SAN ANTONIO--Searches for high-risk markers may ultimately point the way toward the optimal use of breast-conserving surgery for ductal carcinoma in situ (DCIS); early findings from one study, for example, suggest that a family history of breast cancer may militate against such surgery.
Breast-conserving surgery offers a high degree of local control for DCIS, but questions remain about long-term risks and optimal candidates, Jay R. Harris, MD, said at a plenary session of the San Antonio Breast Cancer Symposium. The risk of recurrence after conservative surgery for DCIS appears slightly increased, and half the recurrences will be invasive, he said. A critical unresolved issue is the salvage rate for recurrences.
"We need more long-term data to know exactly what the additional risk is with breast conservation," said Dr. Harris, professor of radiation oncology, Harvard Medical School. "Maybe we need to refocus our energies and try to separate out those high-risk DCIS patients who need to be treated aggressively."
As an example, he cited a Harvard study of angiogenesis in DCIS. About a third of 55 consecutive patients had one of two distinct patterns of vessel proliferation: a diffuse pattern and a pattern of "vascular cuffing" around the involved duct. "It's possible that one or both of these patterns are predictive of a more aggressive natural history," Dr. Harris commented.
Family History as a Risk Factor
Family history has emerged unexpectedly as a potential risk factor for recurrence among women treated conservatively for DCIS. In an ongoing study at Harvard, 17 patients had a family history of breast cancer. Four have had recurrent disease, and in all four cases, the recurrence has been invasive.
By comparison, disease has recurred in three of 58 women without a family history of breast cancer, and only one of the recurrences was invasive.