Skip to main content

Advertisement

SpringerLink
Log in

Evaluating the Risk of Upstaging HER2-Positive DCIS to Invasive Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Overexpression of human epidermal growth factor 2 (HER2) in invasive breast cancer (IBC) is an independent poor prognostic factor. However, the significance of HER2 overexpression in ductal carcinoma in situ (DCIS) is not well defined. The current study assessed the correlation of HER2+ DCIS with the rate of upstaging to IBC on the final pathology.

Methods

The study retrospectively analyzed patients with the diagnosis of DCIS on core needle biopsy (CNB) at the authors’ institution from 2009 to 2016. Data were analyzed using two-sample t tests. Multivariate analysis was performed using logistic regression.

Results

The study found that HER2+ DCIS had significantly higher rates of upstaging to IBC than HER2− DCIS (odds ratio [OR] 1.89; p = 0.012). In addition, triple-positive disease was more than two times more likely to be upstaged (OR 2.5; p = 0.01), whereas patients with estrogen (ER)-positive, progesterone (PR)-positive, and HER2− diseases were half as likely to be upstaged (OR 0.5; p = 0.04). Upstaging did not differ for patients with triple-negative disease (OR 0.89; p = 0.8). Additionally, patients with HER2+ DCIS were significantly younger regardless of ER/PR status (p = 0.03). The overexpression of HER2 in patients with an initial diagnosis of DCIS on CNB were twice as likely to have IBC on the final pathology as those who did not.

Conclusion

The results suggest that overexpression of HER2 may serve as a biomarker for risk stratification of patients with DCIS and may help to guide treatment strategies in the future. For institutions in which HER2 testing may be performed on DCIS, patients should be counseled appropriately about the risk of upgrade to IBC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A. Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin. 2016;66:31–42. doi:10.3322/caac.21320.

    Article  PubMed  Google Scholar 

  2. Curigliano G, Disalvatore D, Esposito A, Pruneri G, Lazzeroni M, Guerrieri-Gonzaga A, et al. Risk of subsequent in situ and invasive breast cancer in human epidermal growth factor receptor 2-positive ductal carcinoma in situ. Ann Oncol. 2015;26:682–7. doi:10.1093/annonc/mdv013. Epub 18 January 2015.

    Article  CAS  PubMed  Google Scholar 

  3. Han K, Nofech-Mozes S, Narod S, Hanna W, Vesprini D, Saskin R, et al. Expression of HER2neu in ductal carcinoma in situ is associated with local recurrence. Clin Oncol R Coll Radiol. 2012;24:183–9. doi:10.1016/j.clon.2011.09.008. Epub 2011 Sep 29.

    Article  CAS  PubMed  Google Scholar 

  4. Liao N, Zhang GC, Liu YH, Li XR, Yao M, Xu FP, et al. HER2-positive status is an independent predictor for coexisting invasion of ductal carcinoma in situ of the breast presenting extensive DCIS component. Pathol Res Pract. 2011;207:1–7. doi:10.1016/j.prp.2010.08.005. Epub 20 November 2010.

    Article  CAS  PubMed  Google Scholar 

  5. Roses RE, Paulson C, Sharma A, Schueller JE, Nisenbaum H, Weinstein S, et al. HER-2/neu overexpression as a predictor for the transition from in situ to invasive breast cancer. Cancer Epidemiol Biomarkers Prev. 2009;18(5):1386–9.

  6. Meijnen P, Peterse JL, Antonini N, et al. Immunohistochemical categorisation of ductal carcinoma in situ of the breast. Br J Cancer. 2008;98:137–42.16.

  7. Tamimi RM, Baer HJ, Marotti J, et al. Comparison of molecular phenotype of ductal carcinoma in situ and invasive breast cancer. Breast Cancer Res. 2008;10:R67.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Latta EK, Tjan S, Parkes RK, O’Malley FP. The role of HER2/neu overexpression/amplification in the progression of ductal carcinoma in situ to invasive carcinoma of the breast. Mod Pathol. 2002;15:1318–25.

    Article  CAS  PubMed  Google Scholar 

  9. Schuetz CS, Bonin M, Clare SE, et al. Progression-specific genes identified by expression profiling of matched ductal carcinomas in situ and invasive breast tumors, combining laser capture microdissection and oligonucleotide microarray analysis. Cancer Res. 2006;66:5278–86.

    Article  CAS  PubMed  Google Scholar 

  10. Castro NP, Osorio CA, Torres C, et al. Evidence that molecular changes in cells occur before morphological alterations during the progression of breast ductal carcinoma. Breast Cancer Res. 2008;10:R87.25.

    Google Scholar 

  11. Ma XJ, Salunga R, Tuggle JT, et al. Gene expression profiles of human breast cancer progression. Proc Natl Acad Sci USA. 2003;100:5974–79.26.

    Google Scholar 

  12. Abba MC, Sun H, Hawkins KA, et al. Breast cancer molecular signatures as determined by SAGE: correlation with lymph node status. Mol Cancer Res. 2007;5:881–90.27.

    Google Scholar 

  13. Hosseini H, Obradović MM, Hoffmann M, et al. Early dissemination seeds metastasis in breast cancer. Nature. 2016. doi:10.1038/nature20785.

  14. Narod SA, Iqbal J, Giannakeas V, et al. Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol. 2015;1:888–96. doi:10.1001/jamaoncol.2015.2510.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. The Rena Rowan Breast Center, Abramson Cancer Center and the Department of Surgery, Division of Endocrine and Oncologic Surgery, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Rose E. Mustafa MD, Joey Bahng MS, Kahyun Yoon-Flannery DO MPH, Carla S. Fisher MD, Paul J. Zhang MD & Julia Tchou MD PhD

  2. Department of Surgery, Mercy Catholic Medical Center, Darby, PA, USA

    Lauren M. DeStefano MD

  3. Department of Surgery, Moffitt Cancer Center, Tampa, FL, USA

    Brian J. Czerniecki MD PhD

  4. Department of Oncology, Jupiter Medical Center, Margaret Neidland Breast Center, Jupiter, FL, USA

    Lucy M. De La Cruz MD

Authors
  1. Rose E. Mustafa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lauren M. DeStefano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joey Bahng MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kahyun Yoon-Flannery DO MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carla S. Fisher MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul J. Zhang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Julia Tchou MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Brian J. Czerniecki MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lucy M. De La Cruz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lucy M. De La Cruz MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mustafa, R.E., DeStefano, L.M., Bahng, J. et al. Evaluating the Risk of Upstaging HER2-Positive DCIS to Invasive Breast Cancer. Ann Surg Oncol 24, 2999–3003 (2017). https://doi.org/10.1245/s10434-017-5941-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-017-5941-0

Keywords

Search

Navigation