High - Grade dcis, what is it? - Dr. jay harness

>>>DR. JAY HARNESS: In talking about ductal carcinoma in situ (DCIS), there are various things that go into the description of DCIS. The number one thing that we talk about is the grade of the in situ breast cancer. We actually have a grading system also for invasive breast cancers but I am going to focus right now on the grading system for in situ of breast cancer. There are three grades high grade, intermediate grade, and low grade. The three separate grades then are related to the biology of the in situ breast cancer. Low-grade in situ breast cancer can develop over years, very similar to low-grade cancer of the prostate in men can be there for years; remember we often cannot diagnose in situ breast cancer unless there is an associated (a) mass or (b) microcalcifications. The natural history of low-grade truly low-grade in situ breast cancer is being actively debated now. There are some who feel that they do not even need to treat low-grade DCIS but more to be revealed on that subject later. Intermediate grade DCIS is the next step-up. They turnover rate, the growth, the size is typically a little more aggressive than the low grade. I think there is consensus that all intermediate grade DCIS needs to be appropriately treated, typical treatment is lumpectomy, often with radiation therapy, and/or mastectomy. As we get into the whole issue about radiation therapy and in situ breast cancer, I already done a video here at breastcanceranswers.com about the role of the oncotype DX analysis in determining and helping us to determine things about the biology of the in situ breast cancer with the chances are of the in situ breast cancer reoccurring and therefore extrapolating that to the need for radiation therapy. Let me finish up then by talking about high-grade DCIS. High grade DCIS can be quite aggressive. If it gets very-very large, it is often associated with areas of invasive breast cancer and the same is true by the way of immediate grade DCIS that if there is a large area of intermediate grade DCIS, there can also be associated small areas of invasive cancer. But high grade DCIS tends to be a horse of a different colour here, and what we have found and what I have found in my experience is that breast MRI can be very helpful in defining the extent of a high-grade DCIS to help us make decision about lumpectomy with radiation therapy versus mastectomy. The high grade DCIS can grow larger than the area of associated microcalcifications. I have recently also had a patient with extremely high-grade DCIS where there are malignant appearing microcalcifications all over the breast and this is an entity that has been particularly talked about by the world famous breast radiologist Dr. Laszlo Tabar. Dr. Tabar feels that this really extensive high-grade DCIS should be thought of as invasive breast cancer and treated accordingly. Now everything that we talked about when it comes to in situ breast cancer, there are multitude of factors that go into treatment decisions, the need for radiation therapy, being on the lookout for invasive cancer associated with it and therefore we need to be testing the sentinel lymph nodes. So, again, my plea is always work with the multidisciplinary team, work with the group of people, and professionals who know how to sort these issues out to give you the very best advice about your in situ breast cancer. Hi, I am Dr. Jay Harness and I want to share with you an important information that I believe that every newly diagnosed patient with breast cancer needs to know. Susan Denver: I am a breast cancer survivor. Katherine Stockton: I am a breast cancer survivor. Coree: I am a breast cancer survivor. Susan Denver: And I want every woman to know… Katherine Stockton: …about personalized breast cancer treatment… Susan Denver: …and the Genomic Test. Coree: A test that helps guide a woman and her doctor… Katherine Stockton: …to the best treatment options for her. Susan Denver: Pass it on!