Ductal Carcinoma in Situ (DCIS) is non-invasive breast cancer. Because it is limited to being inside the duct of the breast, it is classified as being Stage 0.
Symptoms
DCIS has no accompanying symptoms. This form of breast cancer is found on a mammogram. The image of the breast appears as though it has microcalcifications that are irregular in shape (versus spherical) and are clustered tightly together. That cluster could be DCIS or ADH, so a biopsy is recommended. There are some cases where microcalcifications could also be an invasive breast cancer.
Diagnosis
We are sensitive to the anxiety a possible diagnosis of breast cancer creates for our patients. If the radiologist who read your mammogram suspects you have DCIS, he or she will arrange for you to have a stereotactic biopsy. The biopsy can sometimes be done the same day, but is always done within a week. On the day of your breast biopsy, you will be given the probability that the biopsy is a breast cancer. Firm confirmation will follow within 24 hours.
Treatment
- Lumpectomy with radiation therapy. Most patients have great success rates having a lumpectomy and radiation treatment, or breast conserving.
- Mastectomy. Some women have extensive DCIS occupying several ducts and quadrants of the breast (known as extensive DCIS), or the noninvasive breast cancer is found at several areas throughout the breast, known as multicentric breast disease. For women with this presentation of the cancer, their physician may recommend a mastectomy as the surgical treatment instead of a lumpectomy.
- Chemotherapy. Chemotherapy is not needed for DCIS, since the disease is noninvasive.
- Hormonal Therapy. Hormonal therapy may be recommended if the cancer has a prognostic factor of being hormone receptor positive.
What is The Prognosis for DCIS?
Women with DCIS have an excellent prognosis. Our pathologists are thorough at identifying DCIS and strive to reduce the risk that any invasive cancer was missed.
It is important to maintain a rigorous screening schedule to monitor for local recurrence in the original breast and to monitor the healthy breast. By definition, there is no risk of distant recurrence since the cancer is noninvasive. For women having lumpectomy with radiation, the risk of local recurrence ranges from 5-15 percent. For women having mastectomy, the risk of local recurrence is less than 2 percent. Women who take hormonal therapy after surgery further reduce their risk of recurrence by half.
Breast cancer may develop in the woman's other breast, so careful monitoring is important. This happens only to about five percent of women diagnosed with breast cancer. If a cancer develops in the patient's other breast, it is not referred to as recurrence, but is a new primary breast cancer. It can also be a different type of breast cancer than the original cancer.