For women who have DCIS
DCIS stands for ductal carcinoma in-situ. It is not breast cancer but will become breast cancer if left untreated. It is most commonly diagnosed by mammograms and usually has no symptoms. Very occasionally it can present as nipple discharge or as eczema- like change on the nipple or as a lump or thickening in the breast. DCIS is graded under the microscope and this reflects the likelihood that it will change into breast cancer.
Low grade DCIS may take many years to change into breast cancer.
Intermediate grade DCIS may take several years.
High grade DCIS will change into breast cancer within a few years.
The main treatment for DCIS is surgery. As long as the DCIS is completely excised, the chance of recurrence is extremely small. Recurrences can happen but they are rare. Other treatments such as hormone therapy are under investigation and can be discussed.
Surgery for DCIS
Breast-conserving surgery for DCIS is similar to breast-conserving surgery for breast cancer except that radiotherapy is not always necessary. If the extent of DCIS is large relative to breast size then a mastectomy is necessary. This can be combined with breast reconstruction.
The aim of breast-conserving surgery for DCIS is to remove the disease with a wide margin. If the margin is very wide and/or the DCIS is low or intermediate grade then radiotherapy may not be required.
Therapeutic mammaplasty or LICAP operations can sometimes be used to enable a very wide excision. It is more difficult to predict the extent of DCIS pre-operatively compared to invasive breast cancer. This means that on average it is more likely that more than one operation will be necessary to ensure that a clear margin has been achieved around DCIS (Nationally in the UK about 30% of women require more than one operation to achieve a clear margin and completely excise DCIS, compared to about 15% for invasive breast cancer). The chances of obtaining a clear margin and completely excising the disease are greater if a wide margin is taken with the first operation (Oncoplastic surgery can reduce the need of requiring a second operation for DCIS to less than 10%). A variety of different surgical techniques can allow this and these can be discussed.
Additional treatments for DCIS
Radiotherapy is commonly used after breast-conserving surgery for DCIS. There is no need for radiotherapy after mastectomy for DCIS. Hormone therapy is very occasionally considered for DCIS that is hormone sensitive.