2011 SABCS, San Antonio Breast Cancer Symposium, 6-10 December, San Antonio, USA

A new test to determine risk of recurrence in DCIS breast cancer

Dr Larry Solin – Albert Einstein Medical Center, Philadelphia, USA


I’m Larry Solin, I’m a radiation oncologist, I work in Philadelphia and I’m a member, also, of the Eastern Co-operative Oncology Group, or ECOG. ECOG E5194 was a study that we ran through ECOG, it’s a trial designed to look at low risk DCIS patients, as determined based on conventional clinical and pathologic parameters. We enrolled patients between 1997 and 2000 and we now have ten years of follow-up on these patients for the parent study.

So for the ECOG E5194 study, in conjunction with Genomic Health, we looked at these DCIS tumours for 49% of the cases that were available. We had developed a pre-specified DCIS score and we were able to show that the DCIS score predicted for local recurrence in these patients. We therefore now have a new marker which is available which gives us important information above and beyond conventional clinical and pathologic parameters to assess risk for these patients and to help us tailor individualised treatment programmes for our patients with newly diagnosed DCIS of the breast.

DCIS is a very common presentation, it’s increasingly common in current developed countries where screening mammography is used. In the United States, for example, we have about 45,000 new cases every year and the number is rising. DCIS is a non-invasive tumour, it’s confined to the milk ducts and it’s a marker for subsequent transformation to invasive disease. Oncotype DX recurrent score is a test that’s been well known for a number of years now and we use this for invasive cancers, not DCIS but invasive cancers, and we’ve now come to a panel which is a subset of those genes. The oncotype recurrent score has 21 genes, the DCIS score has 12 genes, and we use the oncotype DX DCIS score to look at DCIS tumours as opposed to invasive tumours. So we have a panel now of genes which is similar to, but not the same as, the recurrent score and we use that for DCIS.

What does this mean for a patient with DCIS?

For women with DCIS one of the key questions is whether we add adjuvant treatments, such as radiation or tamoxifen, both or neither. And this is a very difficult clinical situation for the patients and the physicians. What the DCIS score allows us to do is to individualise and tailor the risk assessment for that patient and to use that patient’s information to help guide that patient to better treatment decisions, based on a better understanding of the risk-benefit ratios for that specific patient and her specific DCIS tumour.

This is the first presentation of the scientific information at San Antonio, it’s my privilege to present this on behalf of ECOG and CCTG and Genomic Health. So this is the first scientific presentation of the information. It’s available in the United States and hopefully will be available internationally very shortly.

I think this is a really important advance for patients; we get better information for the patients than we had previously. Historically we’ve used clinical and pathologic parameters, things like tumour size, grade and so on and here we can add additional information that goes beyond those sorts of parameters and gives us a much better understanding of the individual’s risk for her individual setting. In my opinion this is a major advance in patient management for DCIS of the breast.