Biomarker Expression and Risk of Subsequent Tumors After Initial Ductal Carcinoma In Situ Diagnosis

Biomarker Expression and Risk of Subsequent Tumors After Initial Ductal Carcinoma In Situ Diagnosis
Karla Kerlikowske, Annette M. Molinaro, Mona L. Gauthier, Hal K. Berman,
Fred Waldman, James Bennington, Henry Sanchez, Cynthia Jimenez, Kim
Stewart, Karen Chew, Britt-Marie Ljung, and Thea D. Tlsty
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Results: 
Factors associated with subsequent invasive cancer differed  from those associated with subsequent DCIS. Eight-year risk of subsequent invasive cancer was statistically significantly (P  = .018) higher for women with initial DCIS lesions that were detected by palpation or that were p16, COX-2, and Ki67 triple positive (p16+COX-2+Ki67+) (19.6%, 95% confidence interval [CI] = 18.0% to 21.3%) than for women with initial lesions that were detected by mammography and were p16, COX-2, and Ki67 triple negative (p16–COX-2–Ki67–) (4.1%, 95% CI = 3.4% to 5.0%). In a multivariable model, DCIS lesions that were p16+COX-2+Ki67+  or those detected by palpation were statistically significantly associated with subsequent invasive cancer, but nuclear grade was not. Eight-year risk of subsequent DCIS was highest for women with DCIS lesions that had disease-free margins of 1 mm or greater combined with either ER–ERBB2+Ki67+  or p16+COX-2–Ki67+ status (23.6%, 95% CI = 18.1% to 34.0%).

Conclusion: 
Biomarkers can identify which women who were initially diagnosed with DCIS are at high or low risk of subsequent invasive cancer, whereas histopathology information cannot

Performance of First Mammography Examination in Women Younger Than 40 Years

Performance of First Mammography Examination in Women Younger Than 40 Years
Bonnie C. Yankaskas, Sebastien Haneuse, Julie M. Kapp, Karla Kerlikowske,
Berta Geller, Diana S. M. Buist, and   for the Breast Cancer Surveillance
Consortium
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Younger women have very low breast cancer rates but after mammography  experience high recall rates, high rates of additional imaging,  and low cancer detection rates. We found no cancers in women  younger than 25 years and poor performance for the large group  of women aged 35–39 years. In a theoretical population of 10 000 women aged 35–39 years, 1266 women who are screened will receive further workup, with 16 cancers detected and 1250 women receiving a false-positive result