Originally published as JCO Early Release 10.1200/JCO.2008.18.3103 on December 8 2008

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Ductal Carcinoma in Situ: State of the Science and Roadmap to Advance the Field

Henry M. Kuerer, Constance T. Albarracin, Wei T. Yang, Robert D. Cardiff, Abenaa M. Brewster, W. Fraser Symmans, Nola M. Hylton, Lavinia P. Middleton, Savitri Krishnamurthy, George H. Perkins, Gildy Babiera, Mary E. Edgerton, Brian J. Czerniecki, Banu K. Arun, Gabriel N. Hortobagyi

From the Departments of Surgical Oncology, Pathology, Diagnostic Radiology, Clinical Cancer Prevention, Radiation Oncology, and Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX; Department of Pathology and Laboratory Medicine, University of California, Davis; Department of Radiology, University of California, San Francisco, CA; and the Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA

Corresponding author: Henry M. Kuerer, MD, PhD, FACS, The University of Texas M. D. Anderson Cancer Center, DCIS Discovery Program and Department of Surgical Oncology, 1515 Holcombe Blvd, Unit 444, Houston, TX 77030; e-mail: hkuerer{at}mdanderson.org

Purpose Ductal carcinoma in situ (DCIS) is the fourth leading cancer for women in the United States. Understanding of the biology and clinical behavior of DCIS is imperfect. This article highlights the current knowledge base and the scientific roadmap needed to advance the field.

Methods This article is based on work done by and consultations obtained from leading experts in the field over a 6-month period that culminated in a full-day symposium designed to systematically review the most pertinent MEDLINE published reports and develop a roadmap to elucidate the molecular steps of carcinogenesis, reduce the extent or prevent the need for therapies, eliminate recurrences, and reduce morbidity.

Results Expression profiling of pure DCIS will help elucidate the molecular characteristics that distinguish high-risk lesions from clinically irrelevant lesions. The development of new methods of extracting RNA from processed tissues may provide opportunities for research. Mammography often underestimates the pathologic extent of DCIS; other imaging methods need to be investigated for detection and monitoring of disease stability or progression. Novel biologic agents are being delivered in neoadjuvant clinical trials, and alternative methods for breast irradiation are being studied. Future trials of treatment versus no treatment for biologically selected cases of DCIS should be developed.

Conclusion There is a critical need for a concerted international effort among patients with DCIS, clinicians, and basic scientists to conduct the research necessary to improve fundamental understanding of the biology and clinical behavior of DCIS and prevent development of invasive breast cancer.

published online ahead of print at www.jco.org on December 8, 2008.

Presented in part at the Breast Cancer Research Program's symposium titled DCIS Discovery: Next Steps Needed to Advance the Field, November 3, 2007, The University of Texas, M. D. Anderson Cancer Center, Houston, TX.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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