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Diagnosed with DCIS?

Know Your Treatment Options

October 10, 2014

Shelley Hwang, MD, a Duke surgical oncologist and nationally recognized expert on DCIS, discusses your treatment options, and the advantages of being treated by a team of specialists at a center like Duke.

If you’ve been diagnosed with DCIS, you may have more options than you realized. Doctors at Duke take several factors into consideration when tailoring your treatment, including a new test which can help determine your risk for recurring DCIS or invasive breast cancer.

DCIS, or ductal carcinoma in situ, develops in the milk ducts of the breast and is the most common type of non-invasive breast cancer. Depending on the type of DCIS you have, traditional treatments include hormonal therapy, lumpectomy, lumpectomy with radiation or mastectomy.While the number of women being diagnosed with DCIS is on the rise, Dr. Hwang, says, “not all will develop into invasive cancer.” She believes radiation is sometimes too aggressive, and, mastectomy, which is performed on 30% of women with DCIS, “is a huge price to pay for a disease with very little mortality.”

Factors that Contribute to Medical Recommendations

Because of this, Dr. Hwang and her Duke colleagues rely on several important factors to tailor their treatment recommendations. “We look at a person’s age when they get DCIS, the size of the tumor when it is diagnosed, and we evaluate the types of cells involved to determine how aggressive they are. We use these factors to create a projection of  a woman’s risk for recurring DCIS and invasive breast cancer.”

At the same time, Dr. Hwang says a new molecular test is being used to identify 12 genes associated with DCIS. “This could help us identify which women have a favorable gene profile that may protect them from developing invasive breast cancer in the future,” she explains.

The clinical observations can be combined with the genetic test to arrive at a more complete DCIS assessment. If a woman is found to be at low risk, radiation may not help. If they are at high risk, radiation may be beneficial. While not all women are appropriate candidates for this additional testing, it has been found to help some patients and providers make important treatment decisions. 

In addition, “Some women are at such extremely low risk that they could be treated without surgery at all,” says Dr. Hwang.  For these women, active surveillance, such as is often offered for patients with early stage prostate cancer, could be considered.  To answer the question of how to identify these women, Dr. Hwang is leading two multi-million dollar project sponsored by the NIH and the DOD to evaluate whether the genes and proteins in DCIS could help predict which women are at the lowest risk of cancer progression even without treatment. 

Such research will help future patients and doctors make better treatment decisions about DCIS. If you have DCIS now, Dr. Hwang says it’s important to educate yourself about your treatment options, and work with an expert team that is committed to creating a treatment plan that best matches your goals.

“When you go to a multidisciplinary center like Duke,” Dr. Hwang says, “you get the combined input of all the cancer specialists who are making decisions about your care, and who are on the leading edge of new research findings. At Duke, we are committed to making sure you get the treatment approach for your disease that is the best one for you and your overall health

Dr. Hwang Interviews

As a nationally recognized expert on DCIS, Dr. Hwang is frequently contacted to share her thoughts and expertise on DCIS treatment options. 

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Scientific American - Dare to do less

NBC News: Some early cancer overtreated; few want to wait

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