What is ductal carcinoma in situ?
Diagnosis and treatment of ductal carcinoma in situ
This information is a general explanation only, and may not cover your situation exactly. All women with DCIS should obtain expert advice.
Ductal carcinoma in situ (DCIS) is a condition that can occur in several different forms. In all of these, there is a change in the cells lining the milk ducts of the breast. Under a microscope, a normal duct shows a lining of a single layer of cells, but in DCIS, many more cells can be seen. Often the cells almost fill the duct, as illustrated below. For some women, DCIS is found in only a few ducts, but for others, it may be discovered in much of the duct system of the breast.
These extra cells in the duct show some of the abnormalities of cancer cells, but they have not spread outside the duct (in situ means 'in place'). For this reason, DCIS is not considered to be 'true' or invasive cancer. When left untreated, DCIS may progress and invade nearby breast tissue, becoming a 'true' breast cancer. However, we cannot predict whether or when this will occur, so the condition needs to be treated. Treatment for DCIS should have a very good outcome because it should prevent progress to an invasive breast cancer.
As screening mammography becomes more common, DCIS is diagnosed more often than in the past. More rarely, a woman may be diagnosed with DCIS after she finds a breast change such as a lump or a nipple discharge.
DCIS can often be seen as a particular pattern of tiny calcifications on the mammogram. Although the shape and size of the calcification may suggest DCIS to the radiologist, the diagnosis will need to be confirmed by further investigation. The doctor will usually recommend a core needle biopsy, which involves removal of a sliver of tissue through a needle under local anaesthetic. This tissue is then sent to a pathologist. The diagnosis may also be made by surgical (open) biopsy. A surgical biopsy is done in a hospital, but you will not usually have to stay overnight.
Treatment for DCIS depends on each woman's situation. More often than in the past, doctors are able to offer conservative treatment. This means that the surgeon will only remove the area of DCIS, along with a small border of unaffected tissue. Occasionally, further treatment by radiation will be suggested. Radiation therapy can have side effects, and you should find out about these before starting a course of treatment. Click here for more information on radiotherapy.
After this conservative surgery is completed, with or without radiation, there is some risk of recurrence. Sometimes the recurrence will be DCIS (still within the duct), but sometimes it will be invasive breast cancer (spreading into the tissue outside the duct). There is no evidence of any benefit from axillary dissection (removal of lymph nodes from the armpit) in women with DCIS1.
For some women, the doctor will recommend a mastectomy (removal of the affected breast). No further treatment is needed for that breast following mastectomy, and the future risk of breast cancer becomes very small—around one per cent. The other breast should be regularly checked by mammography and physical examination.
When you have been treated for DCIS, you will probably be advised to have more frequent mammograms than before, and regular physical examination. Your doctor may also want to check that you are aware of the best way to examine your own breasts for signs of unusual change.
Tamoxifen therapy may be recommended after DCIS has been diagnosed and treated. It is taken in tablet form for up to five years. Tamoxifen has a proven role in the treatment of invasive breast cancer, and there are now clinical trials indicating it is useful in treating DCIS.
Women with a diagnosis of DCIS may think about taking hormone replacement therapy (HRT) if they are troubled by symptoms arising from menopause. Although the risks are unclear, the benefits of HRT can be important for individual women. If you are considering taking HRT, discuss your situation with your doctor. In particular, ask about the appropriate dosage, the length of time to continue taking HRT, and any other preparations that may help with problems arising from menopause.
You can also ring the Cancer Helpline on 13 11 20 if you would like to discuss questions of concern to you.
Updated June 2007.
