What is DCIS?

There are words in your biopsy report that may be difficult to understand, but there are some key phrases you can learn to help unravel the meaning of this report. First, you will need to become familiar with two terms, which are ductal carcinoma in situ and invasive breast cancer. Let’s find out about ductal carcinoma in situ.

After you receive your biopsy results, you will want to know if the tissue shows cancer cell that invade other structures around it or are confined to an area within the breast duct.  Another name for carcinoma is cancer and another name for situ is local, or “on site.” Therefore, ductal carcinoma in situ, or breast cancer that is local and not spreading, means that there are some changes on your biopsy that suggest cancer, but these cells do invade the structures around it. The breast duct is the passageway where milk travels to reach the nipple after it has been made by special glands within the breast. Cancer tends to occur within the cells that make up this duct. The abbreviation for ductal carcinoma in situ is DCIS. DCIS accounts for 20-25% of all breast cancers. (1) It is thought the DCIS has become more common because we are better able to detect it on mammography; and mammogram has become more widely used over the years. Those with DCIS on a biopsy have a unique treatment pathway that usually does not involve chemotherapy. Let’s find out more about the kinds of treatment that those with DCIS may receive.

Women with DCIS can usually be treated with breast conserving surgery, also known as lumpectomy. With lumpectomy only a portion of the breast is removed and the surgeon works to maintain the aesthetics of your breast without the need for implants. Those with DCIS also require radiation after surgery. If DCIS is larger and a mass can be felt, another biopsy of the lymph nodes may be required to determine if chemotherapy is needed. Also, if DCIS if larger than anticipated, removal of the whole breast may be considered. In fairness, there is some controversy as to whether adding radiation or removing the whole breast is beneficial in women with DCIS.

In addition to knowing the type of cells on your biopsy report, it is also important to know whether these cells respond to estrogen. Breast cancer cells that are responsive to hormones, such as estrogen, tend to have a better outlook.  Fortunately, about 75% of cases of DCIS will be responsive to estrogen (2). If your breast biopsy shows DCIS that is responsive to hormones, a medication called tamoxifen should be considered. Treatment with tamoxifen for 5 years can decrease the recurrence of breast cancer in this case. Yet, there is a small risk of cancer in the lining of the womb, called the endometrium, and blood clots. Although this risk is small, it remains important to discuss treatment with tamoxifen following breast conserving surgery with your doctor.

Understanding your biopsy report can be daunting, but knowing some key words and phrases can help you understand potential treatment options. Ductal carcinoma in situ, or local cancer of the breast duct, does not invade other structures and can be treated with breast conserving surgery and radiation. There are times where DCIS may require another biopsy of the lymph node, chemotherapy or removal of the whole breast. Also, cancer cells that are responsive to estrogen can also be treated with tamoxifen, which has its own risks. Such decisions regarding you care require an in-depth discussion with your doctor. It’s my prayer that after listening to this podcast your will be better equip to ask questions and understand answers that chart a treatment course that leads to a cure.

REFERENCES

1. In Alguire, P. C., & American College of Physicians, (2018). MKSAP 18: Medical knowledge self-assessment program.

2. Hird RB, Chang A, Cimmino V, Diehl K, Sabel M, Kleer C, Helvie M, Schott A, Young J, Hayes D, Newman L. Impact of estrogen receptor expression and other clinicopathologic features on tamoxifen use in ductal carcinoma in situ. Cancer. 2006 May 15;106(10):2113-8.