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