Abstract IA016: The DCIS: A biological challenge and clinical dilemma

Currently, one of the most challenging problems in oncology is predicting more precisely whether lesions that are detected by sensitive screening tests are indolent (hence, not requiring extensive treatment) or progressive and potentially life-threatening. For example, the increase in breast cancer “incidence” observed over the last 20 years is largely attributable to increased detection of ductal carcinoma in situ (DCIS) and stage I disease by imaging. Despite the increase in early-stage disease, the rates of advanced stage disease have changed only minimally, and the rate of metastatic disease has been virtually unchanged. Conversely, all screening tests miss some life-threatening cancers, known as “interval cancers,” that are diagnosed between scheduled screening tests. Breast cancer best illustrates the problem of interval cancers. It is known that more-aggressive types of breast cancer are more likely to be missed by screening; the cancer grows so quickly it becomes symptomatic after a normal screening test. For example, interval-detected breast cancers are 1.8 to 2.6-fold more likely to be estrogen receptor (ER) negative compared to screen-detected tumors, are likely to be diagnosed at a more advanced stage and are faster growing on average than screen-detected cancers. Relatively little is known about the molecular and cellular differences between screen- detected lesions and interval tumors which might be used to distinguish among the two types of lesions and potentially point to more effective strategies and targets for intervention. The National Cancer Institute has established programs to identify cellular and molecular characteristics that distinguish progressive from non-progressive lesions. Recent progress in this direction will be discussed by the speaker.

Citation Format: Sudhir Srivastava. The DCIS: A biological challenge and clinical dilemma [abstract]. In: Proceedings of the AACR Special Conference on Rethinking DCIS: An Opportunity for Prevention?; 2022 Sep 8-11; Philadelphia, PA. Philadelphia (PA): AACR; Can Prev Res 2022;15(12 Suppl_1): Abstract nr IA016.