How Common Is Ductal Carcinoma In Situ
The American Cancer Society expects that 63,960 new cases of DCIS will be found in 2018. Today more and more women are aware of the importance of early detection and are getting mammograms each year. Because of this, the number of cases of DCIS has increased. In addition, mammography technology has greatly improved as well and is better able to detect problems at an earlier stage. An estimated 12.4% of women in the U.S. will develop invasive breast cancer at some time in their lives.
Treatment Options For Ductal Carcinoma In Situ
Treatment options for DCIS depend on a number of things, including the size of the DCIS compared to the size of the breast, the grade of DCIS, the womans age and whether she has a family history of breast cancer. Because ductal carcinoma in situ may develop into invasive breast cancer and invasive breast cancer can spread and cause death, its recommended that all women with DCIS have treatment. The aim of treatment for DCIS is to help prevent invasive breast cancer from developing and to help stop DCIS from coming back in the breast.
How Is Invasive Ductal Carcinoma Diagnosed
Your healthcare provider will perform a physical examination. In addition to feeling for lumps in your breast, they may also feel for swollen lymph nodes in your underarm area.
In most cases, invasive ductal carcinoma is found during routine mammograms. If your healthcare provider thinks you may have IDC, they may order other tests, including:
- Magnetic resonance imaging . This imaging test uses radio waves and magnets to produce detailed pictures of your breast tissue.
- Ultrasound. Using high-frequency sound waves, an ultrasound provides clear images of your internal organs and other tissues.
- Biopsy. Your healthcare provider takes a small sample of your breast tissue with a needle. The sample is then sent to a pathology lab for further testing.
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Lumpectomy Versus Mastectomy: Prognosis For Dcis
The survival rate following mastectomy for DCIS is reported to be 98% to 99%. That represents a 1% to 2% rate of local recurrence.
Medical studies of excision of DCIS reported a 20% to 44% local recurrence rate over a 10 year period.
For women who underwent breast conserving therapy and radiation there was a 10% to 15% rate of local recurrence.
However, the increased local recurrence risk following breast conservation surgery did NOT affect breast cancer-specific survival when compared with patients who underwent mastectomy for DCIS.
Both groups of patients had a 99% long term breast cancer specific survival.
The gold standard of treatment for DCIS at the moment is wide local excision with radiotherapy. According to one 2012 medical study, surgery and radiation therapy is superior to just surgery regarding recurrence rates. However, neither of these approaches affect overall survival rates.
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How Likely Is Dcis To Come Back
The chance of the DCIS coming back depends on various factors. But after mastectomy DCIS almost never comes back. In women who have just the area of DCIS removed the chance of it coming back is a bit higher. But it depends on the grade and type of DCIS.
Your doctor can give you more information about the chance of the DCIS coming back in your case.
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A Test Can Help You Determine Your Risk
Sometimes doctors will recommend a genomic test, called the Oncotype DX test, to help determine a DCIS patient’s risk of getting another cancer in the future. A sample from the DCIS biopsy or lumpectomy is sent to a lab, where pathologists study the activity of 12 different cancer-related genes.
“You get back what’s called a DCIS score, from zero to 100, that tells you the likelihood of a DCIS recurrence or of an invasive cancer in the next 10 years,” says Dr. White. “I want to help patients keep their breasts, so if they have a high risk of recurrence we want to recommend radiation so they can prevent that invasive cancer in the future.”
Memorial Sloan Kettering Cancer Center has also developed a free online assessment tool to helps DCIS patients estimate their risk of another cancer, based on age, family history, and details about their specific tumor. “We want to help patients understand their individual risks, so they can make an informed decision about how much treatment they’re going to have,” says Dr. White.
What Is Stage 0 Lcis
Lobular carcinoma in situ at Stage 0 generally is not considered cancer. Although it has carcinoma in the name, it really describes a growth of abnormal but non-invasive cells forming in the lobules. Some experts prefer the name lobular neoplasia for this reason because it accurately refers to the abnormal cells without naming them as cancer. LCIS, however, may indicate a woman has an increased risk of developing breast cancer.
If you have been diagnosed with LCIS, your doctor may recommend regular clinical breast exams and mammograms. He or she may also prescribe Tamoxifen, a hormone therapy medication that helps prevent cancer cells from growing.
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The Prognosis For Microinvasive Carcinoma Of The Breast Is Very Good
There is universal agreement that the prognosis for ductal carcinoma discovered and intervened at a microinvasive stage, is very good. Patients with microinvasive breast cancer can typically expect a cure rate very close to 100%, with local treatment alone. Most microinvasive breast cancers will be treated by breast conserving surgery or by radical mastectomy . Adjuvant treatment is still a bit controversial, but radiotherapy is very common , while chemical and endocrine treatments are much common and will likely depend on the hormone receptor status of individual patients.
Sentinel Node Biopsy And Mastectomy For Dcis
A sentinel node biopsy is a procedure used to check whether or not invasive breast cancer has spread to the lymph nodes in the underarm area . The surgeon removes 1-5 nodes.
Having a sentinel node biopsy during a mastectomy helps some people with DCIS avoid an axillary dissection. Once a mastectomy has been done, a person cant have a sentinel node biopsy.
If it turns out theres invasive breast cancer in the tissue removed during the mastectomy, a sentinel node biopsy will have already been done.
If a sentinel node biopsy wasnt done and invasive breast cancer is found, an axillary dissection may be needed. An axillary dissection removes more axillary lymph nodes than a sentinel node biopsy. Because it disrupts more of the normal tissue in the underarm area, axillary dissection is more likely to affect arm function and cause lymphedema.
So, even though a sentinel node biopsy may not be needed with DCIS, most people who have a mastectomy for DCIS will have a sentinel node biopsy done at the same time.
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Treatment Of Ductal Carcinoma In Situ
Ductal carcinoma in situ means the cells that line the milk ducts of the breast have become cancer, but they have not spread into surrounding breast tissue.
DCIS is considered non-invasive or pre-invasive breast cancer. DCIS cant spread outside the breast, but it is often treated because if left alone, some DCIS cells can continue to undergo abnormal changes that cause it to become invasive breast cancer .
In most cases, a woman with DCIS can choose between breast-conserving surgery and simple mastectomy. But sometimes, if DCIS is throughout the breast, a mastectomy might be a better option. There are clinical studies being done to see if observation instead of surgery might be an option for some women.
It’s Usually Found On A Mammogram
For most women, DCIS is picked up on routine mammograms. “Typically, the mammogram finds a calcificationa small cluster of cells with abnormal shapes and sizesand then it is diagnosed after a biopsy,” says Dr. Meyers.
Occasionally, though, DCIS grows large enough that it forms a noticeable lump. Some people with DCIS may also have unusual nipple discharge, or a condition called Paget’s disease that causes skin around the nipple to become thick and dry.
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Dcis And Invasive Breast Cancer
If DCIS is not treated, over time it may spread into the breast tissue surrounding the ducts. It then becomes an invasive breast cancer.
Not every untreated DCIS will develop into an invasive breast cancer. But breast specialists usually advise treating DCIS. This is because it is not possible to tell for certain which individual cases of DCIS will become an invasive cancer.
Having DCIS means you have a slightly higher risk of getting cancer elsewhere in the same breast or in your other breast.
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How The Breast Cancer Staging Process Starts
The breast cancer staging process begins with diagnostic testing. Depending on previous screening results, if any breast cancer symptoms are present, and other factors, your doctor may recommend one of the following tests:
- Diagnostic mammogram A mammogram involves using an X-ray to take photos of your breast tissue at different angles. To do this, your breasts are gently compressed between two plates so the X-ray can be taken.
- Ultrasound An ultrasound is a non-invasive imaging test that bounces soundwaves of your breast tissue to create a picture of the inside of your breast.
- MRI An MRI is another non-invasive imaging test that uses radio waves and a magnetic field to create an image of your breast tissue. This can help doctors determine the size and placement of tumors.
- Biopsy A biopsy removes small masses and growths from your breast so they can be examined under a microscope by a pathologist and determine if theyre cancerous.
If cancer is detected, a CT scan may be ordered to look for any distant metastasis or local invasion to other organs. And youll likely be connected with a breast surgeon right away, either through a nurse navigator or your doctor.
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What Is Ductal Carcinoma In Situ
Ductal carcinoma in situ is a type of breast cancer. This is also called non-invasive or pre-invasive breast cancer. The cancer cells are found along the sides of the milk duct within the breast. Milk ducts are within each breast and are the tubes that let milk travel from the lobes to the nipple openings for breastfeeding.
DCIS is non-invasive, which means that the cancer cells are found only within the milk duct and have not spread through the walls of the ducts and to other nearby tissues in the breast. It is a Stage 0 breast cancer and is treatable. Doctors characterize cancer in stages, using Roman numerals from 0, or zero, to IV, or four. In order to determine the stage of a tumor, doctors must look at the original tumor and determine where it is located, its size, and if it has been noticed in other areas. The lower the stage number, the better chance for successful treatment of the disease and for the best results.
Although DCIS is always considered Stage 0, the tumor can be any size and may be found within several milk ducts inside the breast. With proper treatment, the prognosis is excellent.
What Are The Symptoms
You cant usually see or feel the abnormal cells in your milk duct. As a result, you may not have any symptoms. In fact, in the vast majority of cases, DCIS is detected during a breast cancer screening using a mammogram.
The abnormal cells typically show up on a mammogram as clusters of bright white flecks with irregular shapes.
In some cases, DCIS may cause symptoms such as:
- discharge coming from a nipple that isnt milk
- a small lump
Most breast symptoms or changes arent caused by cancer, but tests are often needed to rule out the possibility of abnormal breast cells.
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How To Improve Your Breast Cancer Survival Rates
While some things that influence breast cancer survival rates cannot be changed , there are several ways a patient can potentially improve his or her outcomes. For instance:
- Studies suggest that outcomes tend to be better for patients who undergo radiation therapy after surgery. Even though surgery by itself can be effective, radiation therapy can destroy residual cells that were not visible or accessible during an operation.
- Hormone therapies can help prevent recurrences in patients whose tumors are found to be hormone-receptive. Some of these therapies are only available through clinical trials patients can discuss the potential risks and benefits of participation with their treatment teams.
- The outcomes for stage 0 breast cancer are generally more favorable than the outcomes for more advanced stages of breast cancer. Although ductal carcinoma in situ does not always progress into a more invasive malignancy, treating it early before it progresses to a more advanced stage of cancer can improve a patients outcome.
Not only are there several ways to improve survival outcomes, but also quality of life outcomes as well. For instance, reconstructive surgery can be performed to improve aesthetic results after a lumpectomy or mastectomy. Women who hope to breastfeed can discuss possible breast-tissue-sparing techniques with a surgeon. Additionally, supportive care services are available to help patients better manage the side effects of breast cancer treatment.
What Are The Symptoms Of Invasive Ductal Carcinoma
In the early stages, invasive ductal carcinoma may not cause any obvious symptoms. Some people may develop certain warning signs, including:
- A new lump in the breast.
- Swelling of the breast.
- Prior radiation to the chest.
- Early start of menstrual periods.
- Late menopause.
- Never being pregnant or having children later in life.
In approximately 5% to 10% of breast cancer cases, invasive ductal carcinoma has been linked to hereditary factors. These include mutations of the breast cancer gene 1 , breast cancer gene 2 and other genes such as PALB2, CHEK2 and ATM.
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What Is A Breast Cancers Grade
Cancer cells are given a grade when they are removed from the breast and checked in the lab. The grade is based on how much the cancer cells look like normal cells. The grade is used to help predict your outcome and to help figure out what treatments might work best.
A low grade number usually means the cancer is slower-growing and less likely to spread.
A high grade number means a faster-growing cancer thats more likely to spread.
An intermediate grade number means the cancer is growing faster than a grade 1 cancer but slower than a grade 3 cancer.
Current Diagnosis And Imaging
DCIS is usually straightforward to detect by mammography because of its association with calcifications the proliferation of cells itself is not visible on the mammogram. However, as only 75% of all DCIS lesions contain calcifications, a substantial percentage of DCIS lesions will not be detected by mammography, implying that some lesions might be mammographically occult or that the diameter of the area containing calcifications underestimates the extent of DCIS., This suggests that DCIS might be left behind following breast-conserving treatment in a proportion of cases.
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Stage 0 Breast Cancer
DCIS is considered Stage 0 breast cancer. On a pathology report, DCIS is reported as Tis .
There isnt a change in the staging of DCIS depending on the size of the tumor. However, tumor size is one of the factors that goes into the staging of invasive breast cancers.
DCIS can be located in one location of the breast, or it can be found in many different areas of the breast. In that case, it is usually called multi-focal.
The Sojourn Time For Early Breast Tumor Development Is Faster In Younger Women
Breast tumors in younger women do seem to progress faster than with older women, particularly in the pre-clinical phases .
This is sometimes called the sojourn time. The sojourn time is the difference in time between abnormalities found on mammogram and the time it takes for them to be clinically detectable, .
Sojourn time sometimes formally defined as, the mean duration of pre-clinical disease, has been consistently shown to be longer for older women and for slower-growing breast tumors.
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Younger Age At Diagnosis Of Dcis
A medical study published in 2015 set out to estimate the 10 and 20-year mortality rate after an initial diagnosis of ductal carcinoma in-situ.
The statistics were taken from the Surveillance, Epidemiology and End Results from 108,196 women diagnosed with DCIS between the years of 1988 to 2011.
The study found that the average age of diagnosis for DCIS was 53.8 years. In general the overall breast cancer death rate over a 20 year period was only 3.3%.
However, the mortality rate at 20 years increased to 7.8% in women who were diagnosed with DCIS before the age of 35 years old.
A further 2014 research study concluded that after 10 years the rates of local recurrence after breast conservative therapy and radiotherapy were as follows:-
- Women over 50 years at diagnosis: 11% recurrence rate
- For women between 45 and 50 years: 15% recurrence rate
- Women under 45 years: 25% recurrence rate
We can see from the above figures that the younger the age at diagnosis, the higher the percentage likelihood of recurrence.
However, this is often because younger women present with a higher grade tumor and are not as rigorously followed up by mammogram screening.
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Why Is Dcis Treated
The aim of treating DCIS is to prevent invasive breast cancer from developing. If DCIS is not treated it may develop into invasive breast cancer, which can spread outside the ducts into the breast tissue and then possibly to other parts of the body.
We dont know for certain how many women with DCIS would develop invasive breast cancer if they were not treated. Also, it is not possible to predict which women with DCIS will develop invasive breast cancer if they were not treated or how long after the diagnosis of DCIS an invasive breast cancer would develop. Some women with DCIS may never develop any problems if they are not treated. However, some women with DCIS may develop invasive breast cancer.
Because DCIS may develop into invasive breast cancer and invasive breast cancer can spread and cause death, women with DCIS are generally recommended to have treatment. Treatment for DCIS aims to help prevent invasive breast cancer from developing and DCIS from coming back in the breast.
DCIS can be treated successfully and most women diagnosed and treated for DCIS will not later develop invasive breast cancer.
Treatment for DCIS usually involves:
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