From the Guidelines
Hormone receptor-negative DCIS does not require adjuvant hormone therapy. The most recent and highest quality study, published in 2015 1, indicates that tamoxifen may be considered for ER-positive DCIS, but there is no mention of its use in hormone receptor-negative DCIS. This suggests that hormone-blocking medications would provide no benefit in hormone receptor-negative DCIS, as the cancer cells do not rely on hormones for growth and survival.
Key Points to Consider
- Hormone therapy is only beneficial for hormone receptor-positive breast cancers, where it can block the effects of estrogen that stimulate cancer growth.
- In hormone receptor-negative DCIS, the cancer cells lack estrogen and progesterone receptors, making hormone-blocking medications ineffective.
- Treatment for hormone receptor-negative DCIS typically involves surgery (lumpectomy or mastectomy), possibly followed by radiation therapy if a lumpectomy was performed.
- The hormone receptor status is determined through immunohistochemistry testing of the tissue sample obtained during biopsy or surgery, guiding this treatment decision.
Relevant Evidence
The 2015 study 1 provides guidance on the treatment of DCIS, including the use of tamoxifen in ER-positive cases, but does not support its use in hormone receptor-negative DCIS. Earlier studies, such as those from 2010 1 and 2009 1, also discuss the treatment of DCIS but do not provide evidence to support the use of adjuvant hormone therapy in hormone receptor-negative cases.
Clinical Implications
In clinical practice, the decision to use adjuvant hormone therapy should be based on the hormone receptor status of the DCIS, with tamoxifen or other hormone-blocking medications reserved for ER-positive cases. For hormone receptor-negative DCIS, treatment should focus on surgery and possibly radiation therapy, depending on the individual case.
From the Research
DCIS and Adjuvant Hormone Therapy
- DCIS (Ductal Carcinoma In Situ) that is hormone receptor-negative does not typically require adjuvant hormone therapy, as the cancer cells do not have receptors for hormones such as estrogen or progesterone 2, 3.
- Adjuvant hormone therapy is generally considered for patients with hormone receptor-positive DCIS, as it can help reduce the risk of recurrence 4, 5.
- The decision to use adjuvant hormone therapy should be made on a case-by-case basis, taking into account the individual patient's risk factors, tumor characteristics, and personal preferences 2, 5.
Factors Influencing Adjuvant Hormone Therapy Use
- The use of adjuvant hormone therapy in DCIS patients is influenced by factors such as estrogen receptor status, surgery type, and radiation use 3.
- Patients with hormone receptor-positive DCIS who undergo breast-conserving surgery and radiation are more likely to receive adjuvant hormone therapy 3.
- The use of adjuvant hormone therapy in patients with hormone receptor-negative DCIS is generally not recommended, as it is not effective in reducing the risk of recurrence 2, 3.
Current Approaches and Future Directions
- Current approaches to managing DCIS include breast-conserving surgery, radiation therapy, and adjuvant hormone therapy, with the goal of reducing the risk of recurrence and improving patient outcomes 5.
- Future directions in DCIS management may include the use of molecular profiling to stratify patients by risk and guide treatment decisions, as well as the development of new therapies and treatment strategies 5, 6.