Exclusive interview / Dr. Anton Titov MD and Professor Dr. Jack Cuzick, world's leading cancer prevention expert, breast cancer, cervical cancer and prostate cancer prevention
If a woman has a new breast cancer diagnosis, potentially DCIS, and is really looking for therapy, and making care decisions that are optimal and in accordance with the latest clinical trials. What she should discuss with her oncologist? What potential tests or molecular tests on the tumor could be done to really narrow decision-making in DCIS? It's fair to say that none of the molecular markers are well enough established to be used clinically with the exception of estrogen receptor and progesterone receptor. Those are important for deciding whether to consider endocrine therapy, either tamoxifen or aromatase inhibitors. The use of HER2, I think, is still quite interesting, it looks like there will be important decisions to be made on that, but I don't think we're in position to recommend HER2 testing routinely at this stage. There is a whole range of other markers, which we think are important for giving us insights not only into how to treat DCIS, but what is a pathogenesis of breast cancer? Which DCIS [Ductal Carcinoma In Situ] is actually on a pathway that's going to lead to nasty cancer and which ones aren't. So, in a sense, a large proportion of women with DCIS are being over-treated now, in hope that one of them is in the subset that will really progress to invasive ductal carcinoma, but at the same time it exposes people to unnecessary side effects of radiation therapy and maybe even unnecessary extensive surgery? Absolutely right, there is no doubt that we're treating more DCIS than we need to. The challenge is to slowly move back on treatment without endangering the safety of any patient. I think that radiotherapy is the area where there's the biggest opportunity to actually reduce treatment, because it's given to almost everyone, and whether or not it's really needed for small, particularly low-grade tumors is a very open question. So DCIS in breast cancer is actually one of those areas where P4 medicine can really make a lot of inroads, and help a lot of people. Of course, you are absolutely right.
Early breast cancer, DCIS: how to decide on the best treatment (4) top doctors washingtonian
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