How Is Ductal Carcinoma In Situ Diagnosed
A mammogram can reveal abnormalities in your breast tissue that your healthcare provider can investigate further during a biopsy.
A mammogram uses a low-dose X-ray to take images of breast tissue. As old cells die and collect within your milk ducts, they leave tiny hardened calcium deposits called breast calcifications. Calcifications appear as a shadow or white spot on a mammogram. Abnormal calcifications may indicate abnormal cell growth, which may mean DCIS or other types of breast cancer.
Your healthcare provider may order an additional mammogram, called a diagnostic mammogram, if they find suspicious areas on a screening mammogram. A diagnostic mammogram provides more detailed views of your breast tissue. The procedure takes longer than a screening mammogram.
Mammograms used to detect DCIS include:
- 2D mammograms: A traditional mammogram takes at least two images of your breast from different angles to provide a two-dimensional view of your breasts. A 2D mammogram is the most common imaging procedure used for detecting DCIS.
- 3D mammograms : A three-dimensional mammogram takes multiple images of your breast to create a 3D view. This type of mammogram detects breast cancer more accurately than traditional mammograms, especially in dense breast tissue.
A Note About Sex And Gender
Sex and gender exist on spectrums. This article will use the terms, male, female, or both to refer to sex assigned at birth. .
There are many different types of breast cancer.
Each form of breast cancer develops in a different part of the breast and can affect different tissue types.
Since many breast cancers cause no symptoms, people should attend regular screenings. This can help identify the disease in its early stages.
Below, we outline the types of breast cancer and their symptoms.
What You Need To Know
- The risk of getting invasive ductal breast cancer increases with age: According to the American Cancer Society, about two-thirds of women diagnosed with IDC are age 55 or older.
- IDC can affect men.
- Without prompt treatment, invasive ductal carcinoma can spread to lymph nodes or blood vessels and metastasize throughout the body.
- Identifying characteristics of the tumor, such as whether or not the cells are sensitive to certain hormones, can help your doctor choose the best treatment.
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What Are The Symptoms And Signs Of Breast Cancer
The most common symptoms of breast cancer include:
- Feeling a lump in the breast area, with or without pain
- Change in breast shape or size
- Dimple or puckering in breast
- A nipple turning inward into the breast
- Nipple discharge other than breast milk, especially if it is bloody
- Scaly, red, darkened or swollen skin in the breast area
- Itchy, scaly sore or rash on the nipple
- Dimple, pitted appearance or feel in the breast area
- Swollen or enlarged lymph nodes around the breast area, including the collarbone and armpits
Although these symptoms can be caused by other conditions, you should check with a doctor preferably a breast health specialist so they can make a definitive diagnosis.
Coping With A Diagnosis Of Dcis
Being told you have DCIS can be a difficult and worrying time. Everyone reacts differently to their diagnosis and have their own way of coping.
Although DCIS is an early form of breast cancer with a very good prognosis, people understandably may feel very anxious and frightened by the diagnosis. People can often struggle to come to terms with being offered treatments such as a mastectomy, at the same time as being told their DCIS may never do them any harm.
Some people are reluctant to say theyre anxious about a diagnosis of DCIS because they worry others will see it as less important than other types of breast cancer. Because of this they might feel less able to ask for support. But there are people who can support you so dont be afraid to ask for help if you need it. By letting other people know how you feel, particularly your family and friends, they can be more supportive.
Some people find it helpful to discuss their feelings and concerns with their breast care nurse or specialist. If youd like to talk through your feelings and concerns in more depth over a period of time, a counsellor or psychologist may be more appropriate. Your breast care nurse, specialist or GP can arrange this.
Find out more about coping emotionally with breast cancer.
If you want to talk you can also call our Helpline on 0808 800 6000.
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Relationships With Friends And Family
It’s not always easy to talk about cancer, either for you or your family and friends. You may sense that some people feel awkward around you or avoid you.
Being open about how you feel and what your family and friends can do to help may put them at ease. However, don’t be afraid to tell them that you need some time to yourself, if that’s what you need.
Read further information:
- Healthtalkonline: How breast cancer affects families
What Is A Normal Breast
No breast is typical. What is normal for you may not be normal for another woman. Most women say their breasts feel lumpy or uneven. The way your breasts look and feel can be affected by getting your period, having children, losing or gaining weight, and taking certain medications. Breasts also tend to change as you age. For more information, see the National Cancer Institutes Breast Changes and Conditions.external icon
What Increases Your Risk Of Breast Cancer
Factors that can elevate risk breast cancer risk include:
- A personal or family history of breast cancer, including DCIS and LCIS
- Inherited genetic predispositions, most commonly with BRCA1 or BRCA2 gene mutations
- Elevated lifetime estrogen exposure, including:
- Early onset of menstruation
- Late-onset of menopause
- Older age of first childbirth or never having given birth
- Taking estrogen and progesterone after menopause
How Is Dcis Treated
Because DCIS involves the diagnosis of abnormal cells at a very early stage, treatments are usually highly effective.
Also, since the abnormal cells are only found in your breast duct, chemotherapy is never needed for DCIS.
Lets take a closer look at some treatment options you and your healthcare team may decide to use, based on your specific diagnosis and situation.
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How Is Invasive Ductal Carcinoma Diagnosed
Several tests can help your doctor identify and diagnose IDC, including:
Physical exam. Manual examination of your breasts by your doctor can detect lumps and other changes. If your doctor feels a lump or thickening, he or she may recommend further tests to rule out IDC.
Digital mammography is an improved method for breast imaging that is performed much like a regular mammogram. However, it is better than conventional mammography in detecting cancer in younger patients and in those with dense breast tissue. Electronic images can be enhanced with computer-aided detection systems to spot masses, calcifications and abnormalities associated with cancer.
Breast ultrasound uses sound waves to examine the breast tissue and gauge blood flow. It is safe for examining pregnant patients, and does not use radiation.
Breast magnetic resonance imaging uses a large magnet, radio waves and a computer that can detect small breast lesions, and may be especially useful in examining patients with a high risk of breast cancer, such as those with BRCA1, BRCA2 or other gene mutations associated with cancer.
What Are The Symptoms Of Breast Cancer
If you have any symptoms that worry you, be sure to see your doctor right away.
Different people have different symptoms of breast cancer. Some people do not have any signs or symptoms at all.
Some warning signs of breast cancer are
- New lump in the breast or underarm .
- Thickening or swelling of part of the breast.
- Irritation or dimpling of breast skin.
- Redness or flaky skin in the nipple area or the breast.
- Pulling in of the nipple or pain in the nipple area.
- Nipple discharge other than breast milk, including blood.
- Any change in the size or the shape of the breast.
- Pain in any area of the breast.
Keep in mind that these symptoms can happen with other conditions that are not cancer.
If you have any signs or symptoms that worry you, be sure to see your doctor right away.
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Grade Of Breast Cancer
The grade describes the appearance of the cancer cells.
- low grade the cells, although abnormal, appear to be growing slowly
- medium grade the cells look more abnormal than low-grade cells
- high grade the cells look even more abnormal and are more likely to grow quickly
Read further information:
Read further information about secondary breast cancer
Lobular Carcinoma In Situ
Lobular carcinoma in situ refers to an area of abnormal cells confined to the breasts milk-producing glands.
Because these cells do not spread to surrounding tissues, doctors do not lobular carcinoma situ to be cancer. However, it can increase the chances of developing other types of invasive breast cancer.
This condition rarely causes symptoms. Doctors lobular carcinoma in situ during a breast biopsy for another problem in the breast area. In some cases, tiny white specs of calcium called microcalcifications appear on a routine mammogram.
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Risk Of Developing Invasive Breast Cancer After Dcis
After treatment for DCIS, theres a small risk of:
- DCIS recurrence
- Invasive breast cancer
These risks are higher with lumpectomy plus radiation therapy than with mastectomy . However, overall survival is the same after either treatment .
Higher grade DCIS appears more likely than lower grade DCIS to progress to invasive cancer after treatment .
With close follow-up, invasive breast cancer is usually caught early and can be treated effectively.
Learn more about tumor grade.
If youve been recently diagnosed with DCIS or feel too overwhelmed to know where to begin to gather information, it may be helpful to download and print some of Susan G. Komen®s resources. For example, we have Questions to Ask Your Doctor About Breast Cancer Surgery and Questions to Ask Your Doctor About Radiation Therapy and Side Effects.
You can write on them at your next doctors appointment. Or, you can download, type and save it on your computer, tablet or phone during a telehealth visit using an app such as Adobe. Plenty of space and a notes section are provided to jot down answers to the questions.
There are other Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download.
What Should A Person With Stage 0 Or Stage 1 Breast Cancer Expect Regarding Treatment
Even though Stage 0 breast cancer is considered non-invasive, it does require treatment, typically surgery or radiation, or a combination of the two. Chemotherapy is usually not part of the treatment regimen for earlier stages of cancer.
Stage 1 is highly treatable, however, it does require treatment, typically surgery and often radiation, or a combination of the two. Additionally, you may consider hormone therapy, depending on the type of cancer cells found and your additional risk factors. Like stage 0, Chemotherapy is often not necessary for earlier stages of cancer.
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How Is It Diagnosed
Most of the time, DCIS is diagnosed through a routine breast cancer screening.
If your doctor thinks you might have DCIS, youll probably need further tests to confirm the diagnosis. These tests may include:
- a diagnostic mammogram
The report that comes back from the pathologists in the lab may contain some unfamiliar terms, like the ones described below:
- High-grade, nuclear grade 3, and high mitotic rate describe DCIS that has a higher likelihood of developing again after treatment.
- Intermediate-grade, nuclear grade 2, and intermediate mitotic rate are terms that indicate DCIS is a little less likely to return after treatment.
- Low-grade, nuclear grade 1, and low mitotic rate describe DCIS that is least likely of the three to come back after treatment.
A biopsy will also be able to determine the hormone receptor status of the DCIS cells. Many times, DCIS will have receptors that respond to the hormones estrogen or progesterone.
If these hormone receptors are present, it can help your doctor decide whether to offer you anti-estrogen medication to reduce the risk of recurrence.
How Is Inflammatory Breast Cancer Treated
Inflammatory breast cancer is generally treated first with systemic chemotherapy to help shrink the tumor, then with surgery to remove the tumor, followed by radiation therapy. This approach to treatment is called a multimodal approach. Studies have found that women with inflammatory breast cancer who are treated with a multimodal approach have better responses to therapy and longer survival. Treatments used in a multimodal approach may include those described below.
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Symptoms Of Angiosarcoma Of The Breast
Another rare form of breast cancer, angiosarcoma forms inside the lymph and blood vessels. Only a biopsy may definitively diagnose this type of cancer. Angiosarcoma can cause changes to the skin of your breast, such as the development of purple-colored nodules that resemble a bruise. These nodules, if bumped or scratched, may bleed. Over time, these discolored areas may expand, making your skin appear swollen in that area. You may or may not have breast lumps with angiosarcoma. If you also have lymphedema, which is swelling caused by a buildup of lymphatic fluid, angiosarcoma may occur in the affected arm. Cancer treatment sometimes damages the lymph vessels, which may lead to lymphedema.
Can Dcis Be Left And Not Treated
Because theres no way of knowing when or if DCIS will become invasive, treatment is usually recommended. Its possible this may lead to unnecessary treatment for some people.
The aim of treatment is to remove all the DCIS from within the breast to reduce the chance of it becoming an invasive cancer.
Research is looking at which cases of DCIS are more likely to develop into invasive breast cancer and which could be closely monitored instead of being treated. If you are diagnosed with low-grade DCIS, you may be invited to join a clinical trial.
If you have any questions or concerns about your diagnosis and treatment, talk to your treatment team.
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Side Effects And Complications
Its important to tell your oncologist about all symptoms, even if they seem minor. Your healthcare team will work with you to ease side effects and deal with complications.
What Is The Difference Between A Clogged Milk Duct And Mastitis
A plugged duct is an obstruction of milk flow in a portion of the breast, either at the nipple or further back in the ductal system.Mastitis is inflammation and infection of the breast. These conditions happen most often in the first six to eight weeks postpartum, but they can occur at any time during breastfeeding.
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When Should I See My Healthcare Provider
Follow your healthcare providers guidance so you receive check-ups and mammograms as frequently as you should. In the meantime, pay attention to your breasts so you dont miss signs of breast cancer.
- Pain in your breast or nipple.
- A nipple that pulls inward.
- Nipple discharge.
Many of these symptoms are also signs of benign conditions. Get any changes checked to be sure.
A note from Cleveland Clinic
Ductal carcinoma in situ is one of the most treatable cancers. It doesnt typically spread beyond your milk ducts and rarely returns after breast-conserving surgery. Talk with your healthcare provider about the benefits of your treatment options versus potential side effects or complications. Multiple factors will determine the type of surgery thats best for you. Similarly, weigh the pros and cons of receiving additional treatments, like hormone therapy, with your provider.
Inflammatory Breast Cancer Symptoms
Unlike other breast cancers, inflammatory breast cancer rarely causes breast lumps and may not appear on a mammogram. Inflammatory breast cancer symptoms include:
- Red, swollen, itchy breast that is tender to the touch
- The surface of the breast may take on a ridged or pitted appearance, similar to an orange peel
- Heaviness, burning, or aching in one breast
- One breast is visibly larger than the other
- Inverted nipple
- No mass is felt with a breast self-exam
- Swollen lymph nodes under the arm and/or above the collarbone
- Symptoms unresolved after a course of antibiotics
Unlike other breast cancers, inflammatory breast cancer usually does not cause a distinct lump in the breast. Therefore, a breast self-exam, clinical breast exam, or even a mammogram may not detect inflammatory breast cancer. Ultrasounds may also miss inflammatory breast cancer. However, the changes to the surface of the breast caused by inflammatory breast cancer can be seen with the naked eye.
Symptoms of inflammatory breast cancer can develop rapidly, and the disease can progress quickly. Any sudden changes in the texture or appearance of the breast should be reported to your doctor immediately.
For women who are pregnant or breast-feeding, redness, swelling, itchiness and soreness are often signs of a breast infection such as mastitis, which is treatable with antibiotics. If you are not pregnant or nursing and you develop these symptoms, your doctor should test for inflammatory breast cancer.
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