25568 Federal Register / Vol. 74, No. 101 / Thursday, May 28, 2009 / Notices 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

National Institutes of Health 

NIH State-of-the-Science Conference: 

Diagnosis and Management of Ductal 

Carcinoma In Situ (DCIS); Notice 

Notice is hereby given of the National 

Institutes of Health (NIH) State-of-theScience Conference: Diagnosis and 

Management of Ductal Carcinoma in 

Situ (DCIS) to be held September 22–24, 

2009, in the NIH Natcher Conference 

Center, 45 Center Drive, Bethesda, 

Maryland 20892. The conference will 

begin at 8:30 a.m. on September 22 and 

23, and at 9 a.m. on September 24, and 

will be open to the public. 

Ductal carcinoma in situ (DCIS) is a 

condition in which abnormal cells are 

found in the lining of a breast duct. As 

‘‘in situ’’ means ‘‘in place,’’ this means 

the abnormal cells have not spread 

outside the duct to other tissues in the 

breast. Also referred to as intraductal 

carcinoma and stage zero breast cancer, 

DCIS is the most common noninvasive 

tumor of the breast. 

DCIS is most often discovered during 

routine mammograms, presenting as 

very small specks of calcium known as 

microcalcifications. However, not all 

microcalcifications indicate the 

presence of DCIS, and the diagnosis 

must be confirmed by biopsy. Magnetic 

Resonance Imaging (MRI) has also been 

used more recently as a diagnostic tool, 

but questions remain about the impact 

of the test on patient outcomes. Since 

the implementation of screening 

mammography, the rate of new DCIS 

cases has increased dramatically. 

DCIS currently accounts for 

approximately twenty percent of 

screening-detected breast cancer, but its 

true prevalence is challenging to 

measure because nearly all affected 

individuals are asymptomatic. By most 

reports, the risk factors associated with 

the development of DCIS are similar to 

those for invasive breast cancer: 

increased age, family history of breast 

cancer, previous biopsies, history of 

hormone replacement therapy, and 

older age at first childbirth. Tamoxifen, 

a hormonal drug, has demonstrated a 

reduction in the incidence of DCIS 

among high-risk women. 

Although the natural course of the 

disease is not well understood, DCIS 

can become invasive cancer and spread 

to other tissues. It is also a marker of 

increased risk for developing cancer 

elsewhere in the same or opposite 

breast. However, not all DCIS will 

progress to invasive disease, and it is 

thought that DCIS can be present in 

some individuals without causing 

problems over a long period of time. 

Recent research suggests that DCIS is a 

spectrum of disease and that certain 

tumor characteristics may be strong or 

weak risk factors for subsequent 

invasive breast cancer. Unfortunately, it 

is currently not clear which lesion types 

are more likely to become invasive, 

leading to difficult treatment decisions 

for patients and providers. 

Because of this uncertainty, DCIS 

patients are typically treated promptly 

following diagnosis and have a 

generally good prognosis. Standard 

DCIS therapies include breast 

conservation, with or without radiation 

or mastectomy, depending on patient 

and tumor characteristics. Sentinel 

lymph node biopsy may also be 

recommended to high-risk patients 

since this is the area where cancer 

spread is often first detected. Hormonal 

therapy may also be used in an effort to 

prevent DCIS recurrence and to lower 

the risk of developing invasive breast 

cancer. However, these drugs’ potential 

side effects must be weighed carefully. 

Since the natural course of DCIS is 

not well understood and treatment 

benefit may depend on specific tumor 

and patient characteristics, the 

treatment of DCIS remains controversial. 

To examine these important issues, the 

NIH National Cancer Institute and 

Office of Medical Applications of 

Research will convene a State-of-theScience Conference from September 22– 

24, 2009. The questions to consider 

include: 

• What are the incidence and 

prevalence of DCIS and its specific 

pathologic subtypes, and how are 

incidence and prevalence influenced by 

mode of detection, population 

characteristics, and other risk factors? 

• How does the use of MRI or sentinel 

lymph node biopsy impact important 

outcomes in patients diagnosed with 

DCIS? 

• How do local control and systemic 

outcomes vary in DCIS based on tumor 

and patient characteristics? 

• In patients with DCIS, what is the 

impact of surgery, radiation, and 

systemic treatment on outcomes? 

• What are the most critical research 

questions for the diagnosis and 

management of DCIS? 

An impartial, independent panel will 

be charged with reviewing the available 

published literature in advance of the 

conference, including a systematic 

literature review commissioned through 

the Agency for Healthcare Research and 

Quality. The first day and a half of the 

conference will consist of presentations 

by expert researchers and practitioners 

and open public discussions. On 

Thursday, September 24, the panel will 

present a statement of its collective 

assessment of the evidence to answer 

each of the questions above. The panel 

will also hold a press conference to 

address questions from the media. The 

draft statement will be published online 

later that day, and the final version will 

be released approximately six weeks 

later. The primary sponsors of this 

meeting are the NIH National Cancer 

Institute and the NIH Office of Medical 

Applications of Research. 

Advance information about the 

conference and conference registration 

materials may be obtained from 

American Institutes for Research of 

Silver Spring, Maryland, by calling 888– 

644–2667 or by sending e-mail to 

consensus@mail.nih.gov. The American 

Institutes for Research’s mailing address 

is 10720 Columbia Pike, Silver Spring, 

MD 20901. Registration information is 

also available on the NIH Consensus 

Development Program Web site at 

http://consensus.nih.gov. 

Please Note: The NIH has instituted 

security measures to ensure the safety of NIH 

employees, guests, and property. All visitors 

must be prepared to show a photo ID upon 

request. Visitors may be required to pass 

through a metal detector and have bags, 

backpacks, or purses inspected or x-rayed as 

they enter NIH buildings. For more 

information about the security measures at 

NIH, please visit the Web site at http:// 

www.nih.gov/about/visitorsecurity.htm. 

Dated: May 20, 2009. 

Lawrence A. Tabak, 

Acting Deputy Director, National Institutes 

of Health. 

[FR Doc. E9–12376 Filed 5–27–09; 8:45 am] 

BILLING CODE 4140–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Health Resources and Services 

Administration 

Recruitment of Sites for Assignment of 

Corps Personnel Obligated Under the 

National Health Service Corps Loan 

Repayment Program (ARRA and FY 

2010) 

AGENCY: Health Resources and Services 

Administration (HRSA), HHS. 

ACTION: General notice. 

SUMMARY: Under the American Recovery 

and Reinvestment Act of 2009 (ARRA), 

additional funds are available to expand 

the National Health Service Corps 

(NHSC) through its programs to provide 

access to, and improve quality of, 

primary health care for millions of 

underserved Americans. The HRSA is