DCIS incidence has increased in recent years

A new report summarizes the results of a survey of 374 academic articles concerning ductal carcinoma in situ (DCIS). The survey was commissioned by the National Institutes of Health. The articles were published between 1965 and January 2009. DCIS incidence has increased in the U.S. from 1.87 per 100,000 during 1973 - 1975 to 32.5 per 100,000 in 2004. Incidence was found to rise in women of all ages, but more so in women over 50. Greater use of mammography screening for breast cancer accounts for some, but not all, of this increase. Not surprisingly, risk factors for DCIS include older age and family history. Although tamoxifen was found to prevent both invasive breast cancer and DCIS, raloxifene (Evista, another selective estrogen receptor modulator) reduced the incidence of invasive breast cancer but not DCIS. Tamoxifen treatment was also found to reduce risk of recurrence. Magnetic resonance imaging (MRI) was found to be more sensitive than mammography for detecting multicentric disease and estimating tumor size among patients with DCIS. Approximately 15% of patients with DCIS identified using core needle biopsy are subsequently diagnosed with invasive breast cancer after breast-conserving surgery (lumpectomy) or mastectomy. DCIS recurrence is associated with younger age, positive surgical margins, increasing tumor size and grade, and comedo necrosis. Lumpectomy plus radiation treatment and mastectomy produced similar outcomes and both were superior to lumpectomy alone. The authors remark that questions deserving further investigation include the relationship between mammography use and DCIS incidence and whether imaging technologies and treatment guidelines can be modified to focus on the cancers that are most likely to progress.

Certain drugs and foods may influence DCIS progression to invasive breast cancer

DCIS, also called intraductal carcinoma, refers to cancer cells that have formed in milk ducts and are confined there. DCIS is classified as non-invasive because the abnormal cells have not spread beyond the walls of the duct to invade the surrounding breast tissue. If left untreated, some DCIS lesions will progress to invasive breast cancer. Like invasive cancer, DCIS varies by hormone receptor and HER2/neu status. We suggest that women and men who have been diagnosed with DCIS review the relevant web pages in our web site concerning what to eat to improve the outcomes of their relevant subtype (e.g., ER+/PR+, triple negative, HER2 overexpressing, ER+/PR-, or ER-/PR+).

There have also been a limited number of studies that focus on DCIS risk and outcome as it relates to specific prescription drugs and foods. Women who use bisphosphonates such as Fosamax, Boniva and Actonel to treat osteoporosis have been found to develop significantly fewer cases of invasive breast cancer, but not fewer cases of DCIS. Use of the lipophilic statin Lescol (fluvastatin) has been found to reduce tumor proliferation and increase cancer cell death in some cases of DCIS. Both holy basil and curcumin (found in the spice turmeric) have been shown to reduce some types of DCIS growth and progression.