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Prognosis

Even though DCIS is noninvasive, it is associated with an increased risk for developing invasive breast cancer. Therefore, it should be treated. There are several factors that are considered to determine the best treatment for a specific woman. These factors have been classified in a system called the Van Nuys Prognostic Index (VNPI), developed in 1996 and then updated in 2003.

This index analyzes and calculates four main factors:

1. Age
2. Size of DCIS involvement
3. Grade of the DCIS
4. Width of the margins

Each of these four factors is given a score of 1 (low), 2 (medium), or 3 (high), as shown in the table below. The total of the four scores is the total VNPI score. The lowest possible score is 4 (4 times 1) and the highest is 12 (4 times 3). The higher the score, the more likely it is that the DCIS will recur.

Score	1	2	3
Size (mm)	less than or equal to 15	16 - 40	more than or equal to 41
Margin width (mm)/td	more than or equal to 10	1 - 9	less than or equal to 1
Pathologic classification	Non-high grade without necrosis (nuclear grades 1 or 2)	Non-high grade with necrosis (nuclear grades 1 or 2)	High grade with or without necrosis (nuclear grade 3)
Age (yrs)	>60	40 - 60	<40

Table from "The University of Southern California/Van Nuys prognostic index for ductal carcinoma in situ of the breast" by Melvin J. Silverstein, American Journal of Surgery, Volume 186, Issue 4, October 2003.

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What score would a woman who is 62 with a 10 mm size area of DCIS, with papillary subtype and 4 mm margins receive on the Van Nuys Prognostic Index for DCIS?