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Ductal Carcinoma in Situ (DCIS)

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Ductal carcinoma in situ (DCIS) is a condition that affects the cells of the milk ducts in the breast. The cells lining the milk ducts turn malignant (cancerous) but stay in place (in situ). DCIS is an early form of breast cancer. It is not invasive — the malignant cells do not grow through the wall of the duct or spread to lymph nodes or the blood stream.

Bonnie Sun, M.D., of Johns Hopkins’ breast center, provides perspective:

Ductal Carcinoma In Situ (DCIS) — What You Need to Know

  • DCIS accounts for about 20% of breast cancers.
  • The condition does not usually cause symptoms but can show up on a mammogram, typically as microcalcification clusters.
  • DCIS can be treated with surgery, sometimes with radiation and medicine. Chemotherapy is not needed.
  • With timely diagnosis and treatment, patients can expect a good outcome.

What are DCIS symptoms?

Ductal carcinoma in situ does not have specific symptoms such a lump or breast pain. “Most cases are diagnosed in a mammogram before causing any symptoms,” Sun says. DCIS most commonly shows up on a mammogram as new calcium deposits, but not always — sometimes, a distortion of the breast tissue on the scan can be a sign of DCIS.

Once the cancerous cells start to invade the milk duct, you might notice itching or ulceration (formation of a sore).

Sun notes that DCIS can occur in men, and since they do not get regular screening mammograms as a rule, the problem can show up as a bloody nipple discharge or lump.

A lump in the breast of a woman or a man can be invasive cancer and should be checked by a doctor right away.

How is DCIS diagnosed?

If a doctor sees the calcifications on your mammogram, he or she will recommend more tests, which could include a breast biopsy. During the biopsy, a doctor or other health care provider takes samples of cells or tissues from your body. The cells are examined by a pathologist — a doctor who checks for signs of disease in body tissues. The pathologist looks at the cells under a microscope to see if cancer is present.

A particular kind of biopsy called a stereotactic core needle biopsy can diagnose DCIS. This is a nonsurgical, outpatient procedure. After giving you medicine to numb the breast area, the doctor or technologist collects cells from the area of concern using a needle guided by mammography.

Lessening the wait time can reduce stress

Waiting for results can be stressful, and advanced breast centers keep that in mind and try to minimize the time between testing and results.

“At Johns Hopkins, we are sensitive to the anxiety a possible diagnosis of DCIS creates for our patients,” Sun says. “If the radiologist who read your mammogram suspects you have DCIS, he or she will arrange for you to have a stereotactic biopsy as soon as possible.” Biopsy results are usually returned in about a week.

What is the treatment for DCIS?

Lumpectomy with radiation. The standard treatment is breast-preserving surgery (a lumpectomy) with radiation therapy, which results in successful outcomes for most patients. Cancers can be larger than expected, so about 20% of the time, patients need a re-excision lumpectomy — another surgery — to remove all of the cancer. Typically, the remaining breast will then have radiation therapy to reduce the risk of local recurrence. Lumpectomy plus radiation is a good alternative to mastectomy for treatment of DCIS.

Mastectomy. Some patients have ductal carcinoma in situ in more than one quadrant of the same breast (multicentric breast disease). Sometimes, the DCIS is very large relative to the patient’s breast size. In these situations, a mastectomy (with or without immediate reconstruction) is required to address malignant cells that are more widespread. Radiation therapy is not needed for DCIS treated with mastectomy.

Chemotherapy. Chemotherapy is not needed for DCIS since the disease is noninvasive.

Hormonal (endocrine) therapy. Hormonal (endocrine) therapy may be appropriate for those whose ductal carcinoma in situ is hormone receptor positive.

What should I expect after a DCIS diagnosis?

The outlook after DCIS diagnosis, Sun says, is encouraging. “With continued, rigorous monitoring, the prognosis for DCIS is excellent,” she explains. “Your doctor will recommend a regular screening schedule to guard against recurrence in the original breast, and to monitor the other breast for any signs of malignancy.

“Our expectation is for a complete resolution of the problem with proper treatment. This is a local disease and treatment by surgery can be sufficient. Chemotherapy isn’t necessary, and in some cases, hormone medication and radiation aren’t either.”

Will DCIS return or spread?

  • Since DCIS is a noninvasive form of cancer, it does not spread throughout the body (metastasize).
  • For patients having a lumpectomy with radiation, the risk of local recurrence ranges from 5% to 15%.
  • For those having mastectomy, the risk of local recurrence is less than 2%. Patients who receive hormonal therapy after surgery further reduce their risk of recurrence by half.
  • Breast cancer may develop in the patient’s other breast, but only in about 5% of cases. If this happens, the cancer in the second breast is not considered a recurrence, but a new primary breast cancer. It can also be a different type of breast cancer.

Surgery can reveal additional cancer

There is a small possibility that invasive cancer will be found during the final pathology examination after surgical removal of DCIS. When that happens,” Sun says, “the diagnosis would be upgraded and additional surgery and other treatments may be needed. We take each situation individually and the most optimal treatment will be tailored. This is important because each tumor and each patient is different.”

She notes that at Johns Hopkins Medicine, the pathologists with whom she works are especially skilled in identifying any invasive cancer that might be present. “Having DCIS treated at a comprehensive breast center ensures you are in the best possible hands,” Sun says.

Moving On After DCIS

Sun emphasizes that quality of life is a very important aspect of breast cancer treatment. “Since many of our patients are successfully treated, we have many years of life to consider,” she says. “By empowering and educating our patients and making treatment plans together, our aim is to minimize any regrets about treatment decisions. We want our patients to feel healthy and happy after breast cancer treatment is finished.”

How do I prevent DCIS?

“Get your mammograms on time,” says Sun. “Mammograms themselves do not prevent DCIS, but can catch it early. Early detection can mean a better outcome with less treatment.”

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