My Sister’s Other Cancer Attacker

Medical Details of my Sister’s Attacker. For What Its Worth

Intraductal carcinoma is a condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, intraductal carcinoma may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive. Also called ductal carcinoma in situ (DCIS).

Causes

The specific causes of intraductal carcinoma are still unknown. The risk factors for developing this condition are similar to those for invasive breast cancer.

Some women are however more prone than others to developing intraductal carcinoma. Women considered at higher risks are those who have a family history of breast cancer, those who have had their periods at an early age or who have had a late menopause. Also, women who have never had children or had them late in life are also more likely to get this condition.

Genetic mutations (BRCA1 or BRCA2 genes), atypical hyperplasia, as well as radiation exposure or exposure to certain chemicals may also contribute in the development of the condition. Nonetheless, the risk of developing noninvasive cancer increases with age and it is higher in women older than 45 years.

Treatment

The main treatment for intraductal carcinoma used to be mastectomy. This treatment therapy consists in the removal of the affected breast and until recently it was the only way in which this condition was treated. The rationale for mastectomy includes a 30% incidence of multicentric disease, a 40% prevalence of residual tumor at mastectomy following wide excision alone, and a 25% to 50% incidence of breast recurrence following limited surgery for palpable tumor, with 50% of those recurrences being invasive carcinoma.

Another treatment option consists of breast-conserving surgery along with radiation therapy. This type of treatment is usually considered in patients with non-palpable lesions and microcalcifications that may be seen on a mammography Breast-conserving surgery, also referred to as lumpectomy, is considered nowadays a reasonable approach in the treatment of intraductal carcinoma. A lumpectomy consists in the removal of the tumor and a part of the surrounding tissues of the breast. Sometimes, lumpectomies are also referred to as partial mastectomies because they mainly consist in the removal of a part of the breast tissue. My sister has already had 5 lumps removed.

According to the results of the trials carried out by EORTC (EORTC-10853), radiation therapy has a consistent efficiency in treating intraductal carcinoma. This clinical trial showed that the recurrence rate of breast carcinoma may be reduced with 10%, from which invasive cancer recurrence was reduced with 5% and noninvasive cancer recurrence with 7%. This study also concluded that the risks of recurrence are greatly dependent on the age of the patient, the type of carcinoma (intermediate or poorly differentiated), the indeterminate margins of the tumor and the growth pattern.

Mastectomies however remain the main treatment option in patients with persistent microscopic involvement of margins after local excision or with a diagnosis of intraductal carcinoma and evidence of suspicious, diffuse micro calcifications.

A clinical study carried out by NSABP revealed that Taximofen may reduce the incidence of contralateral breast neoplasms (invasive and noninvasive) from 0.8% per year to 0.4% per year and the ipsilateral invasive breast cancer with 2% at 5 years.

Chemotherapy is thought to be inefficient in treating this type of noninvasive breast cancer and the role of hormonal therapy in this matter is currently being researched.

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