Professor of Surgery
Chief, Breast Surgical Oncology
Vice Chair of Research, Department of Surgery
Durham, North Carolina
Seeking to identify and test prognostic markers that can detect when pre-invasive cancer progresses to invasive disease.
Women enrolled in active surveillance (AS) program for pre-invasive (stage 0) breast cancer are studied to identify prognostic biomarkers correlated with progression to invasive disease.
This work could result in a paradigm shift that would allow surgery to be reserved only for patients with DCIS most likely to progress to invasive disease.
Widespread access to mammographic screening has resulted in more than a 5-fold increase in detection of ductal carcinoma in situ (DCIS) without a corresponding reduction in the incidence of node-positive or metastatic breast cancer. Active surveillance (AS) is a strategy to monitor early stage disease, reserving treatment when tests indicate the diseased has progressed.
AS is commonly used to manage diseases such as low-risk prostate cancer, and has been proposed to reduce overtreatment of DCIS. Although numerous prognostic markers have been developed for invasive cancer, no validated prognostic markers of invasive progression for DCIS have been developed to guide patient selection for AS.
Recently, the Hwang lab has assembled unique clinical cohorts and resources to study women undergoing AS. In the coming year, they will utilize these resources to establish and test a method to identify prognostic biomarkers for invasion in women with DCIS undergoing AS.
To do this, they will identify mutations in the tumor and surrounding normal tissue that are associated with DCIS progression to invasive cancer among women undergoing AS for DCIS. They are also looking at tumor immune responses and changes in radiologic features.
The overarching goal of these studies is to identify and test prognostic markers of invasive progression in DCIS. If successful, the work would result in a paradigm shift that would allow surgery to be reserved only for patients with DCIS with the greatest tendency for invasive progression. Results will also increase our understanding of the relationship between DCIS and coexisting invasive cancer.
Dr. Shelley Hwang, MD, MPH is a Professor of Surgical Oncology, Vice Chair of Research and Chief of Breast Surgery for the Duke Department of Surgery and the Duke University Comprehensive Cancer Center. Her research focus includes breast cancer prevention, identifying less invasive treatments for early stage breast cancers including ductal carcinoma in situ (DCIS), and understanding the genetic and stromal determinants of cancer progression. Dr. Hwang is an experienced clinical trialist with an interest in both the biology and treatment early stage breast cancer including DCIS. She is lead investigator (PI) of a national cooperative group study through the ALLIANCE evaluating the role of preoperative systemic hormonal therapy for DCIS. She is also surgical PI of the Duke NCI National Clinical Trials Network, which promotes and oversees recruitment to cooperative group trials. She serve as a member of the National Cancer Institute Breast Cancer Steering Committee and the NCCN Screening Guidelines Committee. Other interests of the Hwang group include the evolutionary role of tumor and environmental heterogeneity in driving DCIS progression and the impact of the breast density, microenvironmental factors, and the stromal immune infiltrate in determining breast cancer phenotype and response to chemotherapy. Her team incorportates computational models of cancer progression, and have developed progression models for invasive breast cancer.