NIH State-of-the-Science Conference: Diagnosis and Management of Ductal Carcinoma In Situ (DCIS) September 22-24, 2009 Bethesda, Maryland   Online Registration Can't Attend? Background Sponsors, Co-sponsors and Partners Agenda   Ductal carcinoma in situ (DCIS) is a condition in which abnormal cells are found in the lining of a breast duct.  As “in situ” means “in place,” this means the abnormal cells have not spread outside the duct to other tissues in the breast.  Also referred to as intraductal carcinoma and stage zero breast cancer, DCIS is the most common noninvasive tumor of the breast.  DCIS is most often discovered during routine mammograms, presenting as very small specks of calcium known as microcalcifications. However, not all microcalcifications indicate the presence of DCIS and the diagnosis must be confirmed by biopsy.  Magnetic Resonance Imaging (MRI) has also been used more recently as a diagnostic tool, but questions about the impact of the test on patient outcomes remain.  Since the implementation of screening mammography, the rate of new DCIS cases has increased dramatically.  DCIS currently accounts for approximately twenty percent of screening-detected breast cancer, but its true prevalence is challenging to measure because nearly all affected individuals are asymptomatic.  By most reports, the risk factors associated with the development of DCIS are similar to those for invasive breast cancer: increased age, family history of breast cancer, previous biopsies, history of hormone replacement therapy, and older age at first childbirth.  Tamoxifen, a hormonal drug, has demonstrated a reduction in the incidence of DCIS among high-risk women. Although the natural course of the disease is not well understood, DCIS can become invasive cancer and spread to other tissues.  It is also a marker of increased risk for developing cancer elsewhere in the same or opposite breast.  However, not all DCIS will progress to invasive disease, and it is thought that DCIS can be present in some individuals without causing problems over a long period of time.  Recent research suggests that DCIS is a spectrum of disease and that certain tumor characteristics may be strong or weak risk factors for subsequent invasive breast cancer. Unfortunately, it is currently not clear which lesion types are more likely to become invasive, leading to difficult treatment decisions for patients and providers. Because of this uncertainty, DCIS patients are typically treated promptly following diagnosis and have a generally good prognosis.  Standard DCIS therapies include breast conservation with or without radiation or mastectomy depending on patient and tumor characteristics.  Sentinel lymph node biopsy may also be recommended to high-risk patients, since this is the area where cancer spread is often first detected.  Hormone therapy may also be used in effort to prevent DCIS recurrence and to lower the risk of developing estrogen receptor positive breast tumors.  However, these drugs’ potential side effects must be weighed carefully. Since the natural course of DCIS is not well understood and treatment benefit may depend on specific tumor and patient characteristics, the treatment of DCIS remains controversial.  To examine these important issues, the National Cancer Institute and Office of Medical Applications of Research of the National Institutes of Health will convene a State-of-the-Science Conference from September 22-24, 2009. The conference will address the following key questions:         What are the incidence and prevalence of DCIS and its specific pathologic subtypes, and how are incidence and prevalence influenced by mode of detection, population characteristics, and other risk factors? How does the use of MRI or sentinel lymph node biopsy impact important outcomes in patients diagnosed with DCIS? How do local control and systemic outcomes vary in DCIS based on tumor and patient characteristics? In patients with DCIS, what is the impact of surgery, radiation, and systemic treatment on outcomes? What are the most critical research questions for the diagnosis and management of DCIS? At the conference, invited experts will present information pertinent to these questions, and a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality (AHRQ) will be summarized.  Conference attendees will have ample time to ask questions and provide statements during open discussion periods.  After weighing the scientific evidence, an unbiased, independent panel will prepare and present a consensus statement addressing the key conference questions.         National Cancer Institute (NCI) Office of Medical Applications of Research (OMAR) of the National Institutes of Health   Office of Research on Women's Health      Centers for Disease Control and Prevention Food and Drug Administration   Tuesday, September 22, 2009 8:30 a.m.          Opening Remarks TBA National Cancer Institute National Institutes of Health 8:40 a.m.          Charge to the Panel Barnett S. Kramer, M.D., M.P.H. Director Office of Medical Applications of Research Office of the Director National Institutes of Health 8:50 a.m.          Conference Overview and Panel Activities Carmen J. Allegra, M.D. Panel and Conference Chairperson Chief, Hematology and Oncology Associate Director for Clinical and   Translational Research Shands Cancer Center University of Florida   9:00 a.m.          Terminology, Natural History, and Taxonomy of DCIS                         D. Craig Allred, M.D. Director, Breast Pathology Professor, Pathology and Immunology Washington University School of   Medicine 9:20 a.m.          Epidemiology of DCIS Karla Kerlikowske, M.D., M.S. Professor of Medicine, Epidemiology and Biostatistics University of California at San Francisco School of Medicine   9:40 a.m.          Mode of Detection & Secular Time                         Etta D. Pisano, M.D.             Kenan Professor of Radiology and Biomedical Engineering             Director, University of North Carolina Biomedical Research Imaging Center             University of North Carolina School of Medicine 10:00 a.m.         Evidence-Based Practice Center Presentation I   10:20 a.m.         Discussion 11:00 a.m.         Sentinel Lymph Node Biopsy and Management of the Axilla Thomas B. Julian, M.D., F.A.C.S. Associate Director, Breast Care Center West Penn Allegheny Health System   11:20 a.m.         MRI in Patients Diagnosed With DCIS                         Constance D. Lehman, M.D., Ph.D.                         Professor of Radiology                         Section Head, Breast Imaging                         University of Washington School of Medicine   11:40 a.m.         Evidence-Based Practice Center Presentation II   12:00 p.m.         Discussion   12:30 p.m.         Lunch                         Panel Executive Session 1:30 p.m.          Local Control of DCIS Based on Tumor and Patient Characteristics:                         The Surgeon’s Perspective             Lisa A. Newman, M.D., M.P.H., F.A.C.S. Professor of Surgery Director, University of Michigan Breast Care Center University of Michigan Health Systems   1:50 p.m.          DCIS Outcomes in Breast Cancer Chemoprevention Trials                         Victor G. Vogel III, M.D., M.H.S. Professor of Medicine and Epidemiology Co-Director, Biochemoprevention Program University of Pittsburgh Cancer Institute   2:10 p.m.          Local and Systemic Outcomes in DCIS Based on Tumor and Patient Characteristics: The                         Pathologist’s Perspective                         Stuart Schnitt, M.D.                         Co-Director, Division of Anatomic Pathology                         Beth Israel Deaconess Medical Center   2:30 p.m.          Meta-Analysis of DCIS Trials: Outcomes From the Early Breast Cancer Trialists’ Collaborative Group                         Sara C. Darby, Ph.D.                         Professor of Medical Statistics                         Clinical Trials Service Unit                         University of Oxford   2:50 p.m.          Local and Systemic Outcomes in DCIS Based on Tumor and Patient Characteristics: The Radiation Oncologist’s Perspective Nina Bijker, M.D., Ph.D.                                                                                                                         Department of Radiation Oncology                         Academic Medical Center                         University of Amsterdam                         3:10 p.m.          Evidence-Based Practice Center Presentation III   3:30 p.m.          Discussion 4:30 p.m.          The Impact of Radiation Therapy on DCIS Outcomes                         Lawrence J. Solin, M.D., F.A.C.R.                         Professor and Chair                         Department of Radiation Oncology                         Albert Einstein Medical Center   4:50 p.m.          The Impact of Surgery on DCIS Outcomes: The Van Nuys Prognostic Index                         Melvin J. Silverstein, M.D. Professor of Surgery Henrietta C. Lee Chair in Breast Cancer Research Director, University of Southern California/Norris Lee Breast Center University of Southern California Keck School of Medicine   5:10 p.m.          Discussion   5:30 p.m.          Adjournment Wednesday, September 23, 2009   8:30 a.m.          The Impact of Surgery on DCIS Outcomes: The Use of Mastectomy                         Eun-Sil (Shelley) Hwang, M.D., M.P.H.                         Assistant Professor of Surgery University of California at San Francisco School of Medicine                         8:50 a.m.          The Impact of Systemic Therapy on DCIS Outcomes                         Sandra M. Swain, M.D.                         Medical Director                         Washington Cancer Institute                         Washington Hospital Center                                     9:10 a.m.          Communications Between Patients and Providers and Informed Decision-Making             Joann G. Elmore M.D., M.P.H. Professor of Medicine Adjunct Professor of Epidemiology University of Washington School of Medicine   9:30 a.m.          Evidence-Based Practice Center Presentation IV   9:50 a.m.          Discussion 10:50 a.m.         Molecular Markers for the Diagnosis and Management of DCIS                         Kornelia Polyak, M.D., Ph.D.                         Associate Professor of Medicine                         Department of Medical Oncology                         Dana-Farber Cancer Institute                                     11:10 a.m.         Imaging for the Diagnosis and Management of DCIS                         Carl J. D'Orsi, M.D., F.A.C.R.                           Professor of Radiology,  Hematology, and Oncology Director, Division of Breast Imaging Winship Cancer Institute Emory University Hospital   11:30 a.m.         Quality of Life Issues and Outcomes Research in DCIS                         Patricia Ganz, M.D.                         Professor of Health Services and Medicine                         Division of Cancer Prevention and Control Research University of California, Los Angeles School of Medicine and Public Health                         11:50 a.m.         Discussion   12:20 p.m.         Adjournment Thursday, September 24, 2009 9:00 a.m.          Presentation of the Draft Conference Statement   9:30 a.m.          Panel Meets in Executive Session   11:00 a.m.        Press Conference   2:00 a.m.          Adjournment Back to top Contact Consensus Program | Privacy Notice | Disclaimer | Accessibility | Contact NIH