Is aggressive treatment necessary for stage 0 DCIS?

Question

Hello doctor,

I am 54 years old and was recently diagnosed with stage 0 ductal carcinoma in situ (DCIS) in my left breast following a mammogram. My doctor explained that it is non-invasive, but still recommended treatment options, including a lumpectomy followed by radiation or a mastectomy.

Is it always necessary to treat DCIS aggressively, or can it sometimes be monitored? I am also concerned about the risk of it progressing to invasive cancer. Which treatment offers the best prognosis while minimizing potential complications? Additionally, are there any less invasive treatments currently being used for DCIS?

Please help.

Answer 1

Hello,

Welcome to iCliniq.com.

I am deeply concerned about your worries.

Ductal carcinoma in situ (DCIS) is a type of very early breast cancer where cancer cells line your milk ducts within one or both breasts. Milk ducts are tubes that carry milk from the lobes of your breasts to your nipples so you can breastfeed (chestfeed). The cancer is “in situ,” or situated (contained) inside your milk ducts. Healthcare providers may call DCIS noninvasive or pre-invasive breast cancer. This means that the cancer cells have not spread beyond the walls of your milk ducts. Ductal carcinoma in situ does not typically metastasize, or spread to other organs in your body, as aggressive or invasive cancers do.

While DCIS can not spread outside of your breast, it can turn into invasive ductal carcinoma, which can spread outside of your breast, in some cases. That is why talking to a healthcare provider is so important. They can discuss treatment options to help reduce this risk.

Risk factors for DCIE: Certain factors can increase your risk of ductal carcinoma in situ, like:

A biological family history of breast cancer.
A personal history of breast cancer or atypical hyperplasia.
Being assigned female at birth (AFAB).
Being over age 30.
Getting your period before age 12.
Having a baby after 30.
Having dense breast tissue.
Having gene mutations associated with increased cancer risk (BRCA1 or BRCA2 ).
Had previous radiation therapy directed at your breasts or chest.
Never being pregnant or breastfeeding.
Starting menopause after age 55.

Investigation of ductal carcinoma:

Mammography: In addition to a routine screening mammogram, your healthcare provider might order a diagnostic mammogram. This test provides more detailed views of your breast tissue. It takes longer than a screening mammogram.
Breast biopsy: Healthcare providers use this test to confirm that cancer cells are in your breast.

Treatment:

Breast-conserving surgery or lumpectomy: This removes all cancer cells, along with healthy breast tissue bordering the cancer growth. Removing small amounts of nearby healthy tissue increases the chance that no abnormal cells are left behind. Your provider will leave most of your breast intact.
Radiation therapy typically follows BCS (breast-conserving surgery): Some people need this therapy for a few days, others for a few weeks. Your healthcare provider can tell you about your personalized treatment plan.
Mastectomy: This removes the entire affected breast or both breasts (double mastectomy). You may need a mastectomy if you are not a candidate for BCS. Mastectomy may be a better option if the cancer has spread throughout multiple milk ducts or if a tumor is especially large.

I hope this helps you.

Thank you.