Treatment for DCIS
What is DCIS?
DCIS (ductal carcinoma in situ) is a non-invasive breast cancer.
In DCIS, the abnormal cells are contained in the milk ducts (canals that carry milk from the lobules to the nipple openings during breastfeeding). It’s called “in situ” (which means “in place”) because the cells have not left the milk ducts to invade nearby breast tissue.
Image source: National Cancer Institute (http://www.cancer.gov)
DCIS is also called intraductal (within the milk ducts) carcinoma. You may hear the terms “pre-invasive” or “pre-cancerous” to describe DCIS.
DCIS is treated to try to prevent the development of invasive breast cancer.
DCIS diagnosed with invasive breast cancer
DCIS can be found alone or with invasive breast cancer.
If DCIS is diagnosed with invasive breast cancer, treatment and prognosis are based on the invasive breast cancer (not the DCIS).
Learn about treatment for early breast cancer.
Treatment for DCIS
DCIS is non-invasive, but without treatment, the abnormal cells could progress to invasive cancer over time.
Left untreated, it’s estimated 20-50 percent of DCIS cases may progress to invasive breast cancer [1-5].
Health care providers cannot predict which cases of DCIS will progress to invasive breast cancer and which will not. Because DCIS might progress to invasive breast cancer, almost all cases of DCIS are treated.
Learn more about treatments for DCIS.
Learn more about emerging areas in the treatment of DCIS.
Although the exact treatment for DCIS varies from person to person, guidelines help ensure high-quality care. These guidelines are based on the latest research and agreement among experts.
In addition, the National Cancer Institute (NCI) provides treatment overviews.
Prognosis for DCIS
With treatment, prognosis (chance of survival) for DCIS is usually excellent.
Thelma Brown, Komen Advocates in Science member
“A diagnosis of any stage of breast cancer can be very frightening. Often, the first instinct is to act quickly. There is not a one size fits all approach to breast cancer, and DCIS is no different. Therefore, it is important to slow down and take the time to learn about DCIS and your treatment options. This will enable you to be an active member of your health care team and share in the decision making.”
Surgery for DCIS
Surgery is the first step to treat DCIS. It removes the abnormal tissue from the breast.
If DCIS is spread throughout the ducts, affecting a large part of the breast, a total (simple) mastectomy will be done. With a total mastectomy, the surgeon removes the entire breast and possibly some lymph nodes, but no other tissue.
If there’s little spread of DCIS within the ducts, a choice can be made between mastectomy or lumpectomy.
With lumpectomy, the surgeon removes only the abnormal tissue in the breast and a small rim of normal tissue around it. The rest of the breast is left intact. Lymph nodes are not usually removed with lumpectomy for DCIS.
In the U.S., most women with DCIS are treated with lumpectomy followed by radiation therapy .
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 (axillary nodes). 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 can’t have a sentinel node biopsy.
If it turns out there’s invasive breast cancer (along with DCIS) in the tissue removed during the mastectomy, a sentinel node biopsy will have already been done.
If a sentinel node biopsy wasn’t 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.
Radiation therapy is rarely given to women treated with mastectomy for DCIS.
Lumpectomy for DCIS is usually followed by whole breast radiation therapy to lower the risk of [6-13]:
- DCIS recurrence (a return of DCIS) in the treated breast
- Invasive breast cancer in the treated breast
A meta-analysis that combined the results of 4 randomized clinical trials showed lumpectomy plus whole breast radiation therapy reduced the risk of invasive breast cancer (in the breast treated for DCIS) by half compared to lumpectomy alone .
Overall survival is the same for women with DCIS who have lumpectomy with or without whole breast radiation therapy [6-8]. So, questions remain about the need for all women to get radiation therapy after lumpectomy for DCIS.
Some women with small, low grade DCIS and negative surgical margins have a low risk of recurrence after lumpectomy. (Margins are negative when there are no cancer cells in the rim of breast tissue surrounding the tumor that was removed during surgery.) Some of these women may choose to avoid radiation therapy altogether, or consider limited radiation therapy such as partial breast radiation therapy [6,13-14].
For a summary of research studies on lumpectomy plus whole breast radiation therapy in the treatment of DCIS, visit the Breast Cancer Research Studies section.
Hormone receptor status
A pathologist determines the hormone receptor status of the DCIS by testing the tissue removed during a biopsy.
- Hormone receptor-positive (estrogen receptor-positive/progesterone receptor-positive) DCIS tumors express hormone receptors. This means they have a lot of hormone receptors.
- Hormone receptor-negative (estrogen receptor-negative/progesterone receptor-negative) DCIS tumors do not express hormone receptors. This means they have few or no hormone receptors.
Most cases of DCIS are hormone receptor-positive. Hormone receptor-positive DCIS may benefit from hormone therapy (tamoxifen or an aromatase inhibitor) [6,10,15-19].
Learn about hormone receptor status and invasive breast cancer.
Hormone therapy isn’t recommended for women who have a mastectomy for DCIS. These women have an excellent prognosis with a very low risk of DCIS recurrence or developing breast cancer in the opposite breast.
For women who have a mastectomy for DCIS, the benefit of hormone therapy would likely be very small and would mostly affect the risk of cancer in the opposite breast.
The National Comprehensive Cancer Network (NCCN) recommends women who are treated with lumpectomy for estrogen receptor-positive DCIS consider taking hormone therapy (tamoxifen or an aromatase inhibitor) for 5 years .
In women treated with lumpectomy and radiation therapy for DCIS, studies have shown hormone therapy can lower the risk of [6-13]:
- DCIS recurrence
- Invasive breast cancer
These risks are lowered in both the treated breast and the opposite breast.
Learn more about factors that affect treatment options.
Learn about emerging areas in the treatment of DCIS.
For a summary of research studies on tamoxifen as a treatment for DCIS, visit the Breast Cancer Research Studies section.
Read our perspective on DCIS.*
Risk of developing invasive breast cancer after DCIS
After treatment for DCIS, there’s a small risk of:
- DCIS recurrence
- Invasive breast cancer
Higher grade DCIS appears more likely than lower grade DCIS to progress to invasive cancer after treatment (surgery, with or without radiation therapy) .
With close follow-up, invasive breast cancer is usually caught early and can be treated effectively.
Learn more about tumor grade.
The National Academy of Sciences released the report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis in 2013. Susan G. Komen® was one of 13 organizations that sponsored this study.
The report identified key ways to improve quality of care:
Read the full report.
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