Treatment of Infiltrating Mammary Carcinoma with High-Grade DCIS and Negative Lymph Nodes

Introduction to Treatment Considerations

The National Comprehensive Cancer Network recommends adjuvant systemic therapy with chemotherapy followed by endocrine therapy for patients with infiltrating mammary carcinoma and high-grade DCIS, even with negative lymph nodes, to reduce the risk of recurrence and improve survival 1, 2

Post-mastectomy radiation therapy should be strongly considered for patients with high-grade disease and suspicious lymphatic invasion, even with negative lymph nodes, as recommended by the National Comprehensive Cancer Network 1, 2
Radiation therapy to the chest wall with consideration of regional nodal irradiation may reduce locoregional recurrence in patients with negative axillary nodes but high-risk features, such as grade 3 histology and lymphovascular invasion, according to the National Comprehensive Cancer Network 1, 3
The MA.20 trial showed that regional nodal irradiation improved 10-year disease-free survival in patients with high-risk node-negative disease, including those with grade 3 histology, as reported by the National Comprehensive Cancer Network 1

The National Comprehensive Cancer Network recommends adjuvant chemotherapy for patients with grade 3 disease, which is considered high-risk even with negative nodes 2, 4
Chemotherapy should be administered before radiation therapy when both are indicated for patients who have undergone mastectomy, as recommended by the National Comprehensive Cancer Network 2, 3
If the tumor is estrogen receptor (ER) and/or progesterone receptor (PR) positive, adjuvant endocrine therapy is recommended by the National Comprehensive Cancer Network 2, 4
For HER2-positive tumors, trastuzumab should be added to the treatment regimen for a total of one year, as recommended by the National Comprehensive Cancer Network 2, 4

Determining receptor status (ER, PR, HER2) is critical for treatment planning, according to the National Comprehensive Cancer Network and the European Society for Medical Oncology 6, 7
For hormone receptor-positive disease, adjuvant chemotherapy followed by endocrine therapy is recommended for tumors larger than 1 cm, as suggested by the National Comprehensive Cancer Network 1, 2
For HER2-positive disease, adding trastuzumab to the chemotherapy regimen is strongly recommended by the National Comprehensive Cancer Network 1, 2

The National Comprehensive Cancer Network recommends interval history and physical exam every 4-6 months for 5 years, then every 12 months, as well as annual mammography of the contralateral breast 5
For patients on tamoxifen, annual gynecologic assessment is recommended if the uterus is present, according to the National Comprehensive Cancer Network 5
For patients on aromatase inhibitors, monitoring of bone health with bone mineral density determination at baseline and periodically thereafter is recommended by the National Comprehensive Cancer Network 5

Maintaining an active lifestyle and ideal body weight (BMI 20-25) may lead to optimal breast cancer outcomes, as suggested by the National Comprehensive Cancer Network 5