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 benefits and risks of treatments.
The treatment for DCIS is not “one-size fits all.” Because of this, we suggest that you obtain as much information as possible. It is important to discuss the pros and cons of each treatment option. This should be done with your family, friends, and doctors. You may want a second opinion to help you to make your decision. This is especially important if you do not clearly understand all the options.
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 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 (DCIS is non-invasive).
Surgery is usually 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 discuss all treatment options with your doctor. There may be physical, emotional and psychological side effects of treatment. These may include bruising, bleeding, pain and changes to the look and feel of your breasts. These side effects may have an impact on your daily life. For more information about surgery please visit breastcancer.org.
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. For more information about mastectomy please visit breastcancer.org.
A lumpectomy is a form of breast-conserving surgery. It removes only the breast tissue with the DCIS. As much of the unaffected breast as possible is left. A small amount of healthy, normal tissue around the DCIS is also removed. This is to make sure that this area is clear of any abnormal cells. This is called a clear margin. For more information about lumpectomy please visit breastcancer.org.
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. For more information about breast reconstruction please visit breastcancer.org.
Radiation therapy may be offered to women for several weeks 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 it can only be done once. This is important in case breast cancer develops in the future. Radiation side effects may include burns to the skin and changes in the texture of the breast.
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 medicines may be considered based on a patient’s age and menopausal status. If one medicine does not work, a different one may be recommended.
Tamoxifen is recommended for women who still have monthly periods (premenopausal). It may also be given to women who have finished their monthly periods (postmenopausal). Tamoxifen works by blocking hormones to prevent the growth of cancer cells.
Raloxifene is a medication that is related to tamoxifen. It is only recommended for postmenopausal women. It works to prevent cancer, like tamoxifen does. However, it has fewer side effects. It also has the added benefit of strengthening the bones. This is important for women with thinning bones (osteoporosis) to consider.
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.
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 Study (Comparison of Operative to Monitoring and Endocrine Therapy for low-risk DCIS). You can find additional information about the study here.