>>>Dr. Jay Harness: Low grade DCIS.
I had a question about the treatment of low grade DCIS.
Another videos that I have done here at Breast Cancer Answers, I really emphasized high grade
DCIS, and particularly my concerns about high grade DCIS, as far as the propensity or the
odds of high grade will recur locally and other related factors.
So we have had a question about low grade DCIS.
Now, I want to remind everybody that fundamentally there are three grades of in situ breast cancer
just like there are three grades of invasive breast cancers, low, intermediate and high
or, when we talk about invasive cancers we talk about well-differentiated, moderately
or poorly differentiated.
Well, let's stick to DCIS, Ductal Carcinoma In Situ, and let's talk about low grade DCIS.
Well, a lot of debate actually about lower grade DCIS.
There are certainly those who feel that low grade DCIS can probably be treated with may
be a simple lumpectomy.
There is another camp of people who feel that low grade DCIS may not require any treatment
at all.
In other words is low grade DCIS similar to some of the low grade tumors that we see in
the prostates of men who over years and years and years do absolutely nothing.
Well, I think to ultimately answer this question what we have got to have is much more in the
way of molecular information about these various grades of in situ breast cancer, and to then
know what the natural history of that molecular information would be.
Now, one of the advantages of the Oncotype DX test for DCIS is that at least for beginning
that process of starting to look at the molecular profile, if you will, of in situ breast cancer
to help us project whether a patient needs radiation therapy or not, and I would refer
you to one of the prior videos that we have done on this here at breast cancer answers.
So what's the standard treatment of low grade in situ breast cancer right now will certainly,
I think, depending on the age of the patient and many other factors, taking that area out
and having negative margins that I have talked about, larger rim of normal tissue all the
way around.
Frankly, depending on other factors that a local multi-disciplinary team can help you
with, that may be all the treatment you need and then close follow-up.
I certainly have many patients with low grades, small areas of DCIS, that's the case for.
Now, you can also have low grade DCIS that may involve a very large area of the breast,
and in getting all that out might lead to a significant cosmetic deformity of the breast
and frankly, if you are in that situation, believe it or not may be mastectomy is the
way to go.
So, I can generalize, for obviously every case because the size of the in situ matters,
the location of the in situ matters, the size of the breast matters, as far as the surgical
approach and then the issue of radiation therapy, again size can matter, but I will also refer
you to the video here at Breast Cancer Answers about using Oncotype DX with DCIS.
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