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Reason for decline in DCIS recurrence?

Page last modified on: November 20, 2008
Question from RoseB: In the study about declining recurrence rates of DCIS over about a 10-year period, it seemed that a lot of the decline was hard to attribute to a specific cause (tamoxifen or radiation). Was there any discussion of whether pathologists have improved their process for declaring that margins on DCIS are clean? Or perhaps have increased their margin requirements?
Answers —Jennifer Griggs, M.D., M.P.H.: It is definitely the case that the reporting standards for pathology reports are improving. We now get much more information from our pathologists, which helps us give much more accurate treatment advice to our patients. It does appear that not all women with DCIS (ductal carcinoma in situ) benefit from tamoxifen, and most of the studies that were presented at the conference in San Antonio did not break down the findings by whether or not the patient was more or less likely to benefit from tamoxifen. Although we still await large published studies on this, it appears that DCIS that does not have the estrogen receptor is not as likely to benefit from tamoxifen. As I just said, the studies that looked at the benefit of radiation therapy did not all account for the differences in DCIS types. In fact, testing DCIS for the estrogen receptor only recently became something we ask our pathologists to do. Even more important in interpreting these studies, very few women with DCIS choose to take tamoxifen. So the mixed effects of tamoxifen and/or radiation therapy are not as complicated as one might think, because so few women actually take tamoxifen after surgery for DCIS.
Marisa Weiss, M.D., president and founder: In addition, over the years, we've made big strides in the quality of mammography. This is the test that is best able to detect DCIS. For example, through the new technology that provides digital mammography we are able to better catch even DCIS at its earliest point. This earlier diagnosis of a non-invasive breast cancer could also positively influence the outcome of women who have such a condition.

On Wednesday, December 20, 2006, our Ask-the-Expert Online Conference was called Updates from the San Antonio Breast Cancer Symposium 2006. Jennifer Griggs, M.D., M.P.H. and moderator Marisa Weiss, M.D. answered your questions about the newest research on breast cancer treatment, side effects, risk of recurrence, and more.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Jennifer Griggs, M.D., M.P.H.Jennifer Griggs, M.D., M.P.H. is a medical oncologist specializing in the treatment of breast cancer, with a a special interest in cancer survivorship, patient-physician communication, and quality of care for women with breast cancer.

Marisa Weiss, M.D. is a radiation oncologist specializing in breast cancer and the founder, president, and guiding force behind Breastcancer.org.

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