It Can Be A Controversial Diagnosis For Healthcare Providers
One article talked about how pathologists disagree with one another about 8% of the time when diagnosing breast biopsy samples and that cases of DCIS were the most difficult to reach a conclusion about.
About 19% of DCIS cases were overinterpreted in the study, meaning they were mistakenly categorized at a higher grade or invasive cancer. About 12% were underinterpreted or mistakenly categorized at lower grades.
The authors wrote that non-invasive breast lesions represent a “gray zone” in medicine, where there’s not always a right or wrong diagnosis. They said that revised guidelines are needed to make sure DCIS patients get a consistent diagnosis they can trust.
What Else Do Mammograms Show
Other than calcifications, healthcare providers will look for other breast changes to help them determine if more testing may be necessary. Mammograms can show:
- Masses: Breast tissue areas that have a shape and edges, making them look different from other breast tissue
- Asymmetries: White areas on a mammogram with a different tissue pattern than normal breast tissue
- Distortions: Breast tissue areas that have been moved toward a certain position
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.
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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You Can Still Breastfeed After Dcis
Even though DCIS affects the milk ducts, it doesn’t necessarily mean you can’t produce milk if you become pregnant after diagnosis and treatment.
“As long as a woman has surgery alone, and assuming the lesion is not too close to the nipple, DCIS should not cause problems with conceiving or breastfeeding,” explained Dr. Meyers.
If you have been treated with radiation or hormone therapy in addition to surgery, on the other hand, “we usually recommend that a woman see her gynecologist or a fertility doctor to ensure there won’t be an issue,” added Dr. Meyers.
Talk With Others Who Understand
MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.
Do you still have questions about stage 0 breast cancer? Share your experiences in the comments below, or start a conversation by posting on MyBCTeam.
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How Is Stage 0 Detected
Although it rarely presents as a mass, DCIS is most often detected with mammograms, and in certain cases, with MRIs. Keeping up with regular breast self-exams, recommended screenings and mammography, and if appropriate in limited cases MRI, is the best self-defense, says Dr. Cappuccino.
Once detected, surgical removal of the abnormal cells is often recommended, in most cases with a lumpectomy, even though DCIS doesnt usually form a lump. Following surgery, radiation therapy is often recommended to reduce both the risk of a future invasive cancer and the risk of DCIS recurring. Hormone-blocking pills may also be recommended to help decrease the risk of recurrence.
The doctors at Roswell Park are meticulous about providing thorough and expert evaluations using state-of-the-art imaging technology, such as digital breast tomosynthesis, also known as 3D mammography, and ultrasound and MRI as needed. Our pathologists, who specialize in breast diseases, provide expert reviews and work with a multidisciplinary team to offer expert analysis of each patient to determine their treatment with the goal of helping them achieve the best possible outcome, says Dr. Cappuccino.
Physical Emotional And Social Effects Of Cancer
In general, cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
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Side Effects And Complications
All treatments have some side effects that range from mild to severe. Most clear up when treatment ends, but there can be some lasting 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 Types Of Treatment Are Available For Ductal Carcinoma In Situ
Although DCIS isnt an aggressive or fast-spreading cancer, its still important to receive treatment or have your healthcare provider monitor your condition closely. Some forms of DCIS may become invasive without treatment. This means that the cancer spreads beyond your milk ducts and into your surrounding breast tissue.
The most common treatments for DCIS are breast-conserving surgery with radiation or a mastectomy.
Breast reconstruction may be an option if youve had a mastectomy. Speak with your healthcare provider about your preferences for how youd like your breasts to look after treatment.
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Surgery Can Reveal Additional Cancer
There is a small possibility that invasive cancer will be found during the final pathology examination after surgical removal of DCIS. When that happens, Sun says, the diagnosis would be upgraded and additional surgery and other treatments may be needed. We take each situation individually and the most optimal treatment will be tailored. This is important because each tumor and each patient is different.
She notes that at Johns Hopkins Medicine, the pathologists with whom she works are especially skilled in identifying any invasive cancer that might be present. Having DCIS treated at a comprehensive breast center ensures you are in the best possible hands, Sun says.
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.
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Personalized Treatment Is Key For Stage 0 Breast Cancer
An early form of breast cancer called ductal carcinoma in situ has stirred controversy in the medical community nationwide.
DCIS, also known as Stage 0 breast cancer, is abnormal cells that are confined to the milk ducts of the breast. The debate is whether all cases of DCIS should be treated immediately with surgery and additional therapy, or if patients should be monitored instead and treated only if the cancer spreads.
A New York Times article from August 2015 has fanned the flames of this controversy. The article features DCIS patients reacting with a mix of gratitude and outrage about their cancer treatment. Some felt their treatment was unnecessary or too severe others were glad they received proactive care.
Both sides of the debate have a viable argument: of course we dont want to perform surgeries that arent needed or expose women to radiation or hormonal therapy unnecessarily, and DCIS in some women will never spread beyond the milk ducts.
But this is our concern: DCIS has a significant chance of turning into invasive cancer. There is currently no way to know which cases will become invasive. Until we have a way to determine that, we cant just sit back and watch women develop breast cancer. We favor a personalized, case-by-case approach to treating Stage 0 breast cancer over watching and waiting.
Ive asked four of our breast cancer experts to explain our position and clear up some misconceptions about the treatment of DCIS.
Stage 1 Breast Cancer
What is Stage 1 breast cancer?
Stage 1 breast cancers are still relatively small, and theyve either not yet spread to the lymph nodes or theres only been a tiny bit of spread in the sentinel lymph node which is where the cancer is most likely to spread first. There are two types of Stage 1 breast cancer:
- Stage 1A breast cancer Stage 1A breast cancer means the tumor is no larger than 2 centimeters, and the cancer has not spread outside the breast or to lymph nodes.
- Stage 1B breast cancer Stage 1B breast cancer means there are small groups of cancer cells in the lymph nodes. There may or may not be a tumor smaller than 2 centimeters in the breast.
What are the options for Stage 1 breast cancer treatment?
- Surgery Like with Stage 0, a lumpectomy and mastectomy are both options at this stage:
- Lumpectomy This kind of breast conservation surgery is a viable option when the cancerous cells are confined to one area of the breast.
- Mastectomy A mastectomy may be recommended if cancer is found throughout the breast.
What is the Stage 1 breast cancer treatment timeline?
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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.
Considering Complementary And Alternative Methods
You may hear about alternative or complementary methods that your doctor hasnt mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.
Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctors medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.
Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known about the method, which can help you make an informed decision.
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Think About What Is Important To You
After you have talked with a breast cancer surgeon and learned the facts, you may also want to talk with your spouse or partner, family, friends, or other women who have had breast cancer surgery.
Surgery Choices: Theresa, Cindy, Paula
Three women describe how they decided which type of breast cancer surgery was right for them.
Then, think about what is important to you. Thinking about these questions and talking them over with others might help:
What Does It Mean To Have Stage 1 Breast Cancer
In Stage 1 breast cancer, cancer is evident, but it is contained to only the area where the first abnormal cells began to develop. The breast cancer has been detected in the early stages and can be very effectively treated.
Stage 1 can be divided into Stage 1A and Stage 1B. The difference is determined by the size of the tumor and the lymph nodes with evidence of cancer.
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Early Diagnosis And Treatment Are Key
Although DCIS is not an invasive cancer, early diagnosis and treatment can be life changing.
Cynthia Whiteman, who is in her 60s, explains, “When I first was diagnosed with DCIS, I was shocked. I didn’t realize there was a stage 0 cancer.” An Indiana resident, Jan had her routine mammogram in Indiana when her provider recommended a biopsy. Shortly afterward, she learned she had DCIS. “At that point I thought I would seek out the best treatment in the area.” This led her to drive to Chicago and consult with providers at Northwestern Medicine Prentice Women’s Hospital about her options.
This medication could offer women with DCIS another option for treatment.
Treatment for DCIS will differ based on the patient and care plan. However, it can include surgery, radiation or hormone therapy. If it is not found and treated, DCIS can spread outside of its place in the breast milk duct and into surrounding tissue to become invasive breast cancer. “Early detection is so important. I tell everyone to get their annual mammogram. By doing so, I feel like I dodged a bullet,” states Jan.
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Surgery And Radiation Therapy
Currently, breast-conserving treatment for DCIS is frequently recommended. A mastectomy is advised if the DCIS is too extensive to allow breast conservation.43 According to Thompson et al.,21 the recurrence rates with 5 years median follow-up are 0.8% after mastectomy, 4.1% after breast-conserving surgery followed by radiotherapy and 7.2% after breast-conserving surgery alone. According to Elshof et al.,22 invasive recurrence rates are 1.9, 8.8 and 15.4%, respectively, after 10 years median follow-up. The 15-year cumulative incidence in the National Surgical Adjuvant Breast and Bowel Project 17 trial of patients with clear margins is 19.4% after breast-conserving surgery alone and 8.9% after breast-conserving surgery followed by radiotherapy.44 Four randomised clinical trials have been performed to investigate the role of radiotherapy in breast-conserving treatment for DCIS after complete local excision of the lesion. In a meta-analysis, these trials show a 50% reduction in the risk of local recurrences after radiotherapy.45 Radiotherapy was reported to be effective in reducing the risk of local recurrence in all analysed subgroups according to age, clinical presentation, grade and type of DCIS.
Stage 0 Breast Cancer Symptoms
Very early-stage DCIS breast cancers typically dont have symptoms. Though its sometimes possible to feel a small, hard lump, most people discover they have stage 0 breast cancer through regular mammogram screenings.
Pagets disease of the breast is likely to cause noticeable changes, such as:
- Red, crusty or scaly skin of the nipple or areola
- Yellow fluid discharge from the nipple
- Other nipple discharge
- A flat or inverted nipple
- Burning or itching of the breast or nipple
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What Is Apbi In Breast Cancer
In select women, some doctors are using accelerated partial breast irradiation to give larger doses over a shorter time to only one part of the breast compared to the entire breast. Since more research is needed to know if these newer methods will have the same long-term results as standard radiation, not all doctors use them. There are several different types of accelerated partial breast irradiation: