Mammographic density, endocrine therapy and breast cancer risk: a prognostic and predictive biomarker review

CONCLUSIONS: There is low-/very low-certainty evidence to support the hypothesis that breast density change following endocrine therapy is a prognostic biomarker for treatment or prevention. Studies suggested a potentially large effect size with tamoxifen, but the evidence was limited. There was less evidence that breast density change following tamoxifen preventive therapy is a predictive biomarker than prognostic biomarker. Evidence for breast density change as a prognostic treatment biomarker was stronger for tamoxifen than aromatase inhibitors. There were no studies reporting mammographic density change following endocrine therapy as a predictive biomarker in the treatment setting, nor aromatase inhibitor therapy as a prognostic or predictive biomarker in the preventive setting. Further research is warranted to assess mammographic density as a biomarker for all classes of endocrine therapy and review endpoints.PMID:34697802 | DOI:10.1002/14651858.CD013091.pub2
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Source Type: research

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This study suggested that active surveillance could be a reasonable option for certain category of patients. This attitude is not without risks. A patient with DCIS on core needle biopsy could hide an invasive cancer in 25% of cases (12). Today, there are four randomized control trials of active surveillance offered to patients with low-grade DCIS: LORD (LOw Risk DCIS), COMET (Comparison of Operative to Monitoring and Endocrine Therapy), LORIS (LOw RISk DCIS) and LORETTA (10,13-16). Non-surgical approaches are of two types: active surveillance alone or associated with hormone therapy. There are some differences between the...
Source: Cancer Control - Category: Cancer & Oncology Authors: Source Type: research
Dr. Laura Esserman answers the door of her bright yellow Victorian home in San Francisco’s Ashbury neighborhood with a phone at her ear. She’s wrapping up one of several meetings that day with her research team at University of California, San Francisco, where she heads the Carol Franc Buck Breast Care Center. She motions me in and reseats herself at a makeshift home office desk in her living room, sandwiched between a grand piano and set of enormous windows overlooking her front yard’s flower garden. It’s her remote base of operations when she’s not seeing patients or operating at the hospita...
Source: TIME: Health - Category: Consumer Health News Authors: Tags: Uncategorized Source Type: news
This study showed that increased cancer risk persisted for more than 15 years after a diagnosis of DCIS, and that more intensive therapy than lumpectomy alone — whether with mastectomy, radiation therapy, or endocrine therapy — reduced the risk of invasive breast cancer among women with DCIS. The lowest risk of invasive breast cancer was in women who chose mastectomy. The risk of invasive breast cancer was seen regardless of severity of DCIS. Women who had low- or moderate-grade DCIS, as well as high-grade DCIS, had long-term increased risk. Women who are recently diagnosed with DCIS should work with their trea...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Breast Cancer Women's Health Source Type: blogs
AbstractTreatment for ductal carcinoma in-situ (DCIS) has historically been extrapolated from studies of invasive breast cancer. Accepted local therapy approaches range from small local excisions, with or without radiation, to bilateral mastectomies. Systemic treatment with endocrine therapy is often recommended for hormone positive patients. With improvements in imaging, pathologic review, and treatment techniques in the modern era, combined with new information regarding tumor biology, the management of DCIS is rapidly evolving. A multidisciplinary approach to treatment is now more important than ever, with a shift towar...
Source: Journal of Mammary Gland Biology and Neoplasia - Category: Cancer & Oncology Source Type: research
Conclusions High cytonuclear grade, mammographic microcalcification, young age and lack of endocrine therapy were risk factors for DCIS progression to invasive cancer. Surgical excision of high grade DCIS remains the treatment of choice. Given the uncertain long-term natural history of non-high grade DCIS, the option of active surveillance of women with this condition should be offered within a clinical trial.
Source: European Journal of Surgical Oncology (EJSO) - Category: Surgery Source Type: research
Conclusions: With longer follow-up, our rates of local recurrence following breast-conserving therapy for DCIS remain very low (1.5% at 10 years). The vast majority of patients had>2 mm margins, specimen radiographs, and received a tumor bed boost. The majority (60%) of patients with hormone receptor positive disease received adjuvant endocrine therapy. The 10-year incidence of CBC was higher than expected. Predisposing factors for the development of CBC are worthy of investigation.Citation Format: Rattay T, Johnson K, Azria D, Chang-Claude J, Davidson S, Dunning A, de Ruyscher D, Guiterrez-Enriquez S, Lambin P, Rancati...
Source: Cancer Research - Category: Cancer & Oncology Authors: Tags: Poster Session Abstracts Source Type: research
The introduction of mammographic screening has resulted in a rise in the detection rate of ductal carcinoma in situ (DCIS), currently accounting for one‐fifth of screen‐detected breast cancers. Although 60–70% of DCIS are treated with breast‐conserving surgery (BCS) with or without radiotherapy, the frequency of subsequent surgery to re‐excise positive margins in order to reduce the probability of recurrences remains high. DCIS recurrence is associated not only with financial, health and psychological implications; approximately half these recurrences are invasive disease. An appropriate margin width for pati...
Source: Histopathology - Category: Pathology Authors: Tags: Review Source Type: research
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Source: Histopathology - Category: Pathology Authors: Tags: Review Source Type: research
Background: Women with DCIS have increased risk for invasive breast cancer. Limited abilities to accurately identify aggressive DCIS have resulted in inappropriate treatment for many women with mammographically-detected DCIS. miRNAs play a critical role in tumorigenesis. It remains unknown if miRNAs are associated with recurrence and refine risk assessment for DCIS patients.Methods: The study included 16 DCIS cases that developed ipsilateral recurrence (cases) and 32 DCIS cases that did not develop any type of recurrence (controls). Cases and controls were treated with breast conserving surgery and matched on age, race, an...
Source: Cancer Research - Category: Cancer & Oncology Authors: Tags: Poster Session Abstracts Source Type: research
This study will provide so many answers to questions that are critical to resolve,” Hwang said. “One of the key features is the assessment of patient-reported outcomes with each approach, as we believe how patients view their disease and their care must be central to any advances in cancer treatment.” The funding award for the DCIS study has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract. PHOTO: Shelley Hwang, M.D., Duke Cancer Institute and Duke Department of Surgery. CREDIT: Duke Health.
Source: Duke Health Features - Category: Pediatrics Tags: Duke Medicine Source Type: news
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