DCIS: Strategies for Integrating Tumor Biology & Population Sciences Workshop
The Ductal Carcinoma in Situ (DCIS): Strategies for Integrating Tumor Biology
and Population Sciences Workshop took place February 1 - 2, 2007 in San
Francisco, CA. The purpose of this workshop was to bring together investigators studying
DCIS in population-based studies, as well as experts in disciplines such as basic science,
clinical trials, epidemiology and risk modeling. Participants of this workshop had a wide
array of expertise and represented various areas of DCIS research. Given that advances in
technology and screening methods have resulted in increased diagnosis of DCIS, this
workshop was of particular importance.
The goals of the workshop were to:
- Obtain a better understanding of the capacity to share data and methods and
collaborate on DCIS research;
- Discuss the established and promising risk factors and markers for DCIS diagnosis and
prognosis that should be considered in future studies conducted in population studies; and
- Identify current challenges and limitations for successfully conducting
population-based DCIS research and develop strategies for overcoming these limitations.
The following DCIS research key priorities emerged from the workshop presentations and
discussions. These priorities can further enhance existing research efforts and set the
stage for future research studies.
- Better understand the biology and natural history of DCIS lesions
- Develop standardized pathology criteria for the diagnosis of DCIS
- Identify markers to accurately predict response to treatment and markers that may
assist in the development of agents for tailored therapy
- Develop reliable tools for accurately predicting risk of local recurrence and, more
importantly, risk of subsequent invasive disease
- Determine key data items and methods that should be incorporated into research
studies, such as patient and clinical factors, histopathological features, methods for
tissue collection, and study designs and analytic methods most appropriate for
population-based research
- Increase length of patient follow-up in research studies
- Evaluate whether existing data can be used for meta-analyses and whether collection
of additional data would be beneficial.
- Develop better methods to communicate the risks and benefits of treatment choices to
patients
Discussions from the workshop illustrated the following challenges in DCIS
research:
- Making the diagnosis (need standardized criteria, central pathology review)
- Choosing the most appropriate outcome or endpoint (e.g., local recurrence, invasive
breast cancer, ki-67 or other surrogate endpoint)
- Establishing large cohorts of patients with clinical data, available pathology
materials, and sufficient follow-up time
- Deciding which tumor markers are promising enough to examine in large-scale studies
of DCIS patients
- Selecting the most appropriate study designs and statistical methods for identifying
and validating new markers
- Identifying and collaborating with researchers from other disciplines
The topics of the presentations at this workshop ranged from the epidemiology of DCIS,
to characterization of the disease, to prevention, to treatment. Many of the
presentations had implications for prevention of subsequent invasive disease, as risk
factors are being identified and better characterized. Over-treatment of DCIS was another
issue that was discussed. The current survival rate for women with DCIS is more than 95
percent, which will be difficult to improve; however, it is likely that many women could
be treated using more benign measures than those that are currently used.
The researchers in attendance agreed that the workshop forum was a step in the right
direction. Open discussion that helps researchers learn about their colleagues' resources
(e.g., data, patients, skills) and about barriers to DCIS research such as limited tissue
availability, is beneficial for fostering collaborations and advancing research.
This workshop was not a one-time effort, but rather, an initial effort to increase the
focus on DCIS and how DCIS research can be advanced. Future workshops might address
issues such as quality of life and quality of care, which were not a focus of this
meeting.
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