Dr. Lawrence J. Solin discusses how molecular testing has led to customized treatments for patients with an early form of breast cancer known as DCIS.
Dr. Lawrence J. Solin, Chairman, Department of Radiation Oncology Einstein Medical Center
Ductal carcinoma in situ (DCIS) is an early form of breast cancer found in the cells of milk ducts. In some — but not all — patients, DCIS will develop into an invasive cancer of breast tissue. Until now, physicians have not been able to determine which patients are more or less at risk for that form of breast cancer. Predictions have been based on averages resulting from large studies of patients.
New research conducted by Dr. Lawrence J. Solin, chairman of Einstein’s department of radiation oncology, uses genetic analysis of an individual patient’s cancerous duct cells to evaluate her prognosis. Called an Oncotype DX® DCIS Score, it will predict the 10-year risk of recurrence of DCIS or of invasive cancer in the same breast.
“DCIS is a huge issue in the United States affecting approximately 55,000 patients every year,” Solin said. “Because of the uncertainty about patients’ future risk, treatment of DCIS is very controversial. People are concerned about over-treating and under-treating this disease.
“Now, by molecular testing of the duct cells, we are able to determine if a patient is at low, intermediate or high-risk for invasive breast cancer or a DCIS reoccurrence,” Solin explains. “We put that molecular information together with the patient’s other medical information and create a treatment plan tailored to her exact circumstances. We are giving women more information and more options to manage their health.”
Solin started working on the study in 1994. He had to wait for tissue collections to mature and technology to evolve. “At the time, medical science was studying the clinical and pathological characteristics of cancer, but we wanted to look at the molecular component,” Solin explained. “This particular branch of the study is a 12-gene assay that we conducted over four or five years.”
Solin is currently using the molecular test in his practice and expects it and the Oncotype DX® DCIS Score to become a standard part of clinical care. He cautions that it is not appropriate for all patients. And BRCA genetic mutations and other risk factors are separate issues that need to be considered on a case-by-case basis.
“I wear a physician hat as well as a researcher hat,” Solin says. “As a physician, I have seen hundreds of DCIS patients. Being diagnosed with DCIS is very difficult for patients — even if we do not yet know whether their DCIS will progress to invasive breast cancer. Many people hear ‘carcinoma’ and become alarmed, when the operative word is ‘in situ.’ That’s perfectly understandable, and my heart goes out to those patients.
“Now, with this new test being confirmed as effective, I can offer them what every cancer patient wants: more information,” Solin says. “I will be able to use the power of genomic testing to determine their risk and individualize their treatment. While I think this study is great for medicine in general, it is also great for DCIS patients in a very specific, very personal way.”