Making Decisions About Cancer

In some women, DCIS turns into invasive breast cancer and sometimes an area of DCIS contains invasive cancer. In some women, though, the cells may never invade and remain localized within the ducts. If the cells don’t invade, DCIS cannot spread to lymph nodes or other organs, and so cannot be life-threatening. The uncertainty about how DCIS will behave makes it difficult for women to make decisions about what treatment to have, if any. Researchers are looking for ways to help with these challenges.

Researchers are studying the use of computers and statistical methods to estimate the odds that a woman’s DCIS will become invasive. Some of these methods are based on routinely available clinical information about the patient and her DCIS, whereas others also include information about changes in her tumor’s genes. Decision aids are another approach. They ask a woman with DCIS questions that help her decide which factors (such as survival, preventing recurrence, and side effects) she considers most important in choosing a treatment.

Another approach is to look at genes expressed by the DCIS cells using a test such as the Oncotype Dx DCIS Score. This test can be used to predict a woman’s chance of DCIS coming back or a new cancer developing in the same breast if she does not get radiation. So far, though, it hasn’t been studied well enough to predict how much someone would benefit from radiation after surgery for DCIS.

Another recent area of research and debate among breast cancer specialists is whether changing the name of DCIS to one that emphasizes this is not an invasive cancer can help some women avoid overly aggressive treatment.