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Oct 6, 2016 11:56AM
Oct 6, 2016 11:57AM
LAstar, you've hit on what I've considered for 11 years to be one of the biggest mysteries.
It's pretty much agreed that something in the range of 90% of all cases of IDC develop from DCIS, and it's very common to find small amounts of DCIS in the pathology of women diagnosed with IDC (often it's listed as an incidental finding on the pathology report and is never even discussed with or mentioned to the patient). Similarly, women who have large amounts of DCIS, particularly if it is high grade, are at significant risk (as high as 40%, from some reports I've read) to be found to also have a very tiny area of IDC (often just a microinvasion or something just a bit larger).
So why is it that:
- in some cases, a tiny amount of DCIS initially develops but then almost immediately evolves to become IDC and the cancer develops from that point forward as IDC
- in other cases, DCIS develops and continues to spread through the ductal system as DCIS, but somewhere in the middle of all that DCIS, a tiny area of IDC develops - but doesn't continue to spread as IDC.
I think that there must be something biologically different between these two very common development patterns of breast cancer, even though both include DCIS and IDC, and both almost certainly started as DCIS. In one case, the patient might end up with 1.8cm of IDC and 2mm of DCIS, whereas in the other case, she might end up with 7+cm of DCIS and 1mm of IDC (as in my case).
I have bookmarked dozens of studies that look at different theories of what biological/molecular factors might cause some cases of DCIS to evolve to become invasive cancer, while other cases of DCIS don't ever develop beyond DCIS, but I have never seen any study that attempts to explain these two different patterns of DCIS to IDC development.
“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke