Ductal Carcinoma In Situ (DCIS): Symptoms, Screening, and More

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Ductal carcinoma in situ (DCIS) occurs in the breast ducts and is a type of stage 0 breast cancer. While the disease is benign, if a person does not receive treatment, it can lead to invasive breast cancer.

A person should start treatment as soon as they are diagnosed with DCIS. doctors usually Treat this type of breast cancer with surgery and radiation therapy.

Read on to learn more about DCIS and its treatment.

DCIS begins in the lining of the milk ducts. It is a non-invasive breast cancer, which means that the cancer is only in the breast and has not spread throughout the body.

Breastcancer.org notes that people with DCIS are more likely to develop invasive breast cancer in the future, and that it may return within breast cancer as well 5–10 years the first diagnosis.

Learn more about stage 0 breast cancer here.

Researchers are unsure of the exact cause of DCIS, although they believe it is could work in families.

Doctors diagnose 60,000 cases of DCIS each year, and it accounts for one in five new breast cancer cases. While this number is relatively high, it may be due in part to the fact that people are living longer and receiving more mammography screenings than ever before.

DCIS doesn’t have many symptoms, and doctors usually do a mammogram first to detect it. Mammography screenings detect around 90% of DCIS cases. However, some people may notice a lump in their breast or nipple discharge as the first symptoms.

Other ways a doctor will diagnose DCIS lock in a physical exam of the breast and a biopsy. A biopsy will help a healthcare professional identify what stage the DCIS is at.

Hormone receptor status

A pathologist can also check the biopsy for hormone receptors. The test helps determine if the cancer cells have receptors for estrogen and progesterone, which are types of hormones.

If the test result is positive, it means the hormones are helping the cancer cells to grow. In this case, the doctor may prescribe treatments to help block the effects of estrogen or to lower the levels of estrogen in the body.

Breast cancer cells can have one, both, or neither following Receptors:

  • ER-positive: This means that the cells have estrogen receptors.
  • PR positive: This means that the cells have progesterone receptors.
  • Hormone receptor positive: Healthcare professionals use this term when the cancer cells have one or both of the hormone receptors listed above.
  • Hormone receptor negative: Healthcare professionals use this term when the cancer cells do not have any of the hormone receptors listed above.

There are three classes from DCIS. You are:

  • Grade I or low grade: In this case, the DCIS cells appear similar to normal cells and grow slowly. People with low-grade DCIS are more likely to develop invasive breast cancer after 5 years.
  • Grade II or moderate grade: Medium quality cells grow faster and appear less like normal cells.
  • Grade III or high grade: At this stage, the cells grow rapidly and look different from healthy cells. People with high-grade DCIS are more likely to develop invasive cancer and are more likely to have cancer recurring within the first 5 years.

Low and intermediate grade DCIS cells have different patterns:

  • Papillary: The cells are arranged in a finger-like pattern.
  • Crib shape: There are gaps between cells.
  • Solid: The cancer cells completely fill the breast duct.

Healthcare professionals typically do not use chemotherapy to treat DCIS.

Treatment for DCIS depends on how much cancer there is in the breast and whether the DCIS is aggressive.

Treatment options lock in::

Lumpectomy (breast-conserving surgery) with radiation therapy

During this procedure, as a precaution, the surgeon removes the tumor and some healthy breast tissue nearby.

Sometimes they can also remove the lymph nodes and request a biopsy to confirm that the cancer has not spread. Health professionals call this a sentinel lymph node biopsy (SLNB). They are more likely to do this when the tumor is large.

After surgery, a person receives radiation therapy to destroy any remaining cells.

Wide excision

Sometimes a person will only have one lumpectomy. However, this is not standard treatment, and doctors reserve this for people with very inferior DCIS.

A person should speak to their doctor about radiation therapy if they are unsure about this approach.

Mastectomy

If the DCIS is in many areas of the breast or if the tumor is large, a surgeon can remove the entire breast.

Usually, a surgeon will also perform an SLNB to confirm whether there are cancer cells in the lymph nodes. Sometimes a person will have reconstructive surgery immediately after the mastectomy or treated as a separate procedure.

Depending on the individual circumstances, a person would usually not receive radiation therapy after a mastectomy.

Hormone therapy after surgery

If doctors know the cancer is using estrogen and progesterone to grow, they likely suggest hormone therapy.

This treatment blocks Tumor receptors that bind to these hormones or reduce the amount of estrogen and progesterone in the body. A person can continue hormone therapy for 5 years after the operation.

The survival rate from DCIS is high because people get their breast cancer diagnosis early and start treatment before the cancer becomes a more invasive type.

The vast majority of people with DCIS can expect a normal life expectancy. However, compared to the general population, they are at a higher risk of developing invasive breast cancer in the future.

In cases where a person is not receiving treatment for DCIS, the cancer can become an invasive type and spread to other parts of the body.

According to Cancer Research UKIt is rare for DCIS to return after a mastectomy.

Breastcancer.org finds that those who undergo a lumpectomy without radiation have a 25-30% chance of experiencing a relapse. With radiation therapy this is reduced to 15%.

If breast cancer returns after DCIS treatment, there is a 50% chance that it is not invasive breast cancer.

The researchers at a Meta-analysis 2019 found that invasive breast cancer is more likely to develop if:

  • A person is premenopausal
  • Residual tumor cells were present after treatment
  • The DCIS was previously severe or grade III

According to a 2019 article in the magazine cancerCompared to white women, black women are more likely to:

  • die of breast cancer after DCIS
  • develop invasive breast cancer after DCIS
  • Development of ER-positive or PR-positive invasive breast cancer according to DCIS

In addition, black women were disproportionately affected by basal-like tumors, and their chance of developing triple negative breast cancer doubled after DCIS.

The researchers find that the higher death rates are partly due to the higher likelihood of developing more aggressive breast cancers, such as triple negative breast cancer. However, it is also the result of health inequalities including lack of access to competent oncological care and delays in treatment.

Learn more about how breast cancer affects black women here.

Screening for DCIS is incredibly important because the sooner a person is diagnosed, the sooner their treatment can begin.

The Centers for Disease Control and Prevention (CDC) Conduct a National Breast and Cervical Cancer Screening Program (NBCCEDP) for those on low incomes or for those who are underinsured or have no insurance.

The program also includes:

  • People whose annual income is below 250% of federal poverty
  • People between 40 and 64 years of age
  • other people younger or older who may need breast screening

Find out more about breast cancer screening programs here.

Like DCIS, LCIS is a different type of in situ breast cancer. A doctor would find out through a biopsy.

Researchers aren’t sure if LCIS is a type of cancer as it rarely turns into an invasive cancer. However, people with LCIS are at higher risk of developing breast cancer in the future.

Doctors tend to find LCIS after doing a biopsy for another reason usually not appear in mammograms and are less common than DCIS.

Because people with DCIS are at higher risk of developing invasive breast cancer in the future, remember to physically examine their breasts for lumps and speak to their doctor if they have changes in the breast, a lump, or discharge from the breast Notice the nipple.

People should be aware that mammography screenings detect most DCIS cases as the condition is often symptomless. As a result, a person should be sure to have regular screenings.

DCIS is a type of breast cancer that starts in the breast canals.

Doctors usually catch DCIS early, which means the survival rate is high.

If a person cannot get mammography screening because of their insurance coverage, they should look up the CDC NBCCEDP initiative.

After recovering from DCIS, a person should continue to self-examine their breasts and speak to a doctor if they notice any changes.



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