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I Have DCIS, Is Surgery My Only Option?

Before the advent of modern mammography, pre-invasive breast cancers known as ductal carcinoma in situ (DCIS) were rarely detected. Today, with the rise of breast cancer screenings such as 3-D mammography, the diagnosis of DCIS is on the rise. Each year, DCIS is diagnosed in one in every 60,000 American women.

With increased rates of diagnosis, there has been a considerable debate about the risks of DCIS and the best treatment options. Some experts suggest women are being overtreated, while others advocate for more intensive preventive treatments.

“Currently, the standard treatment for DCIS is surgical removal, however, we’re currently looking at whether all types of DCIS really need surgery,” said Molly Decker, DO, a breast surgeon at Banner MD Anderson Cancer Center at McKee Medical Center in Loveland, CO. “The main purpose [of surgery] is to try and prevent DCIS from progressing into invasive carcinoma, but it’s possible some may never progress at all. We’re trying to determine which types, if any, those might be.”

Learning you have DCIS can be overwhelming, but don’t panic. Read on to learn more about DCIS and the latest regarding treatment options.

What is DCIS?

Ductal carcinoma in situ (DCIS) is considered a non-invasive breast cancer, an early type of breast cancer. Ductal refers to the milk ducts of the breasts, carcinoma refers to any cancer that begins in the skin or other tissues and in situ means it’s in place—meaning it hasn’t invaded surrounding tissue or spread to other body tissues.

“DCIS is also called intraductal carcinoma or stage 0 breast cancer,” Dr. Decker said. “Since it’s non-invasive and hasn’t spread through the walls of the ducts into nearby breast tissue, we consider it stage 0. Whereas invasive breast cancers are staged 1 through 4.”

DCIS alone isn’t life-threatening, however, having DCIS can increase your risk of developing an invasive breast cancer later. That’s why it’s important to talk to your team of doctors to assess your risk and discuss tailored treatment options (more on that in a minute!).

Is DCIS hereditary? How can I lower my risk?

Although it isn’t clear what causes DCIS, we do know how it starts. Cells within the lining of the milk ducts go through changes and then start growing out of control. Even though we don’t know why this happens, some factors such as your lifestyle, your environment and genetics may play a role.

[See how genetic testing is improving breast cancer treatment and prevention.]

How do I know if I have DCIS?

Many women won’t have any symptoms, so more often DCIS is discovered during a routine mammogram. If your doctor thinks you have DCIS, they’ll likely recommend additional breast imaging. These tests may include a diagnostic mammogram, an ultrasound, an MRI and a core needle biopsy. During the biopsy, your doctor will use a needle to take a sample of the tissue from inside your breast so they can look at it closer to see if there’s evidence of cancer.

What are the current treatment options for DCIS?

DCIS can’t spread outside the breast, but it will still need to be treated because it can sometimes become invasive. Often, patients can choose between several options:

  • Lumpectomy: This breast-conserving surgery removes the tumor and some healthy surrounding breast tissue. Most patients will also get radiation therapy to reduce the risk for the cancer coming back.
  • Mastectomy: This surgical procedure removes the whole breast if breast-conserving surgery can’t remove the DCIS completely. Typically, radiation therapy isn’t necessary after this surgery.
  • Hormone Therapy: This may be used after either type of surgery, depending on the type of tumor.

The right treatment for you will depend on how fast the cancer grows, the tumor’s size and a few other factors. Based on this information, you may choose to minimize interventions or take a more preemptive approach. One approach that’s become a hot button topic among experts is the use of active surveillance.

Why is DCIS active surveillance controversial?

Active surveillance offers patients a different approach to managing low-risk DCIS. It’s not a wait and see approach. Instead, it involves frequently monitoring a patient’s condition with the goal of avoiding aggressive treatments and side effects unless they are necessary. Currently, this method isn’t a recommended course of treatment for DCIS unless you’re enrolled in a clinical trial, however, every patient has the right to refuse treatment.

“It’s your body and your wishes need to be respected,” Dr. Decker said. “If a patient refuses treatment for DCIS, I offer them active surveillance as an option.”

The current clinical trial underway across the country is called the COMET trial. Eligible patients with DCIS can enroll and are randomized to no surgery versus surgery if they meet what is thought to be a low-risk criteria.

“Until the results of the trial are determined, the current recommendation is still to undergo surgery unless you’re otherwise enrolled in the trial since we don’t yet know the outcome,” Dr. Decker said. “Our hope is that this study will guide us as to whether some patients do not need surgery at all for DCIS.”

What is the latest research telling us about DCIS and how it’s treated?

One thing we’re learning about treatment over the years is that it’s not one-size-fits-most.

“It’s no longer a one-size-fits-all approach and less aggressive treatment plans are possible and often recommended,” Decker said. “That being said, not every type of DCIS is thought to be low-risk, so it’s important to have discussions with your health care providers to assess your personal risk for your type of DCIS profile so they can build a tailored treatment plan for you and help you make an informed decision about your care.”

What is the outlook for DCIS?

The survival rate of DCIS is high when you receive your breast cancer diagnosis early and begin treatment before it progresses to a more invasive type. Talk to your health care provider about your personal risk assessment for your specific DCIS profile and potential treatment options, so you can make an informed decision about your care.

“I highly recommend a specialized and multidisciplinary team approach to your care so you can make the best decision for yourself,” Dr. Decker said.

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