DCIS and Tamoxifen
It has been interesting to watch the changing treatment of DCIS (ductal carcinoma in situ). As you likely know, DCIS is sometimes called "Stage 0" or "pre-cancer". It is not invasive, but contained within the ducts. As long as it stays there, it is not dangerous or a health threat. Doctors and scientists have not yet been able to figure out how to distinguish DCIS that would stay in the ducts forever, and DCIS that is going to gradually morph into an invasive cancer and be a larger problem.
Therefore, everyone with DCIS is treated. Clearly, this is another arena that likely will change in the future as more is understood about an individual situation.
For now, however, DCIS is treated either with a lumpectomy and radiation therapy or, sometimes, by mastectomy (depending on how large the involved area is). Often, it is then recommended that women take five years of Tamoxifen, not to treat what has already happened (since it is not cancer and not dangerous), but to minimize the risk of a future cancer. This is an article from the Journal of Clinical Oncology about that situation. It suggests that this is an important treatment for women with ER positive DCIS.
Here is the abstract and then a link:
Adjuvant Tamoxifen Reduces Subsequent Breast Cancer in Women With Estrogen Receptor-Positive Ductal Carcinoma in Situ: A Study Based on NSABP Protocol B-24
The NSABP (National Surgical Adjuvant Breast and Bowel Project) B-24 study demonstrated significant benefit with adjuvant tamoxifen in patients with ductal carcinoma in situ (DCIS) after lumpectomy and radiation. Patients were enrolled without knowledge of hormone receptor status. The current study retrospectively evaluated the relationship between receptors and response to tamoxifen.
Patients and Methods
Estrogen (ER) and progesterone receptors (PgR) were evaluated in 732 patients with DCIS (41% of original study population). An experienced central laboratory determined receptor status in all patient cases with available paraffin blocks (n ! 449) by immunohistochemistry (IHC) using comprehensively validated assays. Results for additional patients (n ! 283) determined by various methods (primarily IHC) were available from enrolling institutions. Combined results were evaluated for benefit of tamoxifen by receptor status at 10 years and overall follow-up (median, 14.5 years).
ER was positive in 76% of patients. Patients with ER-positive DCIS treated with tamoxifen (v placebo) showed significant decreases in subsequent breast cancer at 10 years (hazard ratio [HR], 0.49; P " .001) and overall follow-up (HR, 0.60; P ! .003), which remained significant in multivariable analysis (overall HR, 0.64; P ! .003). Results were similar, but less significant, when subsequent ipsilateral and contralateral, invasive and noninvasive, breast cancers were considered separately. No significant benefit was observed in ER-negative DCIS. PgR and either receptor were positive in 66% and 79% of patients, respectively, and in general, neither was more predictive than ER alone.
Patients in NSABP B-24 with ER-positive DCIS receiving adjuvant tamoxifen after standard therapy showed significant reductions in subsequent breast cancer. The use of adjuvant tamoxifen should be considered for patients with DCIS.