A very early form of breast cancer is called Ductal carcinoma in situ (DCIS). This cancer begins in cells (ductal carcinoma in situ) confined inside a milk duct. In such cases, the cancer does not spread to breast tissue. In some cases, doctors also call this cancer noninvasive, preinvasive, or stage 0 breast cancer.
Healthcare providers usually identify this cancer form during screening or investigating a breast lump. Although DCIS has a lower chance of spreading to other tissues and becoming dangerous it requires treatment.
This DCIS is commonly treated through surgery, but physicians may also recommend additional treatments. These include hormone therapy, radiation therapy, and others.
Symptoms
Mostly, people with DCIS do not experience any symptoms but when it occurs, they can experience the following symptoms. Examples include:
- Bloody nipple discharge
- Breast lumps
The test that identifies DCIS is called a mammogram. It shows small flecks of calcium (also known as calcifications or calcium deposits) in the tissue of the breast. It is advised to see a doctor if you notice some changes in the breast tissue including a lump, an area of unusual skin, a thickened breast region, or a nipple discharge. In addition, most doctors recommend routine breast cancer screening to start after 40 years old.
Causes
Healthcare providers do not fully understand why DCIS occurs but they think it is caused due to a DNA change in the cells of a breast duct. DNA is a hereditary material that holds information that tells the cell what to do. In normal cases, the DNA gives instructions to grow and multiply at a set and to die. However, if a DNA change occurs it may lead to abnormal growth and multiply of certain cells. As a result, healthy cells die while abnormal ones continue to live and over time form tumors.
Fortunately, cancer cells that appear when a person experiences DICS do not have the ability to break and spread throughout the body. Some healthcare providers think that certain lifestyle, environmental factors, and DNA changes (that usually run in families) could play a role in DCIS.
Risk Factors
Check below some potential risk factors for DCIS:
- Family history of breast cancer – If you have a family member with this breast cancer type, your risk of developing it increases. However, most people diagnosed with breast cancer do not have a family history of the condition.
- Medical history of breast cancer – Those who experienced breast cancer even in one breast have an increased risk of developing this cancer type in another one.
- Breast diseases – People with breast conditions also are at increased risk of getting this cancer type. These include lobular carcinoma in situ (LCIS), atypical hyperplasia of the breast, and others.
- Early period start – When menstrual periods begin before 12 years old, the risk of breast cancer increases.
- Late menopause – If the menopause starts after 55 years old, you are at higher risk of getting breast cancer.
- Women – While anyone can develop breast cancer, females are more prone to experience this cancer type compared to males.
- Misuse of alcohol – People who drink alcohol, especially in high amounts have an increased risk of developing breast cancer.
- First child at an older age – If you become pregnant after 30 years old the risk of breast cancer increases. Furthermore, women who have never been pregnant also are at increased risk of getting this cancer type.
- Age – As a person becomes older, the risk of developing breast cancer elevates.
- Inherited DNA mutations (changes) – There are some genes usually inherited from biological parents that may increase the risk of breast cancer. These include BRCA1 and BRCA2. Although previous genes significantly elevate the risk of breast cancer, not everyone with these genes has this cancer type.
- Obesity – Overweight and obese people also have an increased risk of developing breast cancer.
Dense Breast Tissue
The tissues of the breast consist of fatty tissue and dense tissue. Therefore, dense tissue is produced of milk glands, milk ducts, and fibrous tissue. Sometimes, dense tissues are in an increased amount compared to fatty tissue. Moreover, it is difficult to identify cancer in people with dense tissue of the breast. In such cases, you should discuss it with your healthcare professional for additional tests that may help to determine if you have breast cancer or not.
Menopausal Hormone Therapy
There are some medications known as hormone therapy medications used to relieve menopausal symptoms. However, these medicines can also increase the risk of breast cancer. These include Estrogen in combination with Progesterone. The risk lowers when a person interrupts taking previous medications.
Radiation Exposure
If you are exposed to radiation, especially for long periods, the risk you will develop this cancer type elevates. Usually, people are exposed to high amounts of radiation during radiation therapy (a treatment option used to destroy cancer cells).
Is it Possible to Prevent DCIS?
There are several lifestyle changes that can reduce your risk of getting this cancer type. Check below some of them:
- Ask about breast cancer tests – Discuss with your healthcare provider about the risks and benefits of breast cancer screenings and if you need to perform them or not.
- Limit or avoid alcoholic beverages – However, there is no safe amount of alcohol when it comes to cancer prevention.
- Regularly exercise – Doctors usually recommend exercise at least 30 minutes daily to maintain good overall health.
- Self-examinations of the breast – It is advised to check regularly your breasts and if you notice a lump or other unusual changes, inform your doctor immediately. While self-examinations cannot prevent cancer they may improve the chances of an effective treatment.
- Moderate hormone therapy medicines use – If you follow a treatment with hormone therapy during menopause, you should not administer high doses of medicine because it may increase the risk of breast cancer. Thus, you should the lowest possible dose because it will help to relieve symptoms caused by menopause and not increase your risk of breast cancer significantly.
- Try to get and keep a healthy weight – If you are facing problems with weight loss, consult with your doctor about a diet and exercise effective for you.
Diagnosis
In most cases, a mammogram is enough to diagnose DCIS but some people may need additional tests including breast imaging, a biopsy, and others.
Mammogram
If a screening mammogram shows something abnormal linked with breast cancer doctors may also perform a diagnostic mammogram. The difference between these tests is that a diagnostic mammogram takes views from more angles and at higher magnification. However, to confirm DCIS, physicians may also need to perform ultrasound and a breast biopsy.
Ultrasound
This test involves sound waves to make detailed pictures of the breast tissues. It is usually done if a diagnostic mammogram shows unusual tissue in the breast.
Breast Biopsy
During this procedure, doctors will take a small sample of the affected breast tissue and send it to the laboratory for testing. Commonly, they use ultrasound or imaging tests to guide the needle to the right spot. For example, if the guide used for biopsy involves ultrasound it is called ultrasound-guided breast biopsy, and a stereotactic breast biopsy if it involves X-rays. The tissues sent to the laboratory are checked by doctors (pathologists) for cancer cells.
Treatment
In most cases, the treatment for DCIS cures this health problem. However, treatment options prescribed by doctors for people with this cancer type are different because they depend on the severity of the cancer, the location of the cancer cells, and other factors.
The following treatment options usually cure the cancer without high chances of its recurrence. For example:
- Breast-converting surgery (lumpectomy) and radiation therapy
- Breast-removing surgery (mastectomy)
- Lumpectomy alone or along with hormone therapy (used less commonly)
Surgery
Once a person is diagnosed with DCIS, he/she should decide what surgery type they want to use either lumpectomy or mastectomy.
- Lumpectomy – This surgery option involves the removal of the breast cancer and some healthy tissue around it but the rest of the breast tissue remains. Sometimes, physicians may call this procedure breast-conserving surgery or wide local excision. Furthermore, approximately all people who experience a lumpectomy also need radiation therapy.Some research suggests that there is an increased risk of the recurrence of cancer after lumpectomy compared to mastectomy but the survival rates between previous surgeries are very similar.
- Mastectomy – This treatment option involves the removal of the breast completely. Thereafter, surgeons may begin the breast reconstruction either at the same time or later.
Most people choose lumpectomy but sometimes mastectomy is the only option available. For example:
- Women who have a large region or multiple areas of DCIS
- Biopsy shows that cancerous cells are near breast tissue
- You cannot receive radiation therapy
Radiation Therapy
This treatment option involves powerful energy beams that are produced by X-rays, protons, or other sources. It helps to destroy cancer cells in different body parts. Moreover, this procedure is frequently recommended by doctors after a lumpectomy to destroy cancer cells that may remain after surgery.
Hormone Therapy
This treatment option is also called endocrine therapy. It uses specific medications that block the hormones that cancer cells use as fuel. In such cases, doctors call these cancer types estrogen receptor positive and progesterone receptor positive.
Sometimes, doctors may prescribe this treatment after surgery or radiation therapy to prevent the recurrence of the cancer. Check below some medicines usually recommended by doctors:
- Tamoxifen
- Raloxifene
- Exemestane
- Letrozole
- Anastrozole
However, before taking any medication, discuss it with your healthcare professional.
Frequently Asked Questions
Is DCIS life-threatening?
As per studies, ductal carcinoma in situ has a lower risk of spreading throughout the body and becoming dangerous. In any case, people with DCIS require treatment (usually surgery).
What are the possible complications of DCIS?
If you do not get treatment for this health problem, it may lead to some complications. These include:
- High blood pressure (hypertension)
- Heart disease
- Osteoporosis (brittle bones)
- Invasive breast cancer (less commonly)
If you experience any of the previous complications, it is advised to visit a doctor immediately.
How does common ductal carcinoma in situ occur?
This type of breast cancer accounts for approximately 20% of all breast cancers. If you have additional questions, you should visit a doctor.
