By Kelly Hsu
What is DCIS?
Ductal carcinoma in situ (DCIS) refers to when cells in the breast duct become cancer cells. This is also known as “stage zero” breast cancer. DCIS is a very early stage of cancer and as a result it is considered to be highly treatable. It is also non-invasive, as the cancerous cells have not spread to other tissue areas in the body.
DCIS does not usually present with noticeable symptoms. Though uncommon, some patients have reported experiencing discharge from the nipples or feeling a lump in the breast. Detection and diagnoses have increased since the increased implementation of routine mammogram screenings. Today, DCIS accounts for between 20-25% of breast cancer diagnoses [1].
DCIS and Risk
DCIS itself is not life-threatening, but the main concern is that if left untreated, it could progress into invasive breast cancer, meaning stage 1 or higher invasive ductal carcinoma (IDC). Individuals with DCIS have a higher-than-average risk of developing IDC, but there is not enough information to accurately predict which cases will progress and which will not.
To this day, it is controversial among researchers about whether to consider DCIS as a “real” cancer and recommend treatment, versus recommending less-invasive measures such as active surveillance. However, there is agreement that more research on biomarkers (specific molecules or characteristics in the body that can help give more specific information about a disease) is necessary in order to differentiate risk across cases and make more specific recommendations tailored to each individual patient [2, 3].
Evaluation and Treatment
Currently, almost all patients diagnosed with DCIS are treated [3]. There are a variety of treatment options for those with a DCIS diagnosis [4, 5, 6]:
Surgery
Breast-conserving surgery (BCS), or a lumpectomy, involves removing the local region of affected cells. This is often followed by radiation therapy (RT).
Breast-removing surgery, or a mastectomy, involves surgically removing all breast tissue. This may be followed with breast reconstruction surgery, and does not usually involve any RT.
Radiation therapy
Radiation therapy (RT) will often follow BCS as an adjuvant treatment, with the purpose of killing any remaining cells and reducing the recurrence rate.
Hormone therapy
If the DCIS shows estrogen or progesterone receptors, hormone therapy could be recommended as a treatment option. Examples of hormone therapies include tamoxifen (which blocks estrogen receptors) and aromatase inhibitors (which lowers estrogen levels for postmenopausal women). This treatment would not be given alone, but rather as an adjuvant treatment after a surgery.
Surgery and other therapies can be very effective, but are also invasive and do not come without risks. There are a multitude of active surveillance research trials, where researchers are evaluating whether there is a change in outcomes between those who receive medical treatment upfront for DCIS, versus those who do not, and instead, regularly check in with their clinical team for routine examinations and imaging. The results of these studies may help clinicians better understand if it is possible for certain patients with DCIS to avoid surgery [5].
If you or a loved one have been diagnosed with DCIS, be sure to speak to your healthcare provider to see what options are available, as well as the pros and cons of these different options. Results currently show that with a timely diagnosis and appropriate treatment plan, survival outcomes for DCIS are very high, with a 10-year breast cancer-specific survival rate of about 98% [7].
Treatment routes can also be very specifically tailored to each individual based on important and unique factors such as their disease type, overall health status, age, and personal preferences. Together, your healthcare team can help you figure out what management option is the best fit for you.
Learn More:
References:
Tomlinson-Hansen, S., Khan, M., & Cassaro, S. (2023). Breast Ductal Carcinoma in Situ. In StatPearls. StatPearls Publishing.
American Association for Cancer Research. (2023, January 4). Research updates. Leading Discoveries Magazine. https://leadingdiscoveries.aacr.org/research-updates-9/
Schmitz, R. S. J. M., Wilthagen, E. A., van Duijnhoven, F., van Oirsouw, M., Verschuur, E., Lynch, T., Punglia, R. S., Hwang, E. S., Wesseling, J., Schmidt, M. K., Bleiker, E. M. A., Engelhardt, E. G., & Grand Challenge Precision Consortium (2022). Prediction Models and Decision Aids for Women with Ductal Carcinoma In Situ: A Systematic Literature Review. Cancers, 14(13), 3259.
Mayo Foundation for Medical Education and Research. (2022, May 18). Ductal carcinoma in situ (DCIS). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/dcis/diagnosis-treatment/drc-20371895
Grimm, L. J., Rahbar, H., Abdelmalak, M., Hall, A. H., & Ryser, M. D. (2021). Ductal carcinoma in situ: State-of-the-art review. Radiology, 302(2), 246–255.
Van Seijen, M., Lips, E. H., Thompson, A. M., Nik-Zainal, S., Futreal, A., Hwang, E. S., Verschuur, E., Lane, J., Jonkers, J., Rea, D. W., Wesseling, J., & PRECISION team (2019). Ductal carcinoma in situ: to treat or not to treat, that is the question. British journal of cancer, 121(4), 285–292.
Elshof, L. E., Schmidt, M. K., Rutgers, E. J. T., van Leeuwen, F. E., Wesseling, J., & Schaapveld, M. (2018). Cause-specific Mortality in a Population-based Cohort of 9799 Women Treated for Ductal Carcinoma In Situ. Annals of surgery, 267(5), 952–958.
Author bio: Kelly Hsu
I am a recent graduate of Wellesley College (Class of ‘21), where I studied neuroscience. I am currently working as a Clinical Research Coordinator at the Massachusetts General Hospital Cancer Center on several patient-centered outcomes research studies. Through my experiences, I have developed passions for health education, psychosocial oncology, and palliative care. I plan to attend medical school next fall, where I hope to keep pursuing these interests.
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