Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

The two faces of autophagy and the pathological underestimation of DCIS

Nature Reviews Cancer volume 11, page 618 (2011)Cite this article

Subjects

We read with great interest the Opinion article (What is the malignant nature of human ductal carcinoma in situ? Nature Rev. Cancer 11, 68–75 (2011)) by Espina and Liotta1, in which the authors present the current knowledge on potential survival mechanisms of ductal carcinoma in situ (DCIS) cells, propose a novel strategy for killing DCIS cells and introduce an ongoing neoadjuvant therapy trial. However, several important issues related to the anti-autophagy therapy for DCIS need further discussion.

As it seems that we need to avoid anti-autophagy treatment in invasive breast cancer to prevent cancer progression, the question is therefore, how can we determine that a patient has only DCIS rather than an invasive component of, or even frank, IDC? DCIS with an invasive component is common. We have previously shown that among 550 DCIS cases, 49.3% were pure DCIS, 12.2% were DCIS with microinvasion and 38.5% had an invasion component that exceeded microinvasion5. Many DCIS cases that were initially diagnosed by core-needle biopsy (CNB) have proved to be IDC. Compared with open surgical biopsy, CNB is reported to be safer and more cost-effective; however, it has an inherent problem of sampling error, which contributes to a significant DCIS underestimation rate of about 26%6. High-grade lesions at CNB, and lesion size of larger than 20 mm at imaging, are significantly associated with greater odds of invasive carcinoma after definitive surgery6. Regarding the neoadjuvant preventing invasive neoplasia with chloroquine (PINC) trial, which examines the safety and effectiveness of chloroquine administration to patients with DCIS1, a certain proportion of patients diagnosed with DCIS using CNB will probably have an invasive component. Those underestimated cases are not good candidates for treatment using the anti-autophagy strategy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Differing autophagy effects and survival mechanisms of ductal carcinoma in situ (DCIS) and microinvasive or invasive ductal carcinoma (IDC).

References

  1. Espina, V. & Liotta, L. A. What is the malignant nature of human ductal carcinoma in situ? Nature Rev. Cancer 11, 68–75 (2011).

    Article  CAS  Google Scholar 

  2. Mathew, R. & White, E. Autophagy in tumorigenesis and energy metabolism: friend by day, foe by night. Curr. Opin. Genet. Dev. 21, 113–119 (2011).

    Article  CAS  Google Scholar 

  3. Chen, N. & Karantza, V. Autophagy as a therapeutic target in cancer. Cancer Biol. Ther. 11, 157–168 (2011).

    Article  Google Scholar 

  4. Mathew, R. et al. Autophagy suppresses tumorigenesis through elimination of p62. Cell 137, 1062–1075 (2009).

    Article  CAS  Google Scholar 

  5. Yu, K. D. et al. Different distribution of breast cancer subtypes in breast ductal carcinoma in situ (DCIS), DCIS with microinvasion, and DCIS with invasion component. Ann. Surg. Oncol. 18, 1342–1348 (2011).

    Article  Google Scholar 

  6. Brennan, M. E. et al. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology 260, 119–128 (2011).

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ke-Da Yu and Zhi-Ming Shao are at the Department of Breast Surgery, and the Department of Oncology, Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai 200032, China, as well as the Institutes of Biomedical Science, Fudan University, Shanghai 200032, China.,

    Ke-Da Yu & Zhi-Ming Shao

Authors
  1. Ke-Da Yu
    View author publications

    Search author on:PubMed Google Scholar

  2. Zhi-Ming Shao
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Zhi-Ming Shao.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yu, KD., Shao, ZM. The two faces of autophagy and the pathological underestimation of DCIS. Nat Rev Cancer 11, 618 (2011). https://doi.org/10.1038/nrc2950-c1

Download citation

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/nrc2950-c1

Search

Advanced search

Quick links

Nature Briefing: Cancer

Sign up for the Nature Briefing: Cancer newsletter — what matters in cancer research, free to your inbox weekly.

Get what matters in cancer research, free to your inbox weekly. Sign up for Nature Briefing: Cancer