Treatment for DCIS

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What is DCIS?

DCIS (ductal carcinoma in situ) is a non-invasive breast cancer.

With 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 abnormal cells have not left the milk ducts to invade nearby breast tissue outside the milk ducts.

Image source: National Cancer Institute (www.cancer.gov)

DCIS is also called intraductal (within the milk ducts) carcinoma. Some people use the terms “pre-invasive” or “pre-cancerous” to describe DCIS.

DCIS is treated to try to prevent the development of invasive breast cancer.

The following is a 3D interactive model showing DCIS. The labels show a normal duct and a duct with DCIS.

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 (the chance of survival) 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 breast cancer over time.

Left untreated, it’s estimated 10%-50% of DCIS cases may progress to invasive breast cancer [1-4].

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.

Surgery (with or without radiation therapy) is recommended as the first step to treat DCIS. After surgery and radiation therapy, some people take hormone therapy.

Learn more about treatments for DCIS.

Learn about the risk of invasive breast cancer after treatment for DCIS.

Learn about emerging areas in the treatment of DCIS.

Throughout your treatment and beyond, you’ll get care from many health care providers. Your health care team may include:

Doctors involved in cancer treatment (medical oncologists, surgeons, radiation oncologists)
Doctors involved in other care for people with breast cancer (radiologists, pathologists, palliative care or pain specialists, and others)
Your primary care doctor
Nurses
Genetic counselors
Patient navigators and social workers
Mental health providers (counselors, clinical social workers, psychologists and others)
Dietitians
Physical therapists
Pharmacists
Other health care providers

These health care providers may be involved in your care throughout diagnosis, treatment and recovery.

Learn about choosing a doctor.

Susan G. Komen^®‘s Patient Navigator Program

Komen Patient Navigators can help guide you through the health care system. They can help to remove barriers to high-quality breast care. For example, they can help you with insurance, local resources, communication with health care providers and more.

Call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org to learn more about our Patient Navigator program, including eligibility.

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Online access to your medical information

Most hospitals and doctor offices now allow you access to your medical information online. You set up an account with a login name and password. This provides security to protect your privacy.

An online account gives you access to your test results, pathology and radiology reports, prescription drug information, medical appointments, doctors’ notes and more. It also gives you an easy way to communicate with your health care team.

Staying organized

It may be helpful to use a notebook, 3-ring binder or other organizer to keep track of your breast cancer treatments and health care team.

You may want to include:

A directory of the names, addresses and contact information for your health care team
Insurance information
Medication lists
Pharmacy contact information
Other medical information
A calendar to help plan and keep track of appointments
Blank paper to write down any questions you may have, or to record any side effects you’re having or other information you think your health care team needs to know
Pockets to store materials

Susan G. Komen^® has interactive Questions to Ask Your Doctor resources that you can download and may be helpful to include.

Treatment guidelines

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.

The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) are respected organizations that regularly review and update their guidelines.

In addition, the National Cancer Institute (NCI) provides treatment overviews.

Prognosis for DCIS

With treatment, prognosis (the 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. It’s the main treatment for DCIS, but you may also have other treatments.

Depending on how far the DCIS has spread within the milk ducts, surgery can be a mastectomy or a lumpectomy.

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, you likely have a choice can be made between a mastectomy or a lumpectomy.

With a lumpectomy, the surgeon removes only the abnormal tissue in the breast and a small rim of normal tissue around it (called a margin). The rest of the breast is left intact. Lymph nodes are not usually removed with a lumpectomy for DCIS.

Overall survival is the same for women with DCIS who have a mastectomy and those who have a lumpectomy (with or without radiation therapy) [5].

In the U.S., most women with DCIS are treated with a lumpectomy followed by radiation therapy [6].

Learn about deciding between a mastectomy and a lumpectomy.

Sentinel node biopsy during a 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 lymph nodes). The surgeon removes 1-5 axillary lymph nodes.

Having a sentinel node biopsy during a mastectomy helps some people with DCIS avoid a more invasive lymph node surgery later.

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, and a sentinel node biopsy wasn’t done, another surgery to remove axillary lymph nodes may be needed. This surgery removes more lymph nodes than a sentinel node biopsy. If a sentinel node biopsy was already done, surgery to remove more nodes may be avoided.

So, even though a sentinel node biopsy may not be needed with DCIS, many people who have a mastectomy for DCIS will have a sentinel node biopsy done at the same time.

Radiation therapy

Standard radiation therapy (also called radiotherapy) uses targeted, high-energy X-rays or other forms of radiation to kill cancer cells.

The goal of radiation therapy is to kill any cancer that might be left in the breast after breast cancer surgery.

After a mastectomy

Women treated with a mastectomy for DCIS don’t benefit from radiation therapy. However, in rare cases, it may be recommended because of the extent or location of the DCIS.

After a lumpectomy

A lumpectomy for DCIS is usually followed by radiation therapy to lower the risk of [5-12]:

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 a lumpectomy plus whole breast radiation therapy reduced the risk of DCIS recurrence or invasive breast cancer (each in the breast treated for DCIS) by half compared to a lumpectomy alone [6].

Overall survival is the same for women with DCIS who have a lumpectomy with or without whole breast radiation therapy [5-7]. So, questions remain about the need for all women to get radiation therapy after a lumpectomy for DCIS.

Some women, with small, low-grade or intermediate-grade DCIS, and widely negative surgical margins have a low risk of DCIS recurrence or invasive breast cancer after a lumpectomy [5]. (Low-grade and intermediate-grade DCIS tend to grow more slowly than high-grade DCIS. 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 [5,12-13].

Radiation therapy for DCIS is usually given every day, 5 days a week, for 3-4 weeks.

Learn about going through radiation therapy.

Learn more about surgical margins.

For a summary of research studies on treatment for DCIS with a lumpectomy plus whole breast radiation therapy, visit the Breast Cancer Research Studies section.

Hormone therapy

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-positive tumors need estrogen and/or progesterone to grow.
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. People with hormone receptor-positive DCIS may benefit from hormone therapy (tamoxifen or an aromatase inhibitor) [5,9,14-18].

Learn about hormone receptor status and invasive breast cancer.

After a mastectomy

Hormone therapy isn’t recommended for women who have a mastectomy for DCIS. These women have an excellent prognosis (chance of survival) with a very low risk of DCIS recurrence or developing invasive 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.

After a lumpectomy

The National Comprehensive Cancer Network (NCCN) recommends women who are treated with a lumpectomy for estrogen receptor-positive DCIS consider taking hormone therapy (tamoxifen or an aromatase inhibitor) for 5 years [5].

In women treated with a lumpectomy and radiation therapy for DCIS, studies have shown hormone therapy can lower the risk of [5-12]:

DCIS recurrence (a return of DCIS)
Invasive breast cancer

These risks are lowered in both the treated breast and the opposite breast.

Learn more about tamoxifen, including possible side effects.

Learn more about aromatase inhibitors, including possible side effects.

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 for treatment of DCIS, visit the Breast Cancer Research Studies section.

Komen Perspectives

Read our perspective on DCIS.*

Learn More

Risk of developing invasive breast cancer after DCIS

After treatment for DCIS, there’s a small risk of:

DCIS recurrence (a return of DCIS)
Invasive breast cancer

These risks are higher with a lumpectomy plus radiation therapy than with a mastectomy [5]. However, overall survival is the same after either treatment [5].

Higher grade DCIS appears more likely than lower grade DCIS to progress to invasive cancer after treatment (surgery, with or without radiation therapy) [19].

With close follow-up, invasive breast cancer is usually caught early and can be treated effectively.

Is ductal carcinoma in situ (DCIS) breast cancer? How does DCIS differ from invasive breast cancer?
What are my treatment options? Which treatments do you recommend for me and why?
What are my chances for DCIS recurrence? What about developing invasive breast cancer?
How quickly do I need to make a decision about my treatment plan?
Do you recommend I have a lumpectomy (breast-conserving surgery)? If not, why not?
If I have a lumpectomy plus radiation therapy now, and the breast cancer returns (DCIS recurrence or invasive breast cancer), will I need to have a mastectomy at that time?
Will I need radiation therapy after my surgery? If so, when will I meet with the radiation oncologist to discuss my radiation therapy?
If I have a mastectomy, will a sentinel node biopsy be done?
Is my DCIS estrogen receptor-positive or estrogen receptor-negative? If my DCIS is estrogen receptor-positive, what are the benefits of taking a hormone therapy drug (tamoxifen or an aromatase inhibitor)?
Were my tumor margins negative (also called uninvolved, clean or clear)? If not, what more will be done?
Tell me about breast reconstruction if I have a mastectomy. If I decide I want reconstruction, when can I have it (at the same time as the mastectomy or at a later date)? What are the risks? What about prosthesis options? Who else should I see to discuss and plan for reconstruction or prosthesis?
How often will I have check-ups and follow-up tests after treatment ends?
Will a follow-up care plan be prepared for me?
Who is in charge of my follow-up care?
Are there clinical trials enrolling people with DCIS? If so, how can I learn more?
Will some of the tissue removed during surgery be stored? Where will it be stored? For how long? How can it be accessed in the future?

Learn more about talking with your health care provider.

If you’ve 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 doctor’s appointment. Or you can download, type and save it on your computer, tablet or phone using an app such as Adobe. Plenty of space and a notes section are provided to write 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.

Susan G. Komen^® was one of 13 organizations that sponsored the National Academy of Sciences report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis.

The report identified key ways to improve quality of care:

Make sure cancer patients understand their diagnoses so they can make informed treatment decisions with their health care providers
Develop a trained and coordinated workforce of cancer professionals
Focus on evidence-based care
Focus on quality measures
Provide accessible and affordable care for all

Read the full report.

Clinical trials

After discussing the benefits and risks with your health care provider, we encourage you to join a clinical trial if there’s one right for you.

Susan G. Komen^® Breast Care Helpline

If you or a loved one needs information or resources about clinical trials, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877- 465- 6636) or email clinicaltrialinfo@komen.org.

Se habla español.

BreastCancerTrials.org in collaboration with Komen offers a custom matching service to help find clinical trials that fit your health needs.

Learn what else Komen is doing to help people find and participate in breast cancer clinical trials, including trials supported by Komen.

Learn more about clinical trials.

Updated 09/22/23