Overall survival improved when DCIS accompanies IDC

Says "page not found" I had DCIS with my IDC.

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.

Fascinating! Thanks for posting.

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:

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)

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.

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.

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

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.

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.