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?
Stage 2 Breast Cancer
What is Stage 2 breast cancer?
Stage 2 breast cancer cells or tumors are larger than Stage 1 cancers, and may have spread to nearby lymph nodes. There are two types of Stage 2 breast cancer:
- Stage 2A Generally speaking, Stage 2A breast cancer can indicate one of the following:
- No tumor can be found in your breast, but cancer larger than 2 millimeters can be found in one to three underarm lymph nodes or near the breastbone.
- The tumor measures 2 centimeters or smaller, and has spread the nearby axillary lymph nodes.
- The cancer has not spread to area lymph nodes, however, the tumor measures between 2 and 5 centimeters.
What are the treatment options for Stage 2 breast cancer?
Stage 2 breast cancer treatment timeline
Again, it depends on what treatments or follow-up therapies are needed. Generally, the treatment timeline for Stage 2 breast cancer can last three to six months. Again, certain treatments like hormone therapies designed to stop the cancer from coming back can last for one to 10 years.
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Cancers Linked To Radiation Treatment
Lung cancer:;The risk of lung cancer is higher in women who had radiation therapy after a mastectomy as part of their treatment. The risk is even higher in women who smoke. The risk does not seem to be increased in women who have radiation therapy to the breast after a lumpectomy.
Sarcoma: Radiation therapy to the breast also increases the risk of sarcomas of blood vessels , bone , and other connective tissues in areas that were treated. Overall, this risk is low.
Certain blood cancers: Breast radiation is linked to a higher risk of leukemia and myelodysplastic syndrome . Overall, though, this risk is low.
What Is Stage 2 Breast Cancer
Also known as invasive breast cancer, the tumor in this stage measures between 2 cm to 5 cm, or the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. Stage 2 breast cancer indicates a slightly more advanced form of the disease. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue, and the tumor is larger than in stage 1 disease. However, stage 2 means the cancer has not spread to a distant part of the body.
At stage 2, a tumor may be detected during a breast self-exam as a hard lump within the breast. Breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable.
Stage 2 breast cancer is divided into two categories:
Stage 2A: One of the following is true:
- There is no tumor within the breast, but cancer has spread to the axillary lymph nodes, or
- The tumor in the breast is 2 cm or smaller and cancer has spread to the axillary lymph nodes, or
- The tumor in the breast measures 2 cm to 5 cm but cancer has not spread to the axillary lymph nodes.
Stage 2B: One of the following is true:
- The tumor measures 2 cm to 5 cm and cancer has spread to the axillary lymph nodes, or
- The tumor is larger than 5 cm but cancer has not spread to the axillary lymph nodes.
At stage 2, TNM designations help describe the extent of the disease. Most commonly, stage 2 breast cancer is described as:
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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.
The Tnm System For Staging Breast Cancer
The AJCCs addition of the letters T, N, and M for anatomic breast cancer staging adds more information to a breast cancer diagnosis. Heres what they mean:
- T : The tumor grade shows a higher number for a larger size or density.
- N : Nodes refers to lymph nodes and uses the numerals 0 to 3 to give information about how many lymph nodes are involved in the cancer.
- M : This refers to how the cancer has spread beyond the breast and lymph nodes.
The AJCC also added clarifications in staging for ER, PR, and HER2 expression and also genetic information.
Ultimately, this means someone diagnosed with stage 3 breast cancer can receive more information from their breast cancer staging than ever before.
No matter the stage, the best source of information about your individual outlook is your own oncology team.
Getting the right treatment and the support you need can help you navigate the challenges of being diagnosed with stage 3 breast cancer.
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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%.
Dcis Breast Cancer Survival Rate
The DCIS breast cancer treatment prognosis is very good as it is non-invasive. The survival rate usually not depends upon selected treatment option, as treatment is totally depended upon patient condition, means the size of the tumor. The usual finding shows that the general mortality rate from breast cancer after at 20 years of diagnosis is 3.3%;5,6.
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Breast Cancer Staging Guidelines
The TNM system is the most widely used cancer staging system and looks at the following cancer characteristics:
- Tumor The size of the tumor and whether it has grown into nearby tissue.
- Node Whether the cancer has spread to nearby lymph nodes. And if so, how many.
- Metastasis Indicates whether the cancer has spread to distant organs, like the lungs or liver.
But when it comes to breast cancer staging, the TNM system was expanded to include additional cancer characteristics, including:
- Estrogen-receptor status or progesterone-receptor status Whether the cancer has estrogen or progesterone receptors. A positive status means the cancer can use either hormone to grow.
- HER2 status Whether the cancer produces HER2, a protein that promotes the growth of cancer cells.
- Grade Indicates how much the cancer cells look like healthy cells.
- Oncotype DX recurrence score Indicates how likely a group of genes may respond to treatment, depending on ER, PR and HER2 status.
Dcis Can Happen At Any Age
“DCIS can happen to anybody, anytime,” says Dr. Meyers, but it’s usually diagnosed in women over 40, the age at which many women begin getting mammograms. According to the American Cancer Society, DCIS rates increase with age, and peak around age 70 to 79.
Women diagnosed with DCIS under age 50 have a higher rate of recurrence or of an invasive cancer, and therefore more aggressive treatment is usually recommended, says Dr. White. Those over 50, on the other hand, can take comfort in knowing that a diagnosis does not raise their risk of early death.
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What Is Stage 0
Stage 0 is the least invasive stage of breast cancer and usually detected early in patients, according to the American Cancer Society.;In this stage,;cancer cells or non-cancerous abnormal cells are only in the part;of the breast in which they formed and haven’t spread.;
“At this stage of breast cancer, we tell patients not to be too worried. Stage 0 is extremely treatable and we ask people not to shed a tear over the diagnosis just yet,” said;Cruz.;
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What Is The Life Expectancy For Stage 3 Breast Cancer
The life expectancy for people with breast cancer is improving, according to the American Cancer Society. It points out that current survival rates are based on people who were diagnosed and treated at least 5 years ago and treatments have advanced over that time.
Your life expectancy with stage 3 breast cancer depends on several factors, such as:
- your age
- the size of the tumors
You should talk with your doctor about how these factors may apply to you.
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Pearls And Other Issues
Breast cancer patients are advised to be followed up for life to detect early recurrence and spread. Yearly or biannual follow-up mammography is recommended for the treated and the other breast. The patient must be informed that they must visit a breast clinic;if they have any suspicious manifestations. Currently, there is no role for repeated measurements of tumor markers or doing follow-up imaging other than mammography.
Lumpectomy Plus Radiation Therapy And Local Recurrence
For women who have lumpectomy plus radiation therapy, the chance of local recurrence in 10 years is about 3-15 percent .
The risk of local recurrence depends on tumor characteristics, including biomarkers .
It also depends on whether or not the tumor margins and the lymph nodes in the underarm area contain cancer cells. The chance of local recurrence is lower when :
- Tumor margins do not contain cancer
- Lymph nodes do not contain cancer
Chemotherapy, hormone therapy and/or HER2-targeted therapy can lower the risk of breast cancer recurrence for people treated with lumpectomy plus radiation therapy .
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Ductal Carcinoma In Situ
Ductal carcinoma in situ is breast cancer of the milk ducts. The milk ducts are canals that take milk from the milk glands to the nipple.
Without treatment, DCIS can spread and become more aggressive. In about half of all cases, DCIS may become invasive cancer.
A doctor may recommend an MRI scans or a mammogram and a biopsy to diagnose breast cancer and determine its stage.
They will stage a cancer from 0 to 4. A higher stage indicates more advanced disease.
To determine the stage of breast cancer, doctors look at three factors:
- T, or the size of the breast tumor.
- N, or the spread of the cancer to lymph nodes, and how many it has affected.
- M, or the cancer has spread to other areas of the body, which is known as metastasis.
There are four stages of breast cancer after stage 0:
- Stage 1: The tumors are small and have spread very little, if at all.
- Stage 2: At this stage, the tumors are slightly larger and have spread to nearby tissue but not other organs. They may infect a small number of lymph nodes or a limited section of nearby tissue.
- Stage 3: These cancers are larger and have spread further than stage 2 tumors. They may infect wider areas of breast tissue or several nearby lymph nodes but not other organs.
- Stage 4: The cancer cells have spread to other organs in the body.
Doctors may divide each stage into A and B categories.
Survival Rates For Triple
Triple-negative breast cancer is considered an aggressive cancer because it grows quickly, is more likely to have spread at the time its found and is more likely to come back after treatment than other types of breast cancer. The outlook is generally not as good as it is for other types of breast cancer.
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
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What Is The Chance I Could Die In The Next 5 Years
The average 5-year survival rate for all people with breast cancer is 89%. The 10-year rate is 83%, and the 15-year rate is 78%. If the cancer is located only in the breast , the 5-year survival rate is 99%. More than 70% of breast cancers are diagnosed at an Early Stage.
All survival statistics are primarily based on the stage of breast cancer when diagnosed. Some of the other important factors are also listed below that affect survival.
Stage 0;breast cancer can be also described as a pre-cancer. If you have DCIS you can be quite confident you will do well. DCIS does not spread to other organs. What can be concerning is when an invasive cancer grows back in the area of a prior lumpectomy for DCIS. This type of local recurrence does carry a risk to your life. Luckily, this does not happen frequently. Also, be aware that those who have had DCIS in the past are at a higher risk for developing an entirely new, invasive breast cancer. Take our video lesson on Non-Invasive DCIS to learn more.
Stage I;invasive breast cancer has an excellent survival rate. The chance of dying of Stage I breast cancer within five years of diagnosis is 1 to 5% if you pursue recommended treatments.
Stage II breast cancer is also considered an early stage of breast cancer. There is a slightly increased risk to your life versus a Stage I breast cancer. Altogether, the risk of Stage II breast cancer threatening your life in the next 5 years is about 15%.
The Stages Of Breast Cancer And Your Treatment Options
Compared to most other cancers, staging breast cancer is more complex. And when it comes to treating breast cancer, there isnt a one-size-fits-all approach. Your treatment plan should be created especially for you and be coordinated across specialists and thats where your cancer care team comes in.
At HealthPartners, we believe cancer treatment and care is best managed by a group of doctors and specialists in whats known as multidisciplinary conferences. This is where breast surgeons, oncologists, radiologists, pathologists and other members of your care team gather to discuss the best treatment sequence for you.
Below we dive into the treatment options your care team might recommend at various breast cancer stages.
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