Jacky Luiten

General discussion and future perspectives | 135 9 4. Pathologic diagnostic criteria of DCIS DCIS grading is based on morphologic characteristics, such as growth pattern, cytoplasmic feature, nuclear pleomorphism and mitotic activity. Since diagnostic criteria are not always clear, differences in morphological interpretation make the accuracy of DCIS grading questionable. 66,67 Substantial inter ‐ and intra ‐ laboratory variations in DCIS grade are reported. 68 Consequently, histologic grading of DCIS is currently not meeting high enough standards. 68 Improvement of the accuracy is extremely relevant, when the management of DCIS becomes dependent on histologic grade in the near future. Grading is a prognostic factor based on histologic examination of a tissue sample. Another option might be predicting individual breast cancer risk factors by molecular genetic markers. 5. Molecular genetic profiling In recent years several studies have focused on identifying molecular genetic marker predicting the risk of personalized risk ‐ based breast cancer screening developing invasive carcinoma after DCIS. Molecular genetic markers in DCIS that might be associated with its aggressiveness are also subject of ongoing studies. 69,70 Earlier studies suggest that the genetic pathway of pure DCIS may be genetically different from DCIS associated with invasive carcinoma. 69 This implies that gene sequencing might help to distinguish between different sub ‐ types of DCIS. This will enable the classification of women into groups of varying risk of breast cancer, which in the future may result in the implementation of a and prevention program. 71 The Oncotype DX DCIS score is a multi ‐ gene assay, which might help to distinguish between DCIS grades and predicting the risk of invasive cancer development. 72,73 More research is needed to validate this promising technique and to evaluate the ability to identify high ‐ risk DCIS lesions. 6. Patients perceptive The PRISMA trial is currently investigating the added value of ‘personalized screening’. The success of the implementation of ‘personalized screening’ depends not only on healthcare professionals, but also on the women’s perception. Women’s interest in knowing their breast cancer risk is high, therefore more intensive screening for women with above average risk is generally welcomed. 74 ‐ 76 However, lowering the intensity of surveillance for low ‐ risk lesions could lead to anxiety in women as well as healthcare professionals. 75 Since healthcare professionals will