Ductal carcinoma in situ is a very early form of breast cancer. In ductal carcinoma in situ, the cancer cells are confined inside a milk duct in the breast. The cancer cells haven't spread into the breast tissue. Ductal carcinoma in situ is often shortened to DCIS. It's sometimes called noninvasive, preinvasive or stage 0 breast cancer.
DCIS is usually found during a mammogram done as part of breast cancer screening or to investigate a breast lump. DCIS has a low risk of spreading and becoming life-threatening. However, it does require an evaluation and a consideration of treatment options.
Treatment for DCIS often involves surgery. Other treatments may combine surgery with radiation therapy or hormone therapy.
Ductal carcinoma in situ doesn't typically cause symptoms. This early form of breast cancer also is called DCIS.
DCIS can sometimes cause symptoms such as:
DCIS is usually found on a mammogram. It appears as tiny flecks of calcium in the breast tissue. These are calcium deposits, often referred to as calcifications.
Make an appointment with your doctor or other healthcare professional if you notice a change in your breasts. Changes to look for may include a lump, an area of puckered or otherwise unusual skin, a thickened region under the skin, and nipple discharge.
Ask your healthcare professional when you should consider breast cancer screening and how often it should be repeated. Most healthcare professionals recommend considering routine breast cancer screening beginning in your 40s.
It's not clear what causes ductal carcinoma in situ, also called DCIS.
This early form of breast cancer happens when cells inside a breast duct develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.
In DCIS, the cancer cells don't yet have the ability to break out of the breast duct and spread into the breast tissue.
Healthcare professionals don't know exactly what causes the changes in the cells that leads to DCIS. Factors that may play a part include lifestyle, environment and DNA changes that run in families.
Several factors may increase the risk of ductal carcinoma in situ, also called DCIS. DCIS is an early form of breast cancer. Risk factors for breast cancer may include:
Making changes in your daily life may help lower your risk of ductal carcinoma in situ. This early form of breast cancer also is called DCIS. To lower your risk of breast cancer, try to:
Talk with your doctor or other healthcare professional about when to begin breast cancer screening. Ask about the benefits and risks of screening. Together, you can decide what breast cancer screening tests are right for you.
You may choose to become familiar with your breasts by occasionally inspecting them during a breast self-exam for breast awareness. If you find a new change, lumps or other unusual signs in your breasts, tell a healthcare professional right away.
Breast awareness can't prevent breast cancer. But it may help you to better understand the look and feel of your breasts. This might make it more likely that you'll notice if something changes.
If you choose to drink alcohol, limit the amount you drink to no more than one drink a day. For breast cancer prevention, there is no safe amount of alcohol. So if you're very concerned about your breast cancer risk, you may choose to not drink alcohol.
Aim for at least 30 minutes of exercise on most days of the week. If you haven't been active lately, ask your healthcare professional whether exercising is OK and start slowly.
Combination hormone therapy may increase the risk of breast cancer. Talk with a healthcare professional about the benefits and risks of hormone therapy.
Some people have symptoms during menopause that cause discomfort. These people may decide that the risks of hormone therapy are acceptable to get relief. To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time.
If your weight is healthy, work to maintain that weight. If you need to lose weight, ask a healthcare professional about healthy ways to lower your weight. Eat fewer calories and slowly increase the amount you exercise.
Ductal carcinoma in situ, also called DCIS, is most often discovered during a mammogram used to screen for breast cancer. A mammogram is an X-ray of the breast tissue. If your mammogram shows something concerning, you will likely have additional breast imaging and a biopsy.
If an area of concern was found during a screening mammogram, you may then have a diagnostic mammogram. A diagnostic mammogram takes views at higher magnification from more angles than a mammogram used for screening. This examination evaluates both breasts.
A diagnostic mammogram gives your healthcare team a closer look at any calcium deposits detected in the breast tissue. Calcium deposits, also called calcifications, can sometimes be cancerous.
If the area of concern needs further evaluation, the next step may be an ultrasound and a breast biopsy.
Ultrasound uses sound waves to make images of structures inside the body. A breast ultrasound may give your healthcare team more information about an area of concern. The healthcare team uses this information to decide what tests you might need next.
A biopsy is a procedure to remove a sample of tissue for testing in a lab. For DCIS, a healthcare professional removes the sample of breast tissue using a special needle. The needle used is a hollow tube. The healthcare professional puts the needle through the skin on the breast and into the area of concern. The health professional draws out some of the breast tissue. This procedure is called a core needle biopsy.
Often the healthcare professional uses an imaging test to help guide the needle to the right spot. A biopsy that uses ultrasound is called an ultrasound-guided breast biopsy. If it uses X-rays, it's called a stereotactic breast biopsy. The tissue samples are sent to a lab for testing.
In a lab, a doctor who specializes in analyzing blood and body tissue looks at the tissue samples. This doctor is called a pathologist. The pathologist can tell whether cancer cells are present and if so, how aggressive those cells appear to be.
Ductal carcinoma in situ can often be cured. Treatment for this very early form of breast cancer often involves surgery to remove the cancer. Ductal carcinoma in situ, also called DCIS, also may be treated with radiation therapy and medicines.
DCIS treatment has a high likelihood of success. In most instances, the cancer is removed and has a low chance of coming back after treatment.
In most people, treatment options for DCIS include:
In some people, treatment options may include:
If you're diagnosed with DCIS, one of the first decisions you'll have to make is whether to treat the condition with lumpectomy or mastectomy.
Lumpectomy. A lumpectomy is surgery to remove the breast cancer and some of the healthy tissue around it. The rest of the breast tissue isn't removed. Other names for this surgery are breast-conserving surgery and wide local excision. Most people who have a lumpectomy also have radiation therapy.
Research suggests that there is a slightly higher risk of the cancer coming back after lumpectomy compared to mastectomy. However, survival rates between the two treatment approaches are very similar.
If you have other serious health conditions, you might consider other options, such as lumpectomy plus hormone therapy, lumpectomy alone or no treatment.
Lumpectomy is a good option for most people with DCIS. But mastectomy may be recommended if:
Because DCIS is noninvasive, surgery typically doesn't involve the removal of lymph nodes from under your arm. The chance of finding cancer in the lymph nodes is extremely small.
If your healthcare team thinks the cancer cells may have spread outside the breast duct or if you are having a mastectomy, then some lymph nodes may be removed as part of the surgery.
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources.
For DCIS treatment, the radiation is often external beam radiation. During this type of radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body. Less often, the radiation can be placed inside the body. This type of radiation is called brachytherapy.
Radiation therapy is often used after lumpectomy to reduce the chance that DCIS will come back or that it will progress to invasive cancer. But it might not be necessary if you have only a small area of DCIS that is considered slow-growing and was completely removed during surgery.
Hormone therapy, also called endocrine therapy, uses medicines to block certain hormones in the body. It's a treatment for breast cancers that are sensitive to the hormones estrogen and progesterone. Healthcare professionals call these cancers estrogen receptor positive and progesterone receptor positive. Cancers that are sensitive to hormones use the hormones as fuel for their growth. Blocking the hormones can cause the cancer cells to shrink or die.
For DCIS, hormone therapy is typically used after surgery or radiation. It lowers the risk that the cancer will come back. It also reduces the risk of developing another breast cancer.
Treatments that can be used in hormone therapy include:
Discuss the benefits and risks of hormone therapy with your healthcare team.
No alternative medicine treatments have been found to cure ductal carcinoma in situ, also called DCIS. But complementary and alternative medicine therapies may help you cope with side effects of treatment.
Combined with your healthcare team's recommendations, complementary and alternative medicine treatments may provide some comfort. Examples include:
A diagnosis of ductal carcinoma in situ, also called DCIS, can feel overwhelming. To cope with your diagnosis, it may be helpful to:
Ask your healthcare team questions about your diagnosis and your pathology results. Use this information to research your treatment options.
Knowing more about your cancer and your options may help you feel more confident when making treatment decisions. Still, some people don't want to know the details of their cancer. If this is how you feel, let your care team know that too.
Find a friend or family member who is a good listener. Or talk with a clergy member or counselor. Ask your healthcare team for a referral to a counselor or other professional who works with people who have cancer.
Your friends and family can provide a crucial support network for you during your cancer treatment.
As you begin telling people about your breast cancer diagnosis, you'll likely get many offers for help. Think ahead about things you may want help with. Examples include listening when you want to talk or helping you with preparing meals.
Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you. If an exam or imaging test shows that you might have ductal carcinoma in situ, also called DCIS, your healthcare team will likely refer you to a specialist.
Specialists who care for people with DCIS include:
Here's some information to help you get ready for your appointment.
Your time with your healthcare professional is limited. Prepare a list of questions so that you can make the most of your time together. List your questions from most important to least important in case time runs out. For breast cancer, some basic questions to ask include:
In addition to the questions that you've prepared, don't hesitate to ask other questions you think of during your appointment.
Be prepared to answer some questions about your symptoms and your health, such as:
