Rak wewnątrzprzewodowy in situ (dcis)
Rokowania, prognozy i postęp choroby

Rak wewnątrzprzewodowy in situ (DCIS) stanowi 20-25% rozpoznań raka piersi, charakteryzuje się obecnością nieinwazyjnych komórek w przewodach mlecznych i jest klasyfikowany jako stadium 0 według UICC/AJCC. Prognoza jest bardzo dobra, z 10-letnim wskaźnikiem przeżycia około 98% i ponad 99% pacjentek przeżywających 5 lat od diagnozy. Ryzyko progresji do inwazyjnego raka piersi wynosi 20-50%, jednak większość zmian pozostaje indolentna, co komplikuje decyzje terapeutyczne. Czynniki prognostyczne obejmują stopień złośliwości, obecność wzoru comedo, ekspresję receptorów hormonalnych (ER, PR), status HER2 oraz mutacje p53. Modele uczenia maszynowego i sygnatury molekularne, takie jak DCISionRT, umożliwiają lepszą stratifikację ryzyka i wskazują na potencjalne korzyści z radioterapii u pacjentek wysokiego ryzyka, podczas gdy u niskiego ryzyka radioterapia może być zbędna.

  1. Rak wewnątrzprzewodowy in situ (DCIS) – wprowadzenie do prognozy
  2. Naturalna historia DCIS i ryzyko progresji
    1. Problem nadrozpoznawalności i nadmiernego leczenia
  3. Czynniki prognostyczne DCIS
    1. Czynniki histopatologiczne
    2. Biomarkery molekularne
  4. Modele predykcyjne i narzędzia decyzyjne w DCIS
    1. Podejścia oparte na uczeniu maszynowym
    2. Sygnatury molekularne
  5. Wpływ leczenia na prognozę DCIS
    1. Wpływ chirurgii i radioterapii
    2. Nowe podejścia do leczenia
  6. Monitorowanie i ryzyko nawrotów po DCIS
  7. Wpływ psychologiczny i jakość życia
  8. Podsumowanie prognozy DCIS
    1. Kolejne rozdziały

Rak wewnątrzprzewodowy in situ (DCIS) – wprowadzenie do prognozy

Rak wewnątrzprzewodowy in situ (DCIS) stanowi około 20-25% wszystkich rozpoznanych przypadków raka piersi, głównie dzięki programom przesiewowym badań mammograficznych12. DCIS jest niezaawansowanym, nieinwazyjnym nowotworem, w którym nieprawidłowe komórki znajdują się w obrębie przewodów mlekowych piersi, nie naciekając tkanki otaczającej3. Jest klasyfikowany jako rak piersi w stadium 0 według klasyfikacji UICC i AJCC4.

Prognoza dla pacjentek z DCIS jest doskonała – wskaźnik przeżycia 10-letniego wynosi około 98%, niezależnie od zastosowanego leczenia po zabiegu chirurgicznym56. Oczekiwana długość życia pacjentek z DCIS jest normalna7. Ponad 99% pacjentek z DCIS przeżywa ponad 5 lat od pierwotnej diagnozy8.

Naturalna historia DCIS i ryzyko progresji

Kluczowym aspektem prognozy DCIS jest zrozumienie jego naturalnej historii i ryzyka progresji do raka inwazyjnego. Szacunki dotyczące odsetka przypadków DCIS, które ulegną progresji do inwazyjnego raka piersi, wahają się w zakresie 20-50%9. Innymi słowy, 50-80% przypadków DCIS nigdy nie przekształci się w raka inwazyjnego1011.

Naturalna historia DCIS o niskim stopniu złośliwości może rozciągać się na ponad cztery dekady12. Jednak obecnie nie ma możliwości precyzyjnego przewidzenia, które przypadki DCIS pozostaną indolentne, a które ulegną progresji do raka inwazyjnego, co stanowi główne wyzwanie kliniczne1314.

Problem nadrozpoznawalności i nadmiernego leczenia

Ponieważ leczenie DCIS nie poprawia przeżywalności, istnieją obawy, że DCIS może być nadmiernie leczone, a korzyści z leczenia mogą nie przewyższać negatywnego wpływu na jakość życia pacjentek15. Szacunki dotyczące nadrozpoznawalności wahają się od 34% do 72% dla pacjentek w wieku 50-74 lat poddawanych badaniom przesiewowym co dwa lata16.

Obecne postrzeganie ryzyka i komunikacja między lekarzami a kobietami z diagnozą DCIS często prowadzi do nadrozpoznawalności i nadmiernego leczenia1718. Potrzeba zmiany postrzegania ryzyka i unikania nadmiernego leczenia jest pilna, ponieważ nadmierne leczenie prowadzi do fizycznej i emocjonalnej szkody dla pacjentek oraz niepotrzebnych kosztów dla społeczeństwa19.

Czynniki prognostyczne DCIS

Czynniki histopatologiczne

Stopień zróżnicowania DCIS jest istotnym czynnikiem prognostycznym. DCIS o wysokim stopniu złośliwości jest bardziej prawdopodobne, że nawróci lub ulegnie progresji do raka inwazyjnego20. W odniesieniu do architektury, obecność wzoru typu comedo jest związana z DCIS o wysokim stopniu złośliwości, a tym samym ze zwiększonym ryzykiem progresji do raka inwazyjnego21.

Niedawne badania morfometryczne wykazały, że główne cechy związane z DCIS o niskim ryzyku to mniejsze przewody, niższy stosunek DCIS/podścieliska i mniejsza liczba komórek DCIS w przewodzie, podczas gdy zmiany z większymi przewodami i wyższą komórkowością są związane z wyższym ryzykiem progresji do raka inwazyjnego22.

Biomarkery molekularne

Ekspresja receptorów hormonalnych (ER i PR) w guzach jest związana z lepszym rokowaniem i wrażliwością na terapię endokrynną23. Kilka badań wykazało korelację między ekspresją ER a nawrotem DCIS/inwazyjnym rakiem piersi24.

Status HER2 w DCIS jest czynnikiem prognostycznym. Interesujące jest to, że pozytywny status HER2 w pierwotnej zmianie DCIS wiąże się z niższym ryzykiem późnego nawrotu inwazyjnego raka piersi w porównaniu z negatywnym statusem HER225. Statystycznie znacząco niższe ryzyko wznowy inwazyjnego raka piersi (IBCR) występuje po DCIS HER2-dodatnim w porównaniu z DCIS HER2-ujemnym (Log-Rank P=0,03, (HR) 0,60 (95% CI 0,38-0,94))26.

Dysfunkcja (mutacja/inaktywacja) p53 jest czynnikiem ryzyka późniejszej karcynogenezy piersi, związanym z progresją z DCIS do inwazyjnego raka przewodowego (IDC)27.

Modele predykcyjne i narzędzia decyzyjne w DCIS

Istnieje pilna potrzeba kliniczna opracowania dobrze zwalidowanych, wysokiej jakości modeli predykcyjnych ryzyka DCIS i narzędzi wspomagających podejmowanie decyzji, które uwzględniałyby aktywny nadzór jako opcję postępowania w przypadku DCIS niskiego ryzyka28.

Podejścia oparte na uczeniu maszynowym

Opracowano modele uczenia maszynowego do przewidywania ryzyka nawrotu DCIS. Na przykład, model oparty na analizie obrazów całych slajdów (whole slide image) wykazał doskonałą dokładność w przewidywaniu 10-letniego ryzyka nawrotu u pacjentek z DCIS leczonych oszczędzająco pierś29. Model ten wykazał lepszą dokładność (0,87), swoistość (0,91), dodatnią wartość predykcyjną (0,65), ujemną wartość predykcyjną (0,93) i iloraz szans (23,6) w porównaniu ze zmiennymi klinicznymi30.

Sygnatury molekularne

Sygnatury molekularne mogą rozróżnić kobiety o wysokim i niskim ryzyku, przy czym kobiety o wysokim ryzyku odnoszą znaczącą korzyść z radioterapii w redukcji inwazyjnych i in situ wznów miejscowych, podczas gdy u kobiet o niskim ryzyku radioterapia nie przynosi korzyści w zapobieganiu inwazyjnej wznowie raka piersi31.

DCISionRT jest biosygnaturą, która została zwalidowana w randomizowanym badaniu klinicznym SweDCIS32. W grupie podwyższonego ryzyka, radioterapia znacząco zmniejszyła względne 10-letnie wskaźniki nawrotu całkowitego (TotBE) i 10-letnie wskaźniki nawrotu inwazyjnego (InvBE), HR 0,32 i HR 0,24, z bezwzględnymi spadkami o 15,5% i 9,3%33. W grupie niskiego ryzyka nie zaobserwowano znaczących różnic ryzyka przy zastosowaniu radioterapii34.

Wpływ leczenia na prognozę DCIS

Obecnym standardem leczenia DCIS jest zabieg chirurgiczny z lub bez uzupełniającej radioterapii35. Jednak prowadzone są badania nad mniej inwazyjnymi podejściami dla DCIS niskiego ryzyka.

Wpływ chirurgii i radioterapii

Wskaźniki inwazyjnych wznów piersi (iIBTE) są znacząco niższe u pacjentek, które przeszły zabieg chirurgiczny w porównaniu do tych, które go nie przeszły, zarówno po 5 latach (3,5% vs. 9,0%, P=0,003), jak i po 10 latach (6,4% vs. 22,7%, P=0,008)36. Podobnie, 10-letni wskaźnik przeżycia specyficznego dla raka piersi (BCSS) jest wyższy w grupie poddanej zabiegowi chirurgicznemu (96,0% vs. 99,6%, P=0,010)37.

Dodanie radioterapii po chirurgii oszczędzającej pierś (BCS) jest również związane ze zmniejszonym wskaźnikiem nawrotów (IBTE), ale nie miało wpływu na raka piersi drugiej piersi (CBC) w analizach obserwacyjnych, jak również w randomizowanych badaniach klinicznych38.

Retrospektywne badanie SEER wykazało po raz pierwszy, że pacjentki z DCIS o niskim stopniu złośliwości miały takie same wskaźniki przeżycia ogólnego i przeżycia specyficznego dla raka piersi z lub bez zabiegu chirurgicznego39.

Nowe podejścia do leczenia

Niedawne badania sugerują, że agresywne leczenie może nie być konieczne do ratowania życia w przypadku DCIS4041. Prowadzone są innowacyjne badania, które mogłyby obejść potrzebę ostrej interwencji terapeutycznej w leczeniu indolentnego stanu42.

Zrozumienie mechanizmów i wykorzystanie podstawowych biomarkerów, które mogą prawidłowo przewidzieć progresję DCIS, dodatkowo wzbogaci nasz arsenał w identyfikacji pacjentek o złym rokowaniu lub tych, które skorzystałyby z dostępnych modalności leczenia43.

Monitorowanie i ryzyko nawrotów po DCIS

Pomimo doskonałego rokowania, kobiety, które miały DCIS, mają zwiększone ryzyko rozwoju inwazyjnego raka piersi przez okres do 25 lat po początkowej diagnozie DCIS44. Wskaźnik nawrotów dla DCIS jest ogólnie niski, około 15%, dla pacjentek, które otrzymały zarówno zabieg chirurgiczny, jak i radioterapię jako leczenie45.

Pacjentki z DCIS mają zwiększone ryzyko wystąpienia drugiego raka piersi (SBC), który może być inwazyjnym rakiem piersi (IBC) lub innym typem nowotworu, i jeśli nie jest kontrolowany, może ostatecznie prowadzić do zgonu46.

Wpływ psychologiczny i jakość życia

Pomimo doskonałego rokowania i normalnej oczekiwanej długości życia, kobiety z diagnozą DCIS doświadczają stresu i niepokoju4748. Kobiety z DCIS są etykietowane jako pacjentki z rakiem, z towarzyszącym niepokojem i negatywnym wpływem na ich życie, mimo że większość zmian DCIS prawdopodobnie nigdy nie ulegnie progresji do inwazyjnego raka piersi49.

Podejmowanie decyzji dotyczących leczenia DCIS nie jest proste. Kluczową różnicą jest wpływ, jaki te leczenia mogą mieć na jakość życia pacjentek50. Dobrze zaprojektowane narzędzia wspierające podejmowanie decyzji oparte na dowodach, takie jak pomoce decyzyjne, narzędzia komunikacyjne lub modele predykcyjne, mogą pomóc pacjentom i klinicystom podejmować lepiej poinformowane i zgodne z wartościami decyzje51.

Podsumowanie prognozy DCIS

DCIS ma doskonałe rokowanie, z 10-letnim wskaźnikiem przeżycia wynoszącym około 98%5253. Chociaż 20-50% przypadków DCIS może potencjalnie ulec progresji do inwazyjnego raka piersi, większość zmian DCIS pozostaje indolentna5455.

Trwają intensywne badania nad identyfikacją biomarkerów i opracowaniem modeli predykcyjnych, które mogłyby pomóc w stratyfikacji ryzyka i personalizacji leczenia DCIS. Istnieje nadzieja, że przyszłe postępy pozwolą na bardziej precyzyjne podejście do leczenia DCIS, gdzie intensywne leczenie będzie zarezerwowane dla przypadków wysokiego ryzyka, a aktywny nadzór będzie stosowany w przypadkach niskiego ryzyka5657.

Kolejne rozdziały

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  1. 12.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Ductal carcinoma in situ: to treat or not to treat, that is the question | British Journal of Cancer
    https://www.nature.com/articles/s41416-019-0478-6
    Ductal carcinoma in situ (DCIS) now represents 20-25% of all breast cancers consequent upon detection by population-based breast cancer screening programmes. […] However, most DCIS lesions remain indolent. […] Difficulty in discerning harmless lesions from potentially invasive ones can lead to overtreatment of this condition in many patients. […] Current therapeutic approaches result in overtreatment of some women with DCIS. […] In effect, women with DCIS are labelled as cancer patients, with concomitant anxiety and negative impact on their lives, despite the fact that most DCIS lesions will probably never progress to invasive breast cancer. […] Improving the management and treatment of DCIS presents a central challenge: distinguishing indolent, harmless DCIS lesions from potentially hazardous ones.
  • #2 Ductal carcinoma in situ: to treat or not to treat, that is the question
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6697179/
    Ductal carcinoma in situ (DCIS) now represents 2025% of all breast cancers consequent upon detection by population-based breast cancer screening programmes. […] However, most DCIS lesions remain indolent. […] Difficulty in discerning harmless lesions from potentially invasive ones can lead to overtreatment of this condition in many patients. […] Improving the management and treatment of DCIS presents a central challenge: distinguishing indolent, harmless DCIS lesions from potentially hazardous ones. […] Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up and a normal life expectancy. […] Despite an excellent prognosis and normal life-expectancy, women diagnosed with DCIS experience stress and anxiety.
  • #3 Ductal Carcinoma In Situ (DCIS) – National Breast Cancer Foundation
    https://www.nationalbreastcancer.org/dcis/
    Ductal carcinoma in situ (DCIS) is a common form of breast cancer, accounting for approximately 20-25% of all new breast cancer cases in the United States. DCIS is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk ducts. […] DCIS is early-stage cancer that is highly treatable. Nearly all women with DCIS can be cured. However, if left untreated or undetected, DCIS may spread into the surrounding breast tissue and could become a more advanced cancer. […] The prognosis for DCIS is excellent. More than 99% of patients diagnosed with DCIS will recover and live more than 5 years after their initial diagnosis. […] While some patients may experience a recurrence of DCIS, the recurrence rate for DCIS is generally low, around 15%, for patients who received both surgery and radiation as treatment.
  • #4 Molecular Signatures in Ductal Carcinoma In Situ (DCIS): A Systematic Review and Meta-Analysis
    https://www.mdpi.com/2077-0383/12/5/2036
    Molecular signatures are able to discriminate high- and low-risk women, high-risk ones having a significant benefit of RT in the reduction of invasive and in situ local recurrences, while in low-risk ones RT did not have a benefit for preventing invasive breast recurrence. […] The risk prediction of molecular signatures is independent of other risk stratification tools developed in DCIS, and have a tendency toward RT de-escalation. […] DCIS has an excellent prognosis, and to date is considered stage 0 breast cancer according to the 8th edition of the Union for International Cancer Control (UICC) and American Joint Committee on Cancer (AJCC) classification. […] Interestingly, radiotherapy did not impact 10-years breast cancer mortality in women diagnosed with DCIS treated with BCS (0.8% versus 0.9%; HR, 0.86 (95%CI, 0.67–1.10); p-value = 0.22).
  • #5 Ductal Carcinoma In Situ (DCIS) | BCRF
    https://www.bcrf.org/about-breast-cancer/dcis-ductal-carcinoma-in-situ/
    Though it can be very stressful and alarming, DCIS is not life-threatening; practically all patients with stage 0 breast cancer can be cured. […] Currently, there is not a way to determine which DCIS cases will become invasive breast cancer and which will not, so DCIS is almost always treated. […] DCIS treatment has a high success rate, in most cases removing the tumor and preventing recurrence. The prognosis is excellent—98 percent survival after 10 years. […] Estimates of DCIS cases that will become invasive breast cancer range from 20-50 percent. Put another way, 50-80 percent of DCIS cases will not become invasive. […] The 10-year survival rate for a DCIS diagnosis is very high (at 98 percent) regardless of whether treatment is given after surgery. […] Because DCIS treatment does not improve survival, researchers, clinicians, and others have raised concerns that DCIS may be overtreated and debated whether treatment benefits outweigh impacts on quality of life. […] At this time, it is not possible to predict which cases of DCIS will become invasive breast cancer and which will not, which is why research into DCIS is so needed.
  • #6 Ductal carcinoma in situ: to treat or not to treat, that is the question
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6697179/
    Ductal carcinoma in situ (DCIS) now represents 2025% of all breast cancers consequent upon detection by population-based breast cancer screening programmes. […] However, most DCIS lesions remain indolent. […] Difficulty in discerning harmless lesions from potentially invasive ones can lead to overtreatment of this condition in many patients. […] Improving the management and treatment of DCIS presents a central challenge: distinguishing indolent, harmless DCIS lesions from potentially hazardous ones. […] Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up and a normal life expectancy. […] Despite an excellent prognosis and normal life-expectancy, women diagnosed with DCIS experience stress and anxiety.
  • #7 Ductal carcinoma in situ: to treat or not to treat, that is the question | British Journal of Cancer
    https://www.nature.com/articles/s41416-019-0478-6
    Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up and a normal life expectancy. […] Despite an excellent prognosis and normal life-expectancy, women diagnosed with DCIS experience stress and anxiety. […] A recent study based on an analysis of data from the American Cancer Registry of 100,000 women diagnosed with DCIS suggests that aggressive treatment might not be necessary to save lives. […] A retrospective Surveillance, Epidemiology, and End Results (SEER) study demonstrated for the first time that patients with low-grade DCIS had the same overall survival and breast-cancer-specific survival rates with or without surgery. […] Current perceptions of the risk-framing dialogue between clinicians and women diagnosed with DCIS are currently resulting in the overdiagnosis and overtreatment of DCIS. […] The need to reframe perceptions of risk and to avoid overtreatment is urgent, as overtreatment leads to physical and emotional harm for patients and to unnecessary costs for society.
  • #8 Ductal Carcinoma In Situ (DCIS) – National Breast Cancer Foundation
    https://www.nationalbreastcancer.org/dcis/
    Ductal carcinoma in situ (DCIS) is a common form of breast cancer, accounting for approximately 20-25% of all new breast cancer cases in the United States. DCIS is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk ducts. […] DCIS is early-stage cancer that is highly treatable. Nearly all women with DCIS can be cured. However, if left untreated or undetected, DCIS may spread into the surrounding breast tissue and could become a more advanced cancer. […] The prognosis for DCIS is excellent. More than 99% of patients diagnosed with DCIS will recover and live more than 5 years after their initial diagnosis. […] While some patients may experience a recurrence of DCIS, the recurrence rate for DCIS is generally low, around 15%, for patients who received both surgery and radiation as treatment.
  • #9 Ductal Carcinoma In Situ (DCIS) | BCRF
    https://www.bcrf.org/about-breast-cancer/dcis-ductal-carcinoma-in-situ/
    Though it can be very stressful and alarming, DCIS is not life-threatening; practically all patients with stage 0 breast cancer can be cured. […] Currently, there is not a way to determine which DCIS cases will become invasive breast cancer and which will not, so DCIS is almost always treated. […] DCIS treatment has a high success rate, in most cases removing the tumor and preventing recurrence. The prognosis is excellent—98 percent survival after 10 years. […] Estimates of DCIS cases that will become invasive breast cancer range from 20-50 percent. Put another way, 50-80 percent of DCIS cases will not become invasive. […] The 10-year survival rate for a DCIS diagnosis is very high (at 98 percent) regardless of whether treatment is given after surgery. […] Because DCIS treatment does not improve survival, researchers, clinicians, and others have raised concerns that DCIS may be overtreated and debated whether treatment benefits outweigh impacts on quality of life. […] At this time, it is not possible to predict which cases of DCIS will become invasive breast cancer and which will not, which is why research into DCIS is so needed.
  • #10 Ductal Carcinoma In Situ (DCIS) | BCRF
    https://www.bcrf.org/about-breast-cancer/dcis-ductal-carcinoma-in-situ/
    Though it can be very stressful and alarming, DCIS is not life-threatening; practically all patients with stage 0 breast cancer can be cured. […] Currently, there is not a way to determine which DCIS cases will become invasive breast cancer and which will not, so DCIS is almost always treated. […] DCIS treatment has a high success rate, in most cases removing the tumor and preventing recurrence. The prognosis is excellent—98 percent survival after 10 years. […] Estimates of DCIS cases that will become invasive breast cancer range from 20-50 percent. Put another way, 50-80 percent of DCIS cases will not become invasive. […] The 10-year survival rate for a DCIS diagnosis is very high (at 98 percent) regardless of whether treatment is given after surgery. […] Because DCIS treatment does not improve survival, researchers, clinicians, and others have raised concerns that DCIS may be overtreated and debated whether treatment benefits outweigh impacts on quality of life. […] At this time, it is not possible to predict which cases of DCIS will become invasive breast cancer and which will not, which is why research into DCIS is so needed.
  • #11 Ductal carcinoma in situ: to treat or not to treat, that is the question
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6697179/
    Ductal carcinoma in situ (DCIS) now represents 2025% of all breast cancers consequent upon detection by population-based breast cancer screening programmes. […] However, most DCIS lesions remain indolent. […] Difficulty in discerning harmless lesions from potentially invasive ones can lead to overtreatment of this condition in many patients. […] Improving the management and treatment of DCIS presents a central challenge: distinguishing indolent, harmless DCIS lesions from potentially hazardous ones. […] Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up and a normal life expectancy. […] Despite an excellent prognosis and normal life-expectancy, women diagnosed with DCIS experience stress and anxiety.
  • #12 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research
    https://ar.iiarjournals.org/content/45/4/1305
    The natural history of low-grade DCIS may extend more than four decades. […] The studies discussed in here bring forward potential novel biomarkers and prevention strategies for DCIS that are at high risk of progression to IBC; however, we must keep in mind that these were conducted mostly comparing either DCIS lesions with matched IBC cases or from DCIS lesions co-occurring with IBC and may fail to capture true DCIS progression. […] Understanding these mechanisms and utilizing the underlying biomarkers that can correctly predict DCIS progression will add more to our arsenal in identifying patients with poor prognoses or those who would benefit from our available treatment modalities.
  • #13 Ductal Carcinoma In Situ (DCIS) | BCRF
    https://www.bcrf.org/about-breast-cancer/dcis-ductal-carcinoma-in-situ/
    Though it can be very stressful and alarming, DCIS is not life-threatening; practically all patients with stage 0 breast cancer can be cured. […] Currently, there is not a way to determine which DCIS cases will become invasive breast cancer and which will not, so DCIS is almost always treated. […] DCIS treatment has a high success rate, in most cases removing the tumor and preventing recurrence. The prognosis is excellent—98 percent survival after 10 years. […] Estimates of DCIS cases that will become invasive breast cancer range from 20-50 percent. Put another way, 50-80 percent of DCIS cases will not become invasive. […] The 10-year survival rate for a DCIS diagnosis is very high (at 98 percent) regardless of whether treatment is given after surgery. […] Because DCIS treatment does not improve survival, researchers, clinicians, and others have raised concerns that DCIS may be overtreated and debated whether treatment benefits outweigh impacts on quality of life. […] At this time, it is not possible to predict which cases of DCIS will become invasive breast cancer and which will not, which is why research into DCIS is so needed.
  • #14 Ductal carcinoma in situ: to treat or not to treat, that is the question | British Journal of Cancer
    https://www.nature.com/articles/s41416-019-0478-6
    Ductal carcinoma in situ (DCIS) now represents 20-25% of all breast cancers consequent upon detection by population-based breast cancer screening programmes. […] However, most DCIS lesions remain indolent. […] Difficulty in discerning harmless lesions from potentially invasive ones can lead to overtreatment of this condition in many patients. […] Current therapeutic approaches result in overtreatment of some women with DCIS. […] In effect, women with DCIS are labelled as cancer patients, with concomitant anxiety and negative impact on their lives, despite the fact that most DCIS lesions will probably never progress to invasive breast cancer. […] Improving the management and treatment of DCIS presents a central challenge: distinguishing indolent, harmless DCIS lesions from potentially hazardous ones.
  • #15 Ductal Carcinoma In Situ (DCIS) | BCRF
    https://www.bcrf.org/about-breast-cancer/dcis-ductal-carcinoma-in-situ/
    Though it can be very stressful and alarming, DCIS is not life-threatening; practically all patients with stage 0 breast cancer can be cured. […] Currently, there is not a way to determine which DCIS cases will become invasive breast cancer and which will not, so DCIS is almost always treated. […] DCIS treatment has a high success rate, in most cases removing the tumor and preventing recurrence. The prognosis is excellent—98 percent survival after 10 years. […] Estimates of DCIS cases that will become invasive breast cancer range from 20-50 percent. Put another way, 50-80 percent of DCIS cases will not become invasive. […] The 10-year survival rate for a DCIS diagnosis is very high (at 98 percent) regardless of whether treatment is given after surgery. […] Because DCIS treatment does not improve survival, researchers, clinicians, and others have raised concerns that DCIS may be overtreated and debated whether treatment benefits outweigh impacts on quality of life. […] At this time, it is not possible to predict which cases of DCIS will become invasive breast cancer and which will not, which is why research into DCIS is so needed.
  • #16 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research
    https://ar.iiarjournals.org/content/45/4/1305
    This review describes the histopathological and molecular features distinguishing high-risk ductal carcinoma in situ (DCIS) from low-risk DCIS and their progression to invasive breast cancer (IBC. […] The primary goal of treating DCIS is to prevent progression to IBC, through treatment modalities such as surgery, radiotherapy, and hormonal therapy. […] Molecular characterization of DCIS can potentially bring forward biomarkers for early detection of DCIS, improve prediction of DCIS progression, and help manage patients effectively to reduce unnecessary treatment. […] High-grade DCIS is more likely to recur or progress to IBC and in relation to the architecture, the presence of comedo pattern is associated with high-grade DCIS and therefore an increased risk of progression to IBC. […] Estimates of overdiagnosis range from 34% to 72% for patients aged 50-74 years who underwent screening every other year.
  • #17 Ductal carcinoma in situ: to treat or not to treat, that is the question | British Journal of Cancer
    https://www.nature.com/articles/s41416-019-0478-6
    Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up and a normal life expectancy. […] Despite an excellent prognosis and normal life-expectancy, women diagnosed with DCIS experience stress and anxiety. […] A recent study based on an analysis of data from the American Cancer Registry of 100,000 women diagnosed with DCIS suggests that aggressive treatment might not be necessary to save lives. […] A retrospective Surveillance, Epidemiology, and End Results (SEER) study demonstrated for the first time that patients with low-grade DCIS had the same overall survival and breast-cancer-specific survival rates with or without surgery. […] Current perceptions of the risk-framing dialogue between clinicians and women diagnosed with DCIS are currently resulting in the overdiagnosis and overtreatment of DCIS. […] The need to reframe perceptions of risk and to avoid overtreatment is urgent, as overtreatment leads to physical and emotional harm for patients and to unnecessary costs for society.
  • #18 Ductal carcinoma in situ: to treat or not to treat, that is the question
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6697179/
    A recent study based on an analysis of data from the American Cancer Registry of 100,000 women diagnosed with DCIS suggests that aggressive treatment might not be necessary to save lives. […] These findings prompted the breast healthcare community to explore innovative studies that could circumvent the need for harsh therapeutic intervention for treating an indolent condition. […] Current perceptions of the risk-framing dialogue between clinicians and women diagnosed with DCIS are currently resulting in the overdiagnosis and overtreatment of DCIS. […] The need to reframe perceptions of risk and to avoid overtreatment is urgent, as overtreatment leads to physical and emotional harm for patients and to unnecessary costs for society.
  • #19 Ductal carcinoma in situ: to treat or not to treat, that is the question | British Journal of Cancer
    https://www.nature.com/articles/s41416-019-0478-6
    Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up and a normal life expectancy. […] Despite an excellent prognosis and normal life-expectancy, women diagnosed with DCIS experience stress and anxiety. […] A recent study based on an analysis of data from the American Cancer Registry of 100,000 women diagnosed with DCIS suggests that aggressive treatment might not be necessary to save lives. […] A retrospective Surveillance, Epidemiology, and End Results (SEER) study demonstrated for the first time that patients with low-grade DCIS had the same overall survival and breast-cancer-specific survival rates with or without surgery. […] Current perceptions of the risk-framing dialogue between clinicians and women diagnosed with DCIS are currently resulting in the overdiagnosis and overtreatment of DCIS. […] The need to reframe perceptions of risk and to avoid overtreatment is urgent, as overtreatment leads to physical and emotional harm for patients and to unnecessary costs for society.
  • #20 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research
    https://ar.iiarjournals.org/content/45/4/1305
    This review describes the histopathological and molecular features distinguishing high-risk ductal carcinoma in situ (DCIS) from low-risk DCIS and their progression to invasive breast cancer (IBC. […] The primary goal of treating DCIS is to prevent progression to IBC, through treatment modalities such as surgery, radiotherapy, and hormonal therapy. […] Molecular characterization of DCIS can potentially bring forward biomarkers for early detection of DCIS, improve prediction of DCIS progression, and help manage patients effectively to reduce unnecessary treatment. […] High-grade DCIS is more likely to recur or progress to IBC and in relation to the architecture, the presence of comedo pattern is associated with high-grade DCIS and therefore an increased risk of progression to IBC. […] Estimates of overdiagnosis range from 34% to 72% for patients aged 50-74 years who underwent screening every other year.
  • #21 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research
    https://ar.iiarjournals.org/content/45/4/1305
    This review describes the histopathological and molecular features distinguishing high-risk ductal carcinoma in situ (DCIS) from low-risk DCIS and their progression to invasive breast cancer (IBC. […] The primary goal of treating DCIS is to prevent progression to IBC, through treatment modalities such as surgery, radiotherapy, and hormonal therapy. […] Molecular characterization of DCIS can potentially bring forward biomarkers for early detection of DCIS, improve prediction of DCIS progression, and help manage patients effectively to reduce unnecessary treatment. […] High-grade DCIS is more likely to recur or progress to IBC and in relation to the architecture, the presence of comedo pattern is associated with high-grade DCIS and therefore an increased risk of progression to IBC. […] Estimates of overdiagnosis range from 34% to 72% for patients aged 50-74 years who underwent screening every other year.
  • #22 A morphometric signature to identify ductal carcinoma in situ with a low risk of progression | npj Precision Oncology
    https://www.nature.com/articles/s41698-024-00769-6
    Ductal carcinoma in situ (DCIS) may progress to ipsilateral invasive breast cancer (iIBC), but often never will. […] A combined clinical-morphometric signature, characterized by small-sized ducts, a low number of cells and a low DCIS/stroma ratio, was associated with outcome (HR=0.56; 95% CI 0.280.78). […] The main features related to low-risk DCIS were smaller ducts, lower DCIS/stroma ratio and lower number of DCIS cells per duct, whereas those with larger ducts and a higher cellularity are associated with a higher risk to progress to iIBC. […] By analyzing the 15 years iIBC cumulative risk curve, we observed that patients with lesions classified within the 1-Blue signature (containing lesions with small duct sizes, reduced number of cells, and lower DCIS/stroma ratio) had a significant favorable iIBC-free survival compared with the other signatures (p=0.0001). The association with low-risk of iIBC events remained significant after multivariate Cox regression analysis including histopathological grade, ER, HER2 and COX-2 expression: hazard ratio (HR)=0.56 (0.400.80 95%CI). […] AIDmap has potential to identify harmless DCIS that may not need treatment.
  • #23 The Progressive Journey from Ductal Carcinoma in situ into Invasive Breast Cancer: An Extensive Systematic Literature Review on Biomarkers
    https://www.scitechnol.com/peer-review/the-progressive-journey-fromductal-carcinoma-in-situ-intoinvasive-breast-cancer-anextensive-systematic-literaturereview-on-biomark-uFAz.php?article_id=9166
    Here, we review the biological process that likely to play a significant role in the phenomenon of progression from DCIS to invasive disease, the challenges faced by clinicians, pathologists and researchers in order to improve and develop predictive biomarkers; and define the subsets of DCIS to the probability of progression to Invasive Ductal Cancer (also sometimes called Infiltrating Ductal Carcinoma, IDC). […] All existing DCIS classification schemes, including those focused on nuclear grade are unable to reliably differentiate between DCIS that will remain stable, regress and those likely to progress to full invasive tumors. […] The ability of DCIS to evolve into invasive carcinoma is supported by similarities in morphology and hormone receptor profiles. […] The expression of ER and PR in tumors is associated with better prognosis and sensitivity to endocrine therapy.
  • #24 The Progressive Journey from Ductal Carcinoma in situ into Invasive Breast Cancer: An Extensive Systematic Literature Review on Biomarkers
    https://www.scitechnol.com/peer-review/the-progressive-journey-fromductal-carcinoma-in-situ-intoinvasive-breast-cancer-anextensive-systematic-literaturereview-on-biomark-uFAz.php?article_id=9166
    Several studies have shown the correlation between the expression of ER and the DCIS recurrence/invasive breast cancer. […] Overall, these findings suggest that dysfunction (mutation/inactivation) of p53 is a risk factor for subsequent breast carcinogenesis, associated with the progression from DCIS to IDC. […] DCIS presents a clinical risk of development to invasive. Over century, studies had shown DCIS has a malignant phenotype, prevention of development of invasive, biomarkers play a necessary key component for tumor growth and invasive, the identification of specific markers expressed in DCIS might be useful to identified patients which high risk of recurrence, prognosis and treatment.
  • #25 The prognostic role of HER2 expression in ductal breast carcinoma in situ (DCIS); a population-based cohort study | BMC Cancer | Full Text
    https://bmccancer.biomedcentral.com/articles/10.1186/s12885-015-1479-3
    HER2 is a well-established prognostic and predictive factor in invasive breast cancer. The role of HER2 in ductal breast carcinoma in situ (DCIS) is debated and recent data have suggested that HER2 is mainly related to in situ recurrences. […] The risk of IBCR was statistically significantly lower subsequent to a HER2 positive DCIS compared to a HER2 negative DCIS, (Log-Rank P=0.03, (HR) 0.60 (95 % CI 0.38-0.94)). […] Improved prognostic tools for DCIS patients are warranted to tailor adjuvant therapy. Here, we demonstrate that HER2 positive disease in the primary DCIS is associated with lower risk of recurrent invasive breast cancer. […] In this long-term follow-up DCIS cohort, positive HER2 status in the primary lesion predicted lower risk of late invasive breast cancer recurrence compared to negative HER2 status in the primary DCIS.
  • #26 The prognostic role of HER2 expression in ductal breast carcinoma in situ (DCIS); a population-based cohort study | BMC Cancer | Full Text
    https://bmccancer.biomedcentral.com/articles/10.1186/s12885-015-1479-3
    HER2 is a well-established prognostic and predictive factor in invasive breast cancer. The role of HER2 in ductal breast carcinoma in situ (DCIS) is debated and recent data have suggested that HER2 is mainly related to in situ recurrences. […] The risk of IBCR was statistically significantly lower subsequent to a HER2 positive DCIS compared to a HER2 negative DCIS, (Log-Rank P=0.03, (HR) 0.60 (95 % CI 0.38-0.94)). […] Improved prognostic tools for DCIS patients are warranted to tailor adjuvant therapy. Here, we demonstrate that HER2 positive disease in the primary DCIS is associated with lower risk of recurrent invasive breast cancer. […] In this long-term follow-up DCIS cohort, positive HER2 status in the primary lesion predicted lower risk of late invasive breast cancer recurrence compared to negative HER2 status in the primary DCIS.
  • #27 The Progressive Journey from Ductal Carcinoma in situ into Invasive Breast Cancer: An Extensive Systematic Literature Review on Biomarkers
    https://www.scitechnol.com/peer-review/the-progressive-journey-fromductal-carcinoma-in-situ-intoinvasive-breast-cancer-anextensive-systematic-literaturereview-on-biomark-uFAz.php?article_id=9166
    Several studies have shown the correlation between the expression of ER and the DCIS recurrence/invasive breast cancer. […] Overall, these findings suggest that dysfunction (mutation/inactivation) of p53 is a risk factor for subsequent breast carcinogenesis, associated with the progression from DCIS to IDC. […] DCIS presents a clinical risk of development to invasive. Over century, studies had shown DCIS has a malignant phenotype, prevention of development of invasive, biomarkers play a necessary key component for tumor growth and invasive, the identification of specific markers expressed in DCIS might be useful to identified patients which high risk of recurrence, prognosis and treatment.
  • #28 Prediction Models and Decision Aids for Women with Ductal Carcinoma In Situ: A Systematic Literature Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9265509/
    Ductal carcinoma in situ (DCIS) is a potential precursor to invasive breast cancer (IBC). Although in many women DCIS will never become breast cancer, almost all women diagnosed with DCIS undergo surgery with/without radiotherapy. […] Even though Ductal Carcinoma in Situ (DCIS) can potentially be an invasive breast cancer (IBC) precursor, most DCIS lesions never will progress to IBC if left untreated. Because we cannot predict yet which DCIS lesions will and which will not progress, almost all women with DCIS are treated by breast-conserving surgery +/ radiotherapy, or even mastectomy. As a consequence, many women with non-progressive DCIS carry the burden of intensive treatment without any benefit. […] There remains an unmet clinical need for well-validated, good-quality DCIS risk prediction models and decision aids in which active surveillance is included as a management option for low-risk DCIS.
  • #29 A whole slide image-based machine learning approach to predict ductal carcinoma in situ (DCIS) recurrence risk | Breast Cancer Research | Full Text
    https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-019-1165-5
    Breast ductal carcinoma in situ (DCIS) represent approximately 20% of screen-detected breast cancers. The overall risk for DCIS patients treated with breast-conserving surgery stems almost exclusively from local recurrence. Current clinicopathological markers are insufficient to accurately assess the recurrence risk. Our machine learning-based model fills an unmet clinical need for accurately predicting the recurrence risk for lumpectomy-treated DCIS patients. The recurrence classifier significantly predicted the 10-year recurrence risk in the training […] and independent validation cohorts. Despite the limitations of our cohorts, our tool showed superior accuracy, specificity, positive predictive value, concordance, and hazard ratios relative to tested clinicopathological variables in predicting recurrences. The model provided a superior c-index (0.77), model fit (AIC=239.8) (Table 2) accuracy (0.87), specificity (0.91), PPV (0.65), NPV (0.93), and OR (23.6) to the clinical variables. The model was able to significantly stratify high-grade DCIS patients […] into the subgroups with high and low recurrence risks.
  • #30 A whole slide image-based machine learning approach to predict ductal carcinoma in situ (DCIS) recurrence risk | Breast Cancer Research | Full Text
    https://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-019-1165-5
    Breast ductal carcinoma in situ (DCIS) represent approximately 20% of screen-detected breast cancers. The overall risk for DCIS patients treated with breast-conserving surgery stems almost exclusively from local recurrence. Current clinicopathological markers are insufficient to accurately assess the recurrence risk. Our machine learning-based model fills an unmet clinical need for accurately predicting the recurrence risk for lumpectomy-treated DCIS patients. The recurrence classifier significantly predicted the 10-year recurrence risk in the training […] and independent validation cohorts. Despite the limitations of our cohorts, our tool showed superior accuracy, specificity, positive predictive value, concordance, and hazard ratios relative to tested clinicopathological variables in predicting recurrences. The model provided a superior c-index (0.77), model fit (AIC=239.8) (Table 2) accuracy (0.87), specificity (0.91), PPV (0.65), NPV (0.93), and OR (23.6) to the clinical variables. The model was able to significantly stratify high-grade DCIS patients […] into the subgroups with high and low recurrence risks.
  • #31 Molecular Signatures in Ductal Carcinoma In Situ (DCIS): A Systematic Review and Meta-Analysis
    https://www.mdpi.com/2077-0383/12/5/2036
    Molecular signatures are able to discriminate high- and low-risk women, high-risk ones having a significant benefit of RT in the reduction of invasive and in situ local recurrences, while in low-risk ones RT did not have a benefit for preventing invasive breast recurrence. […] The risk prediction of molecular signatures is independent of other risk stratification tools developed in DCIS, and have a tendency toward RT de-escalation. […] DCIS has an excellent prognosis, and to date is considered stage 0 breast cancer according to the 8th edition of the Union for International Cancer Control (UICC) and American Joint Committee on Cancer (AJCC) classification. […] Interestingly, radiotherapy did not impact 10-years breast cancer mortality in women diagnosed with DCIS treated with BCS (0.8% versus 0.9%; HR, 0.86 (95%CI, 0.67–1.10); p-value = 0.22).
  • #32 Prognostic Risk Assessment and Prediction of Radiotherapy Benefit for Women with Ductal Carcinoma In Situ (DCIS) of the Breast, in a Randomized Clinical Trial (SweDCIS)
    https://www.mdpi.com/2072-6694/13/23/6103
    Prognostic Risk Assessment and Prediction of Radiotherapy Benefit for Women with Ductal Carcinoma In Situ (DCIS) of the Breast, in a Randomized Clinical Trial (SweDCIS) […] Despite clinical advancements in the diagnosis and treatment of DCIS, tailoring individual treatment for women diagnosed with DCIS remains an unmet clinical need. […] Definitive predictive tools that can predict who will or not benefit from radiation therapy (RT) after breast conserving surgery (BCS) remains elusive. […] Here, we used a prospective–retrospective design to validate DCISionRT, using data from the SweDCIS randomized clinical trial. […] DCISionRT identified women with elevated recurrence risk who benefited substantially from RT after BCS. […] In addition, the test identified women with low recurrence risk and little benefit from RT.
  • #33 Prognostic Risk Assessment and Prediction of Radiotherapy Benefit for Women with Ductal Carcinoma In Situ (DCIS) of the Breast, in a Randomized Clinical Trial (SweDCIS)
    https://www.mdpi.com/2072-6694/13/23/6103
    These results support our conclusions that knowledge of the individual risk and benefit from RT provided by the test can help clinicians and patients make individualized treatment decisions for women diagnosed with DCIS. […] The aim was to validate a biosignature, DCISionRT, in the SweDCIS randomized trial. […] In the Elevated Risk group, RT significantly decreased relative 10-year ipsilateral total recurrence (TotBE) and 10-year ipsilateral invasive recurrence (InvBE) rates, HR 0.32 and HR 0.24, with absolute decreases of 15.5% and 9.3%. […] In the Low Risk group, there were no significant risk differences observed with radiotherapy. […] Using a cutoff of DS > 3.0, the test was not predictive for RT benefit (p = 0.093); however, above DS > 2.8 RT benefit was greater for InvBE (interaction p = 0.038).
  • #34 Prognostic Risk Assessment and Prediction of Radiotherapy Benefit for Women with Ductal Carcinoma In Situ (DCIS) of the Breast, in a Randomized Clinical Trial (SweDCIS)
    https://www.mdpi.com/2072-6694/13/23/6103
    These results support our conclusions that knowledge of the individual risk and benefit from RT provided by the test can help clinicians and patients make individualized treatment decisions for women diagnosed with DCIS. […] The aim was to validate a biosignature, DCISionRT, in the SweDCIS randomized trial. […] In the Elevated Risk group, RT significantly decreased relative 10-year ipsilateral total recurrence (TotBE) and 10-year ipsilateral invasive recurrence (InvBE) rates, HR 0.32 and HR 0.24, with absolute decreases of 15.5% and 9.3%. […] In the Low Risk group, there were no significant risk differences observed with radiotherapy. […] Using a cutoff of DS > 3.0, the test was not predictive for RT benefit (p = 0.093); however, above DS > 2.8 RT benefit was greater for InvBE (interaction p = 0.038).
  • #35
    https://link.springer.com/article/10.1007/s10549-024-07473-w
    The current standard of treatment for ductal carcinoma in situ (DCIS) is surgery with or without adjuvant radiotherapy. […] We conducted a systematic review and meta-analysis to evaluate the recurrence of low-risk DCIS under various treatment approaches. […] The pooled 5-year and 10-year iIBTE rates were 3.3% (95% confidence interval [CI]: 1.3, 8.1) and 5.9% (95% CI: 3.8, 9.0), respectively. […] The iIBTE rates were significantly lower in patients who underwent surgery compared to those who did not, at 5 years (3.5% vs. 9.0%, P=0.003) and 10 years (6.4% vs. 22.7%, P=0.008). […] Similarly, the 10-year BCSS rate was higher in the surgery group (96.0% vs. 99.6%, P=0.010). […] This review showed a lower risk of progression and better survival in women who received surgery and additional RT for low-risk DCIS.
  • #36
    https://link.springer.com/article/10.1007/s10549-024-07473-w
    The current standard of treatment for ductal carcinoma in situ (DCIS) is surgery with or without adjuvant radiotherapy. […] We conducted a systematic review and meta-analysis to evaluate the recurrence of low-risk DCIS under various treatment approaches. […] The pooled 5-year and 10-year iIBTE rates were 3.3% (95% confidence interval [CI]: 1.3, 8.1) and 5.9% (95% CI: 3.8, 9.0), respectively. […] The iIBTE rates were significantly lower in patients who underwent surgery compared to those who did not, at 5 years (3.5% vs. 9.0%, P=0.003) and 10 years (6.4% vs. 22.7%, P=0.008). […] Similarly, the 10-year BCSS rate was higher in the surgery group (96.0% vs. 99.6%, P=0.010). […] This review showed a lower risk of progression and better survival in women who received surgery and additional RT for low-risk DCIS.
  • #37
    https://link.springer.com/article/10.1007/s10549-024-07473-w
    The current standard of treatment for ductal carcinoma in situ (DCIS) is surgery with or without adjuvant radiotherapy. […] We conducted a systematic review and meta-analysis to evaluate the recurrence of low-risk DCIS under various treatment approaches. […] The pooled 5-year and 10-year iIBTE rates were 3.3% (95% confidence interval [CI]: 1.3, 8.1) and 5.9% (95% CI: 3.8, 9.0), respectively. […] The iIBTE rates were significantly lower in patients who underwent surgery compared to those who did not, at 5 years (3.5% vs. 9.0%, P=0.003) and 10 years (6.4% vs. 22.7%, P=0.008). […] Similarly, the 10-year BCSS rate was higher in the surgery group (96.0% vs. 99.6%, P=0.010). […] This review showed a lower risk of progression and better survival in women who received surgery and additional RT for low-risk DCIS.
  • #38
    https://link.springer.com/article/10.1007/s10549-024-07473-w
    Our pooled analysis showed that patients who received surgery had lower invasive breast cancer rates, which may contribute to better survival compared to those under AS. […] The addition of RT after BCS was also associated with a reduced rate of IBTE, but had no influence on CBC in observational analyses as well as in the RCTs. […] In summary, this review showed a lower risk of progression and better survival in women who received surgery and additional RT for low-risk DCIS. However, our results were mostly observational and should be confirmed with those from the ongoing trials.
  • #39 Ductal carcinoma in situ: to treat or not to treat, that is the question | British Journal of Cancer
    https://www.nature.com/articles/s41416-019-0478-6
    Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up and a normal life expectancy. […] Despite an excellent prognosis and normal life-expectancy, women diagnosed with DCIS experience stress and anxiety. […] A recent study based on an analysis of data from the American Cancer Registry of 100,000 women diagnosed with DCIS suggests that aggressive treatment might not be necessary to save lives. […] A retrospective Surveillance, Epidemiology, and End Results (SEER) study demonstrated for the first time that patients with low-grade DCIS had the same overall survival and breast-cancer-specific survival rates with or without surgery. […] Current perceptions of the risk-framing dialogue between clinicians and women diagnosed with DCIS are currently resulting in the overdiagnosis and overtreatment of DCIS. […] The need to reframe perceptions of risk and to avoid overtreatment is urgent, as overtreatment leads to physical and emotional harm for patients and to unnecessary costs for society.
  • #40 Ductal carcinoma in situ: to treat or not to treat, that is the question | British Journal of Cancer
    https://www.nature.com/articles/s41416-019-0478-6
    Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up and a normal life expectancy. […] Despite an excellent prognosis and normal life-expectancy, women diagnosed with DCIS experience stress and anxiety. […] A recent study based on an analysis of data from the American Cancer Registry of 100,000 women diagnosed with DCIS suggests that aggressive treatment might not be necessary to save lives. […] A retrospective Surveillance, Epidemiology, and End Results (SEER) study demonstrated for the first time that patients with low-grade DCIS had the same overall survival and breast-cancer-specific survival rates with or without surgery. […] Current perceptions of the risk-framing dialogue between clinicians and women diagnosed with DCIS are currently resulting in the overdiagnosis and overtreatment of DCIS. […] The need to reframe perceptions of risk and to avoid overtreatment is urgent, as overtreatment leads to physical and emotional harm for patients and to unnecessary costs for society.
  • #41 Ductal carcinoma in situ: to treat or not to treat, that is the question
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6697179/
    A recent study based on an analysis of data from the American Cancer Registry of 100,000 women diagnosed with DCIS suggests that aggressive treatment might not be necessary to save lives. […] These findings prompted the breast healthcare community to explore innovative studies that could circumvent the need for harsh therapeutic intervention for treating an indolent condition. […] Current perceptions of the risk-framing dialogue between clinicians and women diagnosed with DCIS are currently resulting in the overdiagnosis and overtreatment of DCIS. […] The need to reframe perceptions of risk and to avoid overtreatment is urgent, as overtreatment leads to physical and emotional harm for patients and to unnecessary costs for society.
  • #42 Ductal carcinoma in situ: to treat or not to treat, that is the question
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6697179/
    A recent study based on an analysis of data from the American Cancer Registry of 100,000 women diagnosed with DCIS suggests that aggressive treatment might not be necessary to save lives. […] These findings prompted the breast healthcare community to explore innovative studies that could circumvent the need for harsh therapeutic intervention for treating an indolent condition. […] Current perceptions of the risk-framing dialogue between clinicians and women diagnosed with DCIS are currently resulting in the overdiagnosis and overtreatment of DCIS. […] The need to reframe perceptions of risk and to avoid overtreatment is urgent, as overtreatment leads to physical and emotional harm for patients and to unnecessary costs for society.
  • #43 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research
    https://ar.iiarjournals.org/content/45/4/1305
    The natural history of low-grade DCIS may extend more than four decades. […] The studies discussed in here bring forward potential novel biomarkers and prevention strategies for DCIS that are at high risk of progression to IBC; however, we must keep in mind that these were conducted mostly comparing either DCIS lesions with matched IBC cases or from DCIS lesions co-occurring with IBC and may fail to capture true DCIS progression. […] Understanding these mechanisms and utilizing the underlying biomarkers that can correctly predict DCIS progression will add more to our arsenal in identifying patients with poor prognoses or those who would benefit from our available treatment modalities.
  • #44 Ductal Carcinoma In Situ (DCIS) – National Breast Cancer Foundation
    https://www.nationalbreastcancer.org/dcis/
    Additionally, women who have had DCIS have a higher risk of developing invasive breast cancer for up to 25 years after the initial DCIS diagnosis. But it is important to remember that every cancer is different and every woman is different. With early detection and thorough treatment, most women diagnosed with DCIS will live a long life.
  • #45 Ductal Carcinoma In Situ (DCIS) – National Breast Cancer Foundation
    https://www.nationalbreastcancer.org/dcis/
    Ductal carcinoma in situ (DCIS) is a common form of breast cancer, accounting for approximately 20-25% of all new breast cancer cases in the United States. DCIS is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk ducts. […] DCIS is early-stage cancer that is highly treatable. Nearly all women with DCIS can be cured. However, if left untreated or undetected, DCIS may spread into the surrounding breast tissue and could become a more advanced cancer. […] The prognosis for DCIS is excellent. More than 99% of patients diagnosed with DCIS will recover and live more than 5 years after their initial diagnosis. […] While some patients may experience a recurrence of DCIS, the recurrence rate for DCIS is generally low, around 15%, for patients who received both surgery and radiation as treatment.
  • #46 The Progressive Journey from Ductal Carcinoma in situ into Invasive Breast Cancer: An Extensive Systematic Literature Review on Biomarkers
    https://www.scitechnol.com/peer-review/the-progressive-journey-fromductal-carcinoma-in-situ-intoinvasive-breast-cancer-anextensive-systematic-literaturereview-on-biomark-uFAz.php?article_id=9166
    Ductal carcinoma in situ (DCIS) is a pre-invasive stage in the development of invasive breast carcinoma. DCIS presents a clinical problem, with high risk of potential progressive disease. A subset of patients with ductal carcinoma in situ (DCIS) will develop Invasive Breast Cancer (IBC). […] Up to now, little is known/or there is still a lot to know about molecular biomarkers (BM) that may help to determine the likelihood that DCIS identified on diagnostic biopsy would remain contained in situ or become invasive. […] Patients with DCIS have an increased risk of second breast cancer (SBC) recurrence, which can be invasive breast cancer (IBC) or any other type of cancers, and if uncontrolled might eventually lead to death. […] The progression from DCIS to IBC remains controversial, involving many types of cell behaviors, including growth, migration, and invasion through various cell signalling pathways.
  • #47 Ductal carcinoma in situ: to treat or not to treat, that is the question | British Journal of Cancer
    https://www.nature.com/articles/s41416-019-0478-6
    Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up and a normal life expectancy. […] Despite an excellent prognosis and normal life-expectancy, women diagnosed with DCIS experience stress and anxiety. […] A recent study based on an analysis of data from the American Cancer Registry of 100,000 women diagnosed with DCIS suggests that aggressive treatment might not be necessary to save lives. […] A retrospective Surveillance, Epidemiology, and End Results (SEER) study demonstrated for the first time that patients with low-grade DCIS had the same overall survival and breast-cancer-specific survival rates with or without surgery. […] Current perceptions of the risk-framing dialogue between clinicians and women diagnosed with DCIS are currently resulting in the overdiagnosis and overtreatment of DCIS. […] The need to reframe perceptions of risk and to avoid overtreatment is urgent, as overtreatment leads to physical and emotional harm for patients and to unnecessary costs for society.
  • #48 Ductal carcinoma in situ: to treat or not to treat, that is the question
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6697179/
    Ductal carcinoma in situ (DCIS) now represents 2025% of all breast cancers consequent upon detection by population-based breast cancer screening programmes. […] However, most DCIS lesions remain indolent. […] Difficulty in discerning harmless lesions from potentially invasive ones can lead to overtreatment of this condition in many patients. […] Improving the management and treatment of DCIS presents a central challenge: distinguishing indolent, harmless DCIS lesions from potentially hazardous ones. […] Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up and a normal life expectancy. […] Despite an excellent prognosis and normal life-expectancy, women diagnosed with DCIS experience stress and anxiety.
  • #49 Ductal carcinoma in situ: to treat or not to treat, that is the question | British Journal of Cancer
    https://www.nature.com/articles/s41416-019-0478-6
    Ductal carcinoma in situ (DCIS) now represents 20-25% of all breast cancers consequent upon detection by population-based breast cancer screening programmes. […] However, most DCIS lesions remain indolent. […] Difficulty in discerning harmless lesions from potentially invasive ones can lead to overtreatment of this condition in many patients. […] Current therapeutic approaches result in overtreatment of some women with DCIS. […] In effect, women with DCIS are labelled as cancer patients, with concomitant anxiety and negative impact on their lives, despite the fact that most DCIS lesions will probably never progress to invasive breast cancer. […] Improving the management and treatment of DCIS presents a central challenge: distinguishing indolent, harmless DCIS lesions from potentially hazardous ones.
  • #50 Prediction Models and Decision Aids for Women with Ductal Carcinoma In Situ: A Systematic Literature Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9265509/
    Decision making about DCIS treatment is not straightforward. The key difference is the impact these treatments can have on patients quality of life. […] Risk perception and views on the role of active surveillance in the management of DCIS differ among clinicians. […] Well-designed evidence-based decision support tools such as decision aids, communication tools or prediction models may help patients and clinicians make better informed and value-congruent decisions. […] The clinical utility of the available models will remain unclear until additional, good-quality external validations are performed in adequately sized cohorts with sufficient events. […] Based on the available evidence, none of the prediction models retrieved are ready to be implemented in daily clinical practice for women with DCIS. Additional validation studies in larger, more diverse populations are urgently needed to establish the clinical utility of these models.
  • #51 Prediction Models and Decision Aids for Women with Ductal Carcinoma In Situ: A Systematic Literature Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9265509/
    Decision making about DCIS treatment is not straightforward. The key difference is the impact these treatments can have on patients quality of life. […] Risk perception and views on the role of active surveillance in the management of DCIS differ among clinicians. […] Well-designed evidence-based decision support tools such as decision aids, communication tools or prediction models may help patients and clinicians make better informed and value-congruent decisions. […] The clinical utility of the available models will remain unclear until additional, good-quality external validations are performed in adequately sized cohorts with sufficient events. […] Based on the available evidence, none of the prediction models retrieved are ready to be implemented in daily clinical practice for women with DCIS. Additional validation studies in larger, more diverse populations are urgently needed to establish the clinical utility of these models.
  • #52 Ductal Carcinoma In Situ (DCIS) | BCRF
    https://www.bcrf.org/about-breast-cancer/dcis-ductal-carcinoma-in-situ/
    Though it can be very stressful and alarming, DCIS is not life-threatening; practically all patients with stage 0 breast cancer can be cured. […] Currently, there is not a way to determine which DCIS cases will become invasive breast cancer and which will not, so DCIS is almost always treated. […] DCIS treatment has a high success rate, in most cases removing the tumor and preventing recurrence. The prognosis is excellent—98 percent survival after 10 years. […] Estimates of DCIS cases that will become invasive breast cancer range from 20-50 percent. Put another way, 50-80 percent of DCIS cases will not become invasive. […] The 10-year survival rate for a DCIS diagnosis is very high (at 98 percent) regardless of whether treatment is given after surgery. […] Because DCIS treatment does not improve survival, researchers, clinicians, and others have raised concerns that DCIS may be overtreated and debated whether treatment benefits outweigh impacts on quality of life. […] At this time, it is not possible to predict which cases of DCIS will become invasive breast cancer and which will not, which is why research into DCIS is so needed.
  • #53 Ductal carcinoma in situ: to treat or not to treat, that is the question
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6697179/
    Ductal carcinoma in situ (DCIS) now represents 2025% of all breast cancers consequent upon detection by population-based breast cancer screening programmes. […] However, most DCIS lesions remain indolent. […] Difficulty in discerning harmless lesions from potentially invasive ones can lead to overtreatment of this condition in many patients. […] Improving the management and treatment of DCIS presents a central challenge: distinguishing indolent, harmless DCIS lesions from potentially hazardous ones. […] Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up and a normal life expectancy. […] Despite an excellent prognosis and normal life-expectancy, women diagnosed with DCIS experience stress and anxiety.
  • #54 Ductal Carcinoma In Situ (DCIS) | BCRF
    https://www.bcrf.org/about-breast-cancer/dcis-ductal-carcinoma-in-situ/
    Though it can be very stressful and alarming, DCIS is not life-threatening; practically all patients with stage 0 breast cancer can be cured. […] Currently, there is not a way to determine which DCIS cases will become invasive breast cancer and which will not, so DCIS is almost always treated. […] DCIS treatment has a high success rate, in most cases removing the tumor and preventing recurrence. The prognosis is excellent—98 percent survival after 10 years. […] Estimates of DCIS cases that will become invasive breast cancer range from 20-50 percent. Put another way, 50-80 percent of DCIS cases will not become invasive. […] The 10-year survival rate for a DCIS diagnosis is very high (at 98 percent) regardless of whether treatment is given after surgery. […] Because DCIS treatment does not improve survival, researchers, clinicians, and others have raised concerns that DCIS may be overtreated and debated whether treatment benefits outweigh impacts on quality of life. […] At this time, it is not possible to predict which cases of DCIS will become invasive breast cancer and which will not, which is why research into DCIS is so needed.
  • #55 Ductal carcinoma in situ: to treat or not to treat, that is the question
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6697179/
    Ductal carcinoma in situ (DCIS) now represents 2025% of all breast cancers consequent upon detection by population-based breast cancer screening programmes. […] However, most DCIS lesions remain indolent. […] Difficulty in discerning harmless lesions from potentially invasive ones can lead to overtreatment of this condition in many patients. […] Improving the management and treatment of DCIS presents a central challenge: distinguishing indolent, harmless DCIS lesions from potentially hazardous ones. […] Generally, patients diagnosed with DCIS have an excellent long-term breast-cancer-specific survival of around 98% after 10 years of follow-up and a normal life expectancy. […] Despite an excellent prognosis and normal life-expectancy, women diagnosed with DCIS experience stress and anxiety.
  • #56 Biomarkers Predicting Progression and Prognosis of Ductal Carcinoma In Situ (DCIS) | Anticancer Research
    https://ar.iiarjournals.org/content/45/4/1305
    The natural history of low-grade DCIS may extend more than four decades. […] The studies discussed in here bring forward potential novel biomarkers and prevention strategies for DCIS that are at high risk of progression to IBC; however, we must keep in mind that these were conducted mostly comparing either DCIS lesions with matched IBC cases or from DCIS lesions co-occurring with IBC and may fail to capture true DCIS progression. […] Understanding these mechanisms and utilizing the underlying biomarkers that can correctly predict DCIS progression will add more to our arsenal in identifying patients with poor prognoses or those who would benefit from our available treatment modalities.
  • #57 Prognostic Risk Assessment and Prediction of Radiotherapy Benefit for Women with Ductal Carcinoma In Situ (DCIS) of the Breast, in a Randomized Clinical Trial (SweDCIS)
    https://www.mdpi.com/2072-6694/13/23/6103
    Prognostic Risk Assessment and Prediction of Radiotherapy Benefit for Women with Ductal Carcinoma In Situ (DCIS) of the Breast, in a Randomized Clinical Trial (SweDCIS) […] Despite clinical advancements in the diagnosis and treatment of DCIS, tailoring individual treatment for women diagnosed with DCIS remains an unmet clinical need. […] Definitive predictive tools that can predict who will or not benefit from radiation therapy (RT) after breast conserving surgery (BCS) remains elusive. […] Here, we used a prospective–retrospective design to validate DCISionRT, using data from the SweDCIS randomized clinical trial. […] DCISionRT identified women with elevated recurrence risk who benefited substantially from RT after BCS. […] In addition, the test identified women with low recurrence risk and little benefit from RT.

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przeżycie ogólne przewód mlekowy badanie morfometryczne inwazyjny rak przewodowy nawrót nowotworu uczenie maszynowe aktywny nadzór model predykcyjny status HER2 rak drugiej piersi receptor hormonalny jakość życia pacjenta niski stopień złośliwości nowotwór nieinwazyjny stopień zróżnicowania nowotworu terapia endokrynna inwazyjny rak piersi radioterapia uzupełniająca sygnatura molekularna nadrozpoznawalność chirurgia oszczędzająca pierś stratyfikacja ryzyka rak wewnątrzprzewodowy in situ rak inwazyjny naturalna historia choroby