A Vaccine May Be Helpful
Patients diagnosed with DCIS may one day get a vaccine to help reduce their risk of developing an invasive breast cancer in the future, according to a 2016 study published in Clinical Cancer Research.
More clinical trials are underway, but researchers hope that a vaccine may be able to stimulate the immune system and keep early DCIS from progressing beyond the milk duct. If trials are successful, experts say it could eventually be an alternative to surgery and radiation for some patients.
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Diagnosis Of Stage 0 Breast Cancer
A stage 0 breast cancer diagnosis usually starts with an abnormality seen on a mammogram. This is followed by a biopsy, which collects cells from the area of suspicion. A pathologist then observes these cells under a microscope and classifies them as cancer based on their appearance. As mentioned earlier, the biopsied cells also help to determine cancer grade, as well as hormone receptor status.
Some People With Dcis Get Radiation
Next, doctors and patients should decide together whether further treatment is needed to reduce the risk of another DCIS or an invasive cancer. This can be determined through genomic testing, or by looking at factors like the patient’s age, family history, and tumor size and grade.
“Several years ago, radiation would have been given to everyone who had DCIS, period,” says Dr. Meyers. “But now, it’s a little more tailored to the type of DCIS and the type of patient, and there’s been a downward trend of getting less radiation or avoiding it completely, if possible.”
Radiation does come with side effectsand it has not been shown to extend survival in patients with DCIS it’s only been shown to reduce the risk of another cancer occurring. So patients should weigh the pros and cons carefully, says Dr. Meyers, and make the best individual decision for them.
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Treatments For Stage 0 Breast Cancer
The following are treatment options for breast cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.
Ductal carcinoma in situ is the most common type of non-invasive breast cancer. Lobular carcinoma in situ increases a womans risk for developing breast cancer, but it is not considered a cancer.
How Is Stage 0 Breast Cancer Diagnosed
Contact your physician if you have a lump or other changes to your breasts. Discuss your family history of cancer and ask how often you should be screened.
Stage 0 breast cancer is often found during mammogram screening. Following a suspicious mammogram, your doctor may order a diagnostic mammogram or another imaging test, such as an ultrasound.
If theres still some question about the suspicious area, youll need a biopsy. Biopsy is the only way to diagnose cancer. For this, the doctor will use a needle to remove a tissue sample. A pathologist will examine the tissue under a microscope and provide a report to your doctor.
The pathology report will say whether there are atypical cells present and, if so, how aggressive they may be.
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Is Surgery The Right Decision For Women With Dcis
Women with ductal carcinoma in situ face the difficult decision of howto treat the condition. Researchers at MD Anderson are studying ways tomake this tough choice easier.
Ligia Toro de Stefani, Ph.D., had just retired from a busy academic medical research career when a mammogram revealed a suspicious mass in her right breast. Her doctors in Brownsville, Texas, referred her to MD Anderson, where she was diagnosed with ductal carcinoma in situ, or DCIS, often called stage 0 breast cancer the very earliest stage.
Toro and her husband, Enrico Stefani, M.D., Ph.D., researched everything they could about the condition before meeting with MD Anderson surgeon Alastair Thompson, M.D., to discuss treatment options.
Investigating came naturally to the scientific couple. Toro is an emeritus professor of anesthesiology and molecular and medical pharmacology at the University of California, Los Angeles. Her husband is a former director of UCLAs anesthesiology division of molecular medicine.
We started reading a lot of papers, not just Googling the disease, but doing a serious literature search, Toro de Stefani says.
DCIS is a cluster of cancer cells inside a milk duct. The cells are held in place by the ducts wall, but they have the ability to break through the wall. Thats when they become invasive.
That wont happen to everyone, Toro de Stefani says, but theres no predicting when cells will break through the duct and spread, and when they wont.
Stage 1b Breast Cancer Means One Of The Following Descriptions Applies:
Lymph nodes have cancer evidence with small clusters of cells between the approximate size of a pinprick to the approximate width of a grain of rice .
AND EITHER No actual tumor is found in the breast.
OR The tumor is smaller than the approximate size of a peanut .
Similar to stage 0, breast cancer at this stage is very treatable and survivable. When breast cancer is detected early, and is in the localized stage , the 5-year relative survival rate is 100%.
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Dcis Can Be Removed With Surgery
DCIS can often be removed via a lumpectomya surgery that spares the surrounding breast tissue.
When performing a lumpectomy, surgeons aim to remove all of the cancerous cells, plus a two-millimeter margin of healthy cells around the tumor. This helps ensure that the cancer is 100% removed, and lowers the risk of a recurrence.
Because some DCIS may never progress, some patients may also opt to skip surgery, adopting a watch-and-wait approach instead.
Diagnoses Are Way Up In Recent Years
“We’ve seen a huge increase in the number of DCIS cases diagnosed in the last 20 years,” Julia White, MD, director of breast radiation oncology at the Ohio State University Comprehensive Cancer Center, tells Health.
In the 1990s, only about 15,000 to 18,000 DCIS cases were diagnosed per year, she says now, that number has grown to more than 60,000, according to the American Cancer Society. “That’s because so many women are now getting mammograms, and the technology is so good, that we pick up very small lesions,” says Dr. White.
The good news? Women are getting treated earlier than ever, which means there are fewer chances for DCIS to break out of the milk duct and become invasive. The bad news? There’s no way to tell which lesions will become invasive, so some experts say there’s a real danger of overdiagnosis and unnecessary treatment.
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Who Is Most At Risk For Dcis
We consider anyone who has previously had DCIS or other types of breast cancer, older women, and women with certain previous breast histories such as atypical hyperplasia, a precancerous condition that affects cells in the breast, to be most at risk for Stage 0 cancer, explains Helen Cappuccino, MD, FACS, Assistant Professor of Oncology. Also at risk are women with radial scars, the benign breast lesions that may be detected as a kind of star-shaped feature that can be detected by mammograms, and intraductal papillomas, benign tumors that grow within the milk ducts of the breast. We also look for a family history of breast cancer and prior breast biopsies, as well as women who have a child at age 30 or older, women who have never had a baby, and women who have had fewer full-term pregnancies.
What Is Ductal Carcinoma In Situ
According to the American Cancer Society, DCIS is non-invasive orpre-invasive breast cancer, which means the cells that line the ductshave changed to cancer cells but havent spread through the walls ofthe ducts into the nearby breast tissue.
DCIS is considered a pre-cancer because sometimes it can become aninvasive cancer. This means that over time, DCIS may spread out of theducts into nearby tissue, and could metastasize. Currently, theres nogood way to predict which will become invasive cancer and which wont.Therefore, almost all women with DCIS will be treated.
In most cases, a woman with DCIS can choose betweenbreast-conserving surgery and simple mastectomy. In cases wherethe area of DCIS is very large, the breast has several areas of DCIS,or BCS cannot remove the DCIS completely, mastectomy might be a better option.
When Helen Spencer learned she had DCIS,she began a journey of decisions ranging from which hospital tochoose, to the type of surgery, to whether adjuvant hormone therapywould be worth the potential side effects. Readher story.
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What Is The Treatment For Dcis
Lumpectomy with radiation. The standard treatment is breast-preserving surgery with radiation therapy, which results in successful outcomes for most patients. Cancers can be larger than expected, so about 20% of the time, patients need a re-excision lumpectomy another surgery to remove all of the cancer. Typically, the remaining breast will then have radiation therapy to reduce the risk of local recurrence. Lumpectomy plus radiation is a good alternative to mastectomy for treatment of DCIS.
Mastectomy. Some patients have ductal carcinoma in situ in more than one quadrant of the same breast . Sometimes, the DCIS is very large relative to the patients breast size. In these situations, a mastectomy is required to address malignant cells that are more widespread. Radiation therapy is not needed for DCIS treated with mastectomy.
Chemotherapy. Chemotherapy is not needed for DCIS since the disease is noninvasive.
Hormonal therapy. Hormonal therapy may be appropriate for those whose ductal carcinoma in situ is hormone receptor positive.
What Should I Expect After A Dcis Diagnosis
The outlook after DCIS diagnosis, Sun says, is encouraging. With continued, rigorous monitoring, the prognosis for DCIS is excellent, she explains. Your doctor will recommend a regular screening schedule to guard against recurrence in the original breast, and to monitor the other breast for any signs of malignancy.
Our expectation is for a complete resolution of the problem with proper treatment. This is a local disease and treatment by surgery can be sufficient. Chemotherapy isnt necessary, and in some cases, hormone medication and radiation arent either.
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Stage 1 Breast Cancer Treatment Options
Stage 1 breast cancers are usually treated with surgery to remove the mass, potentially with radiation therapy to treat the area.
Hormone therapies and chemotherapy can help reduce the risk that cancer will come back. Lymph nodes will also be biopsied or dissected to detect cancer.
Targeted therapies may also be used for HER2-positive stage 1 cancers.
What About Mastectomy To Prevent Future Breast Cancer
More than 20 years ago, when breast conditions like these were diagnosed, they were often treated with mastectomy, surgery which completely removes the affected breast. Sometimes a healthy second breast was also removed , even when there was no sign of cancer or other abnormalities in the other breast.
Today, thanks to advances in scientists understanding of breast cancer and of these other conditions, along with the development of better diagnostic, surgical, and treatment techniques, mastectomy is often unnecessary. In fact, we now know that a less radical treatment or no treatment is just as effective. The latest research indicates that women who undergo lumpectomy and radiation rather than mastectomy tend to live longer. Except in unusual circumstances, mastectomy does not increase survival time for these conditions, and the risks of mastectomy usually outweigh any benefits.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
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Stage Zero Breast Cancer: Whats The Optimal Treatment For Dcis
Before the advent of routine mammography, DCIS was rarely detected. But today, DCIS accounts for 20% of breast cancer diagnoses and would be the fifth most common cancer in women if classified independently.
Often called stage zero breast cancer, DCIS growths are confined to the inside of the breasts milk ducts, and many never develop into invasive cancers. Several treatment options are available, and opinions about the optimal treatment for DCIS vary widely among doctors.
A new study from researchers at Columbia University Vagelos College of Physicians and Surgeons may help women and their physicians narrow down the treatment choices.
DCIS is considered a pre-invasive cancer, but the current standard of care is to treat it like an early-stage invasive breast cancer, says Apar Gupta, MD, assistant professor of radiation oncology at Columbia University Vagelos College of Physicians and Surgeons and lead author of the study.
However, not all treatments for invasive breast cancer may be optimal for DCIS, Gupta says. His study suggests that in most cases of DCIS, the side effects of hormone therapy may outweigh its benefits.
The CUIMC Newsroom spoke with Gupta to learn how the studys findings can help providers and their patients navigate treatment for DCIS. Below are excerpts from the conversation:
Why is DCIS treatment controversial?
How does your study help women make a decision about treatment after lumpectomy?
Is there a role for hormone therapy?
Breast Cancer Staging Process
Breast cancer staging is determined by how large tumors are, how far theyve spread, and other characteristics like the genetics of the tumor. Your cancer stage can be determined before surgery or after surgery .
Cancers clinical stage is determined through a physical exam, biopsy , and imaging tests. These imaging tests may include X-rays, computed tomography , positron-emission tomography , magnetic resonance imaging , or ultrasound.
After surgery, your breast cancer stage will either be confirmed or updated as a pathologic stage, using the features found and any additional information about how far cancer has spread gathered during surgery.
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How Does Breast Cancer Start
To understand breast cancer the language used to describe it, its helpful to first understand breast anatomy. The breast consists of three main kinds of tissue:
Glandular tissue is responsible for milk production, which is stimulated by hormones. This includes many small milk-producing sacs called lobules. The lobules then connect to ducts that create a path for milk to exit through the nipple.
Fibrous tissue is the connective tissue of the breast. This type of tissue is responsible for providing structure to the breast, like collagen.
Fatty tissue is made up of fat cells, and it acts as padding between the fibrous and glandular tissue. The amount of fatty tissue in the breast determines the size of the breast.
Breast cancer begins when breast cells develop mutations that allow the cell to divide more than it should. If this uncontrollable cell is not kept in check, then the cells multiple enough times to form a tumor.
Cancer cells can also travel through the lymphatic system. This is how they spread to local lymph nodes. Lymph nodes are small, round collections of immune system tissue. They often get bigger when actively responding to an infection or cancer. Lymph nodes in the armpit , under the breastbone , and around the collarbone are some of the first places that breast cancer cells can spread.
The two most common types of breast cancer are classified by where they begin in the breast. Ductal cancer is located in the breast ducts, and lobular cancer in the lobules.
What Steps Can I Take To Help Prevent Recurrence After Treatment
The risk of cancer recurrence varies depending on multiple factors: the stage of breast cancer when diagnosed, characteristics of the tumor, individual risk factors, and treatment of the cancer. One study estimated the risk of recurrence with DCIS as less than 20%.
There are certain unavoidable factors that increase your risk of developing breast cancer and cancer recurrence. While you cannot necessarily change or control these factors, it is still helpful to be aware of them. These include:
Genetics , or family history of breast or ovarian cancer
Anything that increases someones exposure to estrogen
The good news is that there are also risk factors for breast cancer recurrence that you can control. These are called modifiable risk factors and include:
One of the best ways to prevent recurrence is follow-up mammography. This is typically recommended with greater frequency than for the general population.
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Lifestyle Also Plays A Role
Some risk factors for DCIS are modifiable. Eating lots of fruits and vegetables, maintaining a healthy weight, and limiting alcohol intake have all been linked to lower breast cancer rates, says Dr. Meyers, and they are smart habits to develop no matter what type of breast cancer you’re trying to avoid.
For women who have already had DCIS, cutting back on drinking may reduce their risk of a recurrence, according to a 2014 study in the journal Cancer, Epidemiology, Biomarkers & Prevention. “It is possible that alcohol consumption may increase risk of second breast cancer incidence,” the authors wrote in their paper, “but may not substantially increase the likelihood of aggressive second diagnoses that result in death, particularly among DCIS survivors.”
How Is Dcis Diagnosed
If a doctor sees the calcifications on your mammogram, he or she will recommend more tests, which could include a breast biopsy. During the biopsy, a doctor or other health care provider takes samples of cells or tissues from your body. The cells are examined by a pathologist a doctor who checks for signs of disease in body tissues. The pathologist looks at the cells under a microscope to see if cancer is present.
A particular kind of biopsy called a stereotactic core needle biopsy can diagnose DCIS. This is a nonsurgical, outpatient procedure. After giving you medicine to numb the breast area, the doctor or technologist collects cells from the area of concern using a needle guided by mammography.
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