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Genomic scoring helps predict ductal carcinoma recurrence in breast cancer patients


INDIANAPOLIS — Physicians have a new resource for managing disease in patients with early-stage breast cancer.

Patients diagnosed with ductal carcinoma in situ — cancer that has not left the breast ducts — now have the benefit of a multi-gene analysis that considers gene patterns to individualize therapy and determine the chance for recurrence, potentially sparing the patient additional therapy.

The DCIS Score, published in the Journal of the National Cancer Institute in May, shows that the expression of 12 genes can provide information in addition to age, personal history, tumor type, tumor size and other factors to determine whether a woman’s risk of recurrence in the same breast is low, medium or high. That score plays a significant role in the treatment options suggested by her physician.

Sunil Badve, M.D., professor of pathology and laboratory medicine and of medicine at the IU School of Medicine and a researcher at the Indiana University Melvin and Bren Simon Cancer Center, was senior author of the Journal of the National Cancer Institute article.

“The DCIS Score will be a blessing to many women who, until now, had no scientific way to determine how much or how little treatment they needed to avoid the spread of their disease,” Dr. Badve said. “The test results can give patients peace of mind, knowing that the conclusions about their risk for recurrence was made with genetic information obtained from their own tumor and therefore is specific to them.”

Researchers compared data from 327 patients with ductal carcinoma in situ treated with surgical removal of the breast tumor but no radiation from an Eastern Cooperative Oncology Group study.

Factors considered in the development of the DCIS Score were age, menopause status, tumor size, margin width of the excision, tumor grade and an analysis of 21 genes, including seven genes that predict recurrence risk. The DCIS Score breakdown is 1-39, low risk; 40-54, intermediate risk; beyond 55, high risk.

Mastectomy was once the standard treatment for DCIS with recurrence rates as low as 1.4 percent. For women with ductal carcinoma treated with breast conserving therapy (lumpectomy), surgery alone cures 70 percent; however 30 percent of women may develop a recurrence in the same breast. The addition of radiation dramatically reduces the risk of recurrence by approximately 50 percent, making the risk about 15 percent. Some physicians recommend the addition of the drug tamoxifen, which blocks the estrogen receptor, further reducing the chance for recurrence to 8 to 10 percent.

The DCIS Score allows physicians to identify the patients in the high-risk group who need the full course of therapies. On the other hand, it also identifies a low-risk group in whom additional treatments with radiation and/or tamoxifen might be unnecessary.

“Giving radiation and drug therapy to 100 percent of all DCIS patients to prevent recurrences in a small percentage of patients is wrong,” Dr. Badve said. “Science can safeguard patients and protect them from unnecessary interventions.”