Background: DCIS, LCIS and the challenge of progression
Screening programs in the UK aim to catch cancers early, but many women are found to have ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS) — pre-invasive changes that may or may not become invasive cancer. Clinicians have long sought tools to predict which cases will progress, to guide treatment decisions without over-treating patients.
The study and its findings
Researchers at King’s College London conducted a study involving more than 2,000 UK women who had DCIS or LCIS and were tested for 313 genetic changes, forming a genetic risk score for breast cancer. Funded by Breast Cancer Now and published in Cancer Epidemiology, Biomarkers & Prevention, the study found that the genetic risk score was associated with a higher likelihood of developing invasive breast cancer in the future. This marks a first where such a score is connected to progression risk in pre-invasive breast conditions.
What this could mean for care
Currently, care for DCIS/LCIS patients ranges from increased surveillance to invasive treatments such as surgery, radiotherapy and anti-estrogen therapy. The genetic risk score could help tailor treatment by identifying those at higher risk of progression, enabling more personalized and potentially less aggressive management for individuals at lower risk.
Expert voices
Jasmine Timbres, the study’s first author, explains that predicting who is most likely to develop invasive breast cancer is essential for offering the best possible options. Professor Elinor Sawyer, senior author and Consultant Clinical Oncologist at King’s College London, notes that combining genetic risk with the cellular appearance of the tissue and lifestyle factors can provide a fuller picture of recurrence risk. Dr. Simon Vincent, Chief Scientific Officer at Breast Cancer Now, says the work could guide future personalized care, though more research is needed before this testing becomes routine practice.
Implications and next steps
The prospect of integrating a genetic risk score into clinical workflows points toward a future of more individualized care for DCIS/LCIS patients. While the findings are promising, experts caution that additional studies are needed to validate the approach and determine how best to apply it alongside existing pathology and patient preferences. The goal is to improve decision-making, optimize wellbeing, and reduce unnecessary treatments.
Conclusion
Breast cancer is the most common cancer among women in the UK, with around 55,000 new cases each year. Being able to predict who among those with pre-invasive changes might develop invasive disease could transform treatment planning and patient experience, helping clinicians balance effective prevention with quality of life.
