although the jury is still out on that).
Small tumor, grade 2, ER+, PR+, tumor includes some DCIS... all good signs, other than that pesky HER2+. But Herceptin takes care of that! Definitely contribute to your 401(K)
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Interesting article and discussion! My left-side tumor had IDC and DCIS, but the right-side tumor had no DCIS but a large amount of LCIS. So I had one of each, but both of my tumors were considered very low risk because of their main characteristics (Grade/ER/PR/HER2).
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I had no detectable DCIS in my initial biopsy and neoadjuvant imaging but a small amount was found at the time of surgery. I'm guessing that indicates it was not widespread and my cancer developed quickly.
I came across some research a while back that demonstrated that the cells in the duct wall play an active role in containing cancer cells and actually reach out and grab escaped cells to pull them back in.
I'm unsure of the signaling mechanism though.
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And just a reminder for the HER2+ gals--my RO told me that while it signifies a more aggressive cancer, it also has better outcomes, specifically because of Herceptin.
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Thanks for posting. Always nice to read of better prognosis to help ease some of our fears of recurrence.
I'm a mixed gal. Left side DCIS -my invasive tumor was 4 cm grade 2 and had both ductal and lobular features. As I understand it, mixed tumors are treated as IDC. Wouldn't you know my right non cancerous breast is LCIS. Wonder if I had previous imaging (like in my 40's) done if I would have been diagnosed with a benign condition 1st before the progression. Very interesting stuff.
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Interesting. So I’m Er+,pr+, and her2+. My tumor was 7mm, 0/3 nodes stage I and grade 3. I’m curious as to why mine would be a grade 3 and not a 2. I’m so confused on how they determined that. He originally told me grade 2 but changed it after lumpectomy biopsy. He also said my her2 was a weak pos
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Libby, it can be confusing at first. Stage and Grade are both given by number. Stage is based on size, number of lymph nodes impacted, etc.
From the cancer.org website discussing grades: Numbers are assigned to different features (gland formation, nuclear grade, and mitotic count) seen under the microscope and then added up to assign the grade. If the numbers add up to 3-5, the cancer is grade 1 (well differentiated). If they add up to 6 or 7, it means the cancer is grade 2 (moderately differentiated). If they add up to 8 or 9, it means the cancer is grade 3 (poorly differentiated).
After lumpectomy, I was a grade 2. My lumpectomy slides were re-read by a cancer center and my grade was changed to grade 3
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Just adding to the conversation. I had a 1.7cm tumor, 10% was DCIS. I was Her2+
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Beesie: thanks for the great information. AND the study was recent. So many of the links offered (via bc.org) are years old. When I read them I sometimes feel the info isn't current. (yes I know studies take time) My cancer before surgery was dx IDC. After surgery path report showed both ICD and DCIS. 1st radiology visit is this week to set up treatment plan. My honest feeling is that the cancer is gone as my margins were clear. I don't want any more tx but family is putting pressure on me to do more than the surgery. Will see.
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Very interesting
My first Dx was IDC, no DCIS, weakly ER+/PR+ (didn't routinely test HER2 back then), grade 2. None of the 14 nodes were positive.
My current Dx was 3.2cm IDC, grade 3, strongly ER+/PR+, HER2- with a DCIS component of 2.4cm also grade 3. Neither of my 2 “suspicious" nodes were positive, but I did have foci of LVI. The DCIS component, according to pathology, surrounded the IDC component.
Both tumors were in the same breast, almost 20 years apart. MO believes this current Dx to be a new primary, not a recurrence. The same breast had numerous fibroadenomas over the years, and in 2016 had ADH and in 2018 had ADH, ALH, and DCIS. My other breast had fibroadenomas over the years, but no other activity (was also clear at Mastectomy pathology).
My left breast has been “busy" since I was 22 and had my first fibroadenoma Dx. 5 years later, at 27, was my first cancer Dx, and it didn't slow down over the years. I had enough this time and had a BMX.
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This is very interesting. I have always been confused as to why the size of the affected area is considered in prognosis. For DCIS, the area can grow very large, like mine, because it is following the milk ducts. Not a mass so to speak. Reading this study, perhaps large size DCIS is suggestive of lower grade due to the fact that it had grown for quite awhile without becoming invasive. If we knew how long the DCIS grew before becoming invasive, if ever, could suggest treatment approaches based upon risk.
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