Many people have never heard of DCIS, and it can be difficult for someone newly diagnosed to explain what it is. Below are answers to frequently asked questions that patients, friends and family may have.
DCIS stands for Ductal Carcinoma in Situ. You may see and hear low-risk DCIS being called different names such as: non-invasive breast cancer, stage zero breast cancer, pre-invasive or a precursor to invasive cancer, precancerous lesion, abnormal cells, and cancer. You might also hear that low-risk DCIS is not cancer at all. Some doctors say low-risk DCIS should not be called "cancer," while others believe the cells are a true early-stage cancer. There is not yet enough evidence to say for sure.
DCIS has the word carcinoma in its name because when viewed under the microscope, DCIS cells have qualities of cancer (carcinoma) cells. However, the cancer cells are confined ("in-situ"), they have not invaded outside the milk ducts. This is one of the reasons there is so much debate about DCIS.
Many people's first response to a diagnosis of any type of "cancer" is to want to remove or destroy it as quickly as possible. However, many years of research have shown that it is not a single entity. Some cancers do not grow rapidly; some do not grow at all. Cells labelled as "cancerous" when examined under a microscope can show behaviors in the body that range from rapidly invasive at one end of the spectrum to very slow-growing and confined at the other. While doctors agree that cancerous cells that show invasion under the microscope need to be removed by surgery or destroyed by radiation or other therapies, there is much more debate and disagreement about what to do with cancerous cells that are contained, such as DCIS in the milk ducts of the breast.
It is important to remember that a DCIS diagnosis is not an emergency and it is important to take time to learn about different treatment options to make decisions that feel right.
"Low-risk" includes low to intermediate grade DCIS. A pathologist will look at tissue taken during a biopsy to determine whether atypical cells resemble cancer cells or normal cells. They will also determine if the atypical cells are contained within the milk ducts of the breast. Using this information, they will determine if a woman has DCIS. It can sometimes be helpful to have the opinion of a second pathologist.
No. All DCIS is non-invasive. In other words, as long as cells remain in the ducts, they are not life threatening.
Most women have no signs, symptoms, lumps or tumors. Tiny white specks called "micro-calcifications" are seen by a radiologist (a specialist who studies x-rays) on mammogram. A needle biopsy is usually recommended to remove a piece of breast tissue that is then examined under a microscope by a pathologist (a physician who specializes in studying tissue). Mammograms and other imaging methods cannot diagnose DCIS. They are used to screen for possible DCIS. A needle or surgical biopsy is currently the only way a woman can be diagnosed with DCIS.
For many years, DCIS was considered to be a single condition. All grades of DCIS were treated the same as invasive breast cancer. Standard treatment for both invasive breast cancer and DCIS involves surgery with or without radiation, and sometimes endocrine (hormone-blocking) therapy. Click here to go to the section of this web site that provides further information.
Active monitoring is not currently available to women outside of a clinical trial. With active monitoring, you have a mammogram and a check-up with a clinician every six months. If no changes in the breast are seen, you stay on active monitoring and avoid surgery and its side-effects. If any changes in the breast are seen on a mammogram, they are explained to you at your visit. The doctor may recommend that you continue with active monitoring or have more tests, such as a biopsy, to investigate the changes. When you have the test results, you may be able to continue with active monitoring, or the results may indicate that you should undergo surgery and radiation therapy, if needed.
There is no need to rush. DCIS is not an emergency. It is important to understand your pathology report, which contains information about the type, grade and size of the DCIS. If you have a lumpectomy, consider asking your doctor about tests that can give you more understanding of your risk of recurrence. These tests can help you and your physician decide if radiation will benefit you. Evaluate the benefits and harms of each treatment.
Until now, no research has directly compared the outcomes of patients receiving different treatments for low-risk DCIS. Some strongly believe low-risk DCIS should continue to be treated immediately with surgery (and radiation if needed) to reduce the risk of invasive cancer as much as possible. Others strongly believe that many patients with low-risk DCIS do not need surgery or radiation and could avoid or delay having these treatments (and their side-effects) by actively monitoring the DCIS. You will find strong supporters of these two very different approaches among doctors, previous and current patients, and in the written and online media. There are also many doctors who would like to be able to offer both treatment options to patients with low-risk DCIS. However, they are currently unable to do so without better evidence to help us understand the treatment options.