Can breast cancer recur after DCIS has been treated?
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What is ductal carcinoma in situ?
The medical term “in situ” means “in place”. Ductal carcinoma in situ (DCIS) refers to cancer cells which are confined to the milk ducts of the breast which have not spread to the fatty tissue of the breast or to any other part of the body such as the lymph nodes.
This is the most common type of non-invasive breast cancer in women.
How is DCIS detected and diagnosed?
DCIS is often first detected when a woman has a mammogram. It may appear as tiny specks of calcium – called microcalcifications – which are too small to be felt during physical examination.
When DCIS is suspected it is confirmed by breast biopsy.
Is DCIS a cancer?
DCIS is regarded as a stage 0 cancer – that is the earliest form of breast cancer. Stage 0 cancer is a contained cancer which has not spread beyond the ductal system of the breast to the lymph nodes or other areas of the body.
The cure rate for DCIS is close to 100% provided the correct treatment is given.
As with any other form of breast cancer, DCIS is not an emergency. There is time to learn about the condition and to discuss the best form of treatment with your doctor.
What are the different types of DCIS?
DCIS refers to a family of cancers which occurs in the breast ducts. There are two categories – comedo and non-comedo.
Comedo is a term which refers to the fact that when these breast tumours are cut across, the dead (necrotic) cells inside them can be squeezed out – like a blackhead or comedo on the skin.
Comedo DCIS tends to be more aggressive than non-comedo DCIS.
The most common types of non-comedo cancer are:
Solid DCIS – in this condition the cancer cells completely fill the affected ducts
Cribriform DCIS – the cancer cells do not completely fill the affected ducts and there are gaps between the cells
Papillary and micropapillary DCIS – the cancer cells are arranged in a fern-like pattern within the affected breast ducts – micropapillary cells are smaller than papillary
These three types of DCIS can be relatively easily distinguished by a pathologist when examining the cancerous ducts and their cells under a microscope.
What are the options for treating DCIS?
There are several general factors used to determine the treatment of DCIS:
The size of the tumour
The type of tumour
The histological grade of the tumour – this means whether the tumour cells are in a well organised pattern or totally disorganised – the latter is usually associated with a more aggressive cancer
Whether the cancer has oestrogen or progesterone receptors present
The age of the patient
DCIS is by definition, a non-invasive cancer. This means that it has not even spread as far as the fatty tissue within the breast. However, DCIS may become invasive cancer. If this happens, it may spread to the lymph nodes and the blood stream.
This means that most cases of DCIS can be treated using a lumpectomy followed by radiation or a simple mastectomy . The indications for lumpectomy or mastectomy for DCIS are the same as those for other forms of breast cancer. As DCIS is not invasive, surgery is rarely performed on the lymph nodes.
Can tamoxifen be used for DCIS?
Tamoxifen has been used for nearly thirty years to treat breast cancer. More recently the drug has been used to treat early breast cancer after lumpectomy or mastectomy.
Tamoxifen is an “anti-oestrogen” preparation. Some types of cancer have receptors to the female hormone oestrogen on them. They use this hormone to grow and reproduce. If the action of oestrogen can be blocked, then the cancer will either not grow at all, or will grow more slowly. Tamoxifen “competes” with oestrogen to bind to the receptors on the cancer cells. This helps to slow the growth and reproduction of any remaining cancer cells after surgery.
There are trials that are looking at the role of tamoxifen in prevention of breast cancer. The early results have shown that tamoxifen is effective in decreasing the incidence of breast cancer in women who are known to be high risk (e.g. women with DCIS) but that there are side effects that may not suggest it can be used for all women.
Can breast cancer recur after DCIS has been treated?
Breast cancer can recur after the initial treatment. It most commonly recurs in the same area as the original cancer.
Women with DCIS who have been treated with lumpectomy are at a slightly higher risk of recurrence of DCIS in the same breast than those who had a mastectomy. But, it is important to remember that studies have shown that women who have a lumpectomy for DCIS rather than a mastectomy are at no greater risk of dying from the disease.
Reviewed by Dr Jenny Edge, General Surgeon, Bsc, MB BS, FRCS (Edin), M Med (Stell.).
Last Updated: 8/6/2003
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