Ductal Carcinoma In Situ and DCIS
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Ductal carcinoma is breast cancer that begins in the milk ducts. When this type of breast cancer is confined to the ducts, it is called ductal carcinoma in situ, or DCIS. When the tumor has spread to the surrounding breast tissue, it is called invasive ductal carcinoma, or IDC. DCIS may or may not become IDC.
DCIS is the most common type of noninvasive breast cancer, with about 60,000 new cases in the United States each year. About 1 in every 5 new breast cancer cases is ductal carcinoma in situ.
Women with DCIS are at higher risk for having cancer return following treatment, although the chance of a recurrence is under 30%. Most recurrences occur within 5 to 10 years after the initial diagnosis, and may be invasive or noninvasive. DCIS also carries a heightened risk for developing a new breast cancer in the other breast. A recurrence of DCIS is not life threatening, but will require additional treatment.
The type of therapy selected may affect the likelihood of recurrence. Treating ductal carcinoma in situ with a lumpectomy (breast-conserving surgery) without radiation therapy carries a 25–35% chance of recurrence. Adding radiation therapy to the treatment decreases this risk to approximately 15%. Currently, the long-term survival rate for women with DCIS is nearly 100%.
DCIS is divided into several subtypes, mainly according to the appearance of the tumor. These subtypes include micropapillary, papillary, solid, cribriform, and comedo.
Ductal Carcinoma In Situ Risk Factors
Any woman may get DCIS. Factors that may increase risk include:
- Age: Women who are age 55 years and older are at greater risk for invasive breast cancer than women under age 55.
- Family history of breast cancer: Having a family history of breast cancer, particularly women with a mother, sister or daughter who has or had breast cancer, may double the risk of developing ductal carcinoma.
- Personal history: Having had benign breast disease in the past carries a heightened risk for developing DCIS
- Pregnancy: Women who were pregnant later in life (over age 35) may have a greater chance of developing DCIS. Breast-feeding may help to lower the risk of breast cancer.
- Hormone replacement therapy: Combination estrogen-progestin after menopause may increase a woman’s risk of developing DCIS.
- BRCA1 and BRCA2 Mutations: BRCA1 and BRCA2 are genes that help repair damaged DNA. Mutations in BRCA1 and BRCA2 can be inherited from a family member and are the most common causes of inherited breast cancer, which can include DCIS.
Ductal Carcinoma In Situ Symptoms
DCIS does not cause any symptoms. Rarely, a woman may feel a lump in the breast or have nipple discharge. However, most cases of DCIS are detected with a mammogram.
Ductal Carcinoma In Situ Treatment
Current treatments for DCIS can eliminate the disease completely and lower the risk of recurrence. Your ductal carcinoma in situ treatment options may include:
- Surgery: Women may undergo a lumpectomy (removal of the lump and some surrounding tissue) or a mastectomy (complete removal of the breast)
- Radiation Therapy: A course of radiation treatment following surgery may help ensure that all cancer cells are eliminated from the body
- Hormone Therapy: Women may also undergo hormone therapy with drugs such as tamoxifen to help reduce the risk of recurrence, particularly following a lumpectomy with or without radiation.