Choosing the best treatment for DCIS is often very difficult. You may feel uncertain, confused, or anxious when considering treatment options. You may receive complex and conflicting information from medical experts. It is important to be informed about the potential benefits and risks of treatments.
DCIS is not invasive breast cancer, and does not spread to other parts of the body. However, it is almost always treated as if it is, with surgery and radiation therapy. Treatment may also include endocrine (hormone-blocking) therapy. As these treatments are the same as those used for invasive breast cancer, there is concern about overtreatment of DCIS. Chemotherapy is not recommended for DCIS.
The treatment for DCIS is not “one-size fits all.” It is important to take your time and obtain as much specific information about your particular kind of DCIS as possible. This information is found on your pathology report. It is also important to understand the pros and cons of each treatment option and consider the potential short and long-term benefits and risks of each treatment. In addition to your doctor, a support team is important to help you gather and understand information about the different kinds of DCIS and potential clinical trials. You may want a second opinion from various specialists such as a pathologist, an oncologist or a breast surgeon. This is especially important if you feel frightened or pressured into making decisions quickly.
Surgery may be advised within a few weeks of diagnosis. Despite this, you should not feel rushed into any major procedures. This is especially true if your diagnosis is low-risk DCIS. It is important to fully understand the potential risks and benefits of all treatment options and feel comfortable discussing your questions and concerns with your doctor. There may be physical, emotional and psychological side effects of treatment including bruising, bleeding, pain and changes to the look and feel of your breasts. Side effects and financial costs may have an impact on your daily life.
A mastectomy is surgery which usually removes all breast tissue. It may be recommended if radiation therapy is not possible, for example, in pregnant women or women who have had previous radiation. Mastectomy may be suggested if there are several areas of DCIS in the breast. It may also be suggested if there is a lot of DCIS within the breast. No radiation is needed since the entire breast is removed. If you choose a mastectomy, you reduce your risk of future breast cancer; however, a recent study showed there is no survival benefit for women with low grade DCIS who have surgery compared to women who had no surgery (Resource: https://www.ncbi.nlm.nih.gov/pubmed/26039049).
A lumpectomy is also known as “breast-conserving surgery.” It removes only the area of breast tissue with the DCIS that is seen on imaging (such as a mammogram or MRI). A small amount of healthy, normal tissue around the DCIS will also be removed to make sure that the area with DCIS is clear of any abnormal cells. This is called a clear margin.
If a mastectomy is performed, breast reconstruction can also be performed. This can either be at the same time or at a later date. Breast reconstruction is a type of plastic surgery that re-builds the breast.
Radiation therapy may be offered to women following surgery. However, it may not be necessary for women with low-risk DCIS. Whether or not to have radiation therapy can often be a hard decision. It may provide peace of mind by lowering the chance of a future breast condition, but there is no survival benefit associated with radiation therapy for DCIS. It is important to note that radiation therapy can only be done once which is a consideration in case invasive breast cancer develops in the future. Radiation side effects may include fatigue, burns to the skin and changes in the texture of the breast. Long-term effects of radiation therapy are not as well studied, but may increase the risk of secondary cancers and damage to the heart, lungs, thyroid and bones.
These treatments are not the same as chemotherapy or hormone replacement therapy. They are typically used for DCIS that responds to treatment that blocks hormones. Medication to control hormone levels may lower future risk. This includes a future DCIS or invasive breast cancer. However, benefits gained should be weighed against potential side effects. These may include hot flashes, joint pain, weight gain, bone changes, blood clots, and cancers. Different types of endocrine (hormone-blocking) therapy may be considered based on a patient’s age and menopausal status.
Tamoxifen is offered to both women who still have monthly periods (premenopausal) or to women who have finished their monthly periods (postmenopausal). Tamoxifen works by blocking hormones to prevent the growth of cancer cells.
Post-menopausal women may be given medicines called aromatase inhibitors. These medicines lower the amount of female hormones in the body. They are usually taken in pill form once a day. There are several different aromatase inhibitors that are similarly effective.
The best way to manage low-risk DCIS is still unknown. One of the newest management strategies is to monitor patients by active surveillance. This is typically not offered to most patients as it is not considered standard care. However, active surveillance is being studied as part of a clinical trial called the COMET (Comparison of Operative to Monitoring and Endocrine Therapy for low-risk DCIS) Study. You can find additional information about the study under the ‘COMET Study' tab of this site.
References for patients seeking more information on treatment options: