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Test May Indentify Which DCIS cells Will Spread

Posted 12/12/2013

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  If this finding holds up to further testing and research, it is a very big deal. As you know, DCIS is a complicated and somewhat controversial diagnosis vis a vis necessary treatment and language. There has been a recent movement to change the name and remove "cancer" from it. In and of itself, DCIS is not cancer as it lacks the ability to move or invade. By definition, "real" cancer is invasive, and that is the problem and the danger, that it can spread to vital organs and cause lethal damage. We have known for a long time that some DCIS will become invasive cancer and some will not. There has not been a way to tell the difference, so everyone with this diagnosis has been treated as though it were the potentially dangerous type.

  Now, from the UK, comes this announcement of a test that may be able to identify those DCIS cells that will transform and spread and those that will just remain stable and non-dangerous. Scientists have found that cells with a high level of integrin αvβ6 are likely to become invasive cancers, while those with a lower level are not. There is reportedly a small risk of false negatives, and that surely is a concern. Overall, however, this potentially is a big step forward and may help thousands of women avoid unnecessary treatments.

  Here is the introduction to an article from NHS Choices and then a link to read more:

New test shows if DCIS breast cancer will spread

Integrin αvβ6 was not found in normal breast cells
"New test for breast cancer that could spare thousands needless treatment,” the Daily Mail reports. Researchers have identified a molecule – integrin αvβ6 – that appears to be associated with the development of invasive breast cancer.
The research investigated an early type of breast cancer called ductal carcinoma in situ (DCIS). DCIS means there are abnormal cancer cells in the breast ducts, but the cancer has not yet spread.
In up to half of DCIS cases the cancerous cells stay where they are. But in the other half of cases the cells spread into other tissues of the breast, and can then spread to other parts of the body.
The difficulty is in accurately predicting which half a woman falls into. As a precaution, all women with DCIS are usually offered treatment, typically a combination of surgery and radiotherapy. This means up to 2,400 women a year in the UK may receive unnecessary treatment.
The new research suggests that DCIS cells with higher levels of integrin αvβ6 were more likely to progress to invasive breast cancer than those with lower levels.
The implication is that testing integrin αvβ6 levels would identify women with “low risk” DCIS and spare them unnecessary treatment.
However, the results suggest the test had a small but important false negative rate; that is it gave an “all clear” result in some cases that progressed to invasive cancer.
This highlights the important fact that it is unlikely a single molecule will be able to predict disease progression in all women.
The results are certainly promising, but the headlines seem to have jumped the gun in welcoming a clinically useful test in the near future.

Integrin%20%CE%B1v%CE%B26%20was%20not%20found%20in%20normal%20breast%20cells%20%22New%20test%20for%20breast%20cancer%20that%20could%20spare%20thousands%20needless%20treatment,%E2%80%9D%20the%20Daily%20Mail%20reports.%20Researchers%20have%20identified%20a%20molecule%20%E2%80%93%20integrin%20%CE%B1v%CE%B26%20%E2%80%93%20that%20appears%20to%20be%20associated%20with%20the%20development%20of%20invasive%20breast%20cancer.%20The%20research%20investigated%20an%20early%20type%20of%20breast%20cancer%20called%20ductal%20carcinoma%20in%20situ%20(DCIS).%20DCIS%20means%20there%20are%20abnormal%20cancer%20cells%20in%20the%20breast%20ducts,%20but%20the%20cancer%20has%20not%20yet%20spread.%20In%20up%20to%20half%20of%20DCIS%20cases%20the%20cancerous%20cells%20stay%20where%20they%20are.%20But%20in%20the%20other%20half%20of%20cases%20the%20cells%20spread%20into%20other%20tissues%20of%20the%20breast,%20and%20can%20then%20spread%20to%20other%20parts%20of%20the%20body.%20The%20difficulty%20is%20in%20accurately%20predicting%20which%20half%20a%20woman%20falls%20into.%20As%20a%20precaution,%20all%20women%20with%20DCIS%20are%20usually%20offered%20treatment,%20typically%20a%20combination%20of%20surgery%20and%20radiotherapy.%20This%20means%20up%20to%202,400%20women%20a%20year%20in%20the%20UK%20may%20receive%20unnecessary%20treatment.%20The%20new%20research%20suggests%20that%20DCIS%20cells%20with%20higher%20levels%20of%20integrin%20%CE%B1v%CE%B26%20were%20more%20likely%20to%20progress%20to%20invasive%20breast%20cancer%20than%20those%20with%20lower%20levels.%20The%20implication%20is%20that%20testing%20integrin%20%CE%B1v%CE%B26%20levels%20would%20identify%20women%20with%20%E2%80%9Clow%20risk%E2%80%9D%20DCIS%20and%20spare%20them%20unnecessary%20treatment.%20However,%20the%20results%20suggest%20the%20test%20had%20a%20small%20but%20important%20false%20negative%20rate;%20that%20is%20it%20gave%20an%20%E2%80%9Call%20clear%E2%80%9D%20result%20in%20some%20cases%20that%20progressed%20to%20invasive%20cancer.%20This%20highlights%20the%20important%20fact%20that%20it%20is%20unlikely%20a%20single%20molecule%20will%20be%20able%20to%20predict%20disease%20progression%20in%20all%20women.%20The%20results%20are%20certainly%20promising,%20but%20the%20headlines%20seem%20to%20have%20jumped%20the%20gun%20in%20welcoming%20a%20clinically%20useful%20test%20in%20the%20near%20future.


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