Ductal Carcinoma in Situ
Ductal carcinoma in situ (DCIS) is a very early form of breast cancer. It develops from cells of the ducts. Ducts carry milk to the nipple. DCIS has not spread beyond the ducts, so it is considered stage 0 breast cancer.
For some patients, DCIS will eventually spread beyond the duct and into nearby tissue. When this happens, it becomes an invasive breast cancer. Other people can have DCIS for years without it moving outside the ducts. There is no way to predict if DCIS will spread.
At one point, very few women were diagnosed with DCIS, but better screening practices and technology are catching more cases. DCIS today accounts for around 20% of breast cancer diagnoses.
Because DCIS is found at cancer’s earliest stage, it responds very well to treatment. The outlook for patients with DCIS is excellent, and the disease has a 10-year survival rate of more than 98%.
Molecular receptors and DCIS
Molecular receptors are molecules made by cells. These receptors sit inside the cells or on their surface. They can bond with, or recognize, specific proteins and hormones in the patient’s body. In cancer cells, some receptors fuel the cancer’s growth when they form a bond.
Women with DCIS may be tested for receptors for the hormones estrogen and progesterone. If these tests come back positive, the patient may be put on hormone therapy after DCIS treatment is complete. This therapy does not treat DCIS. Instead, it helps stop a new breast cancer from developing. Learn more about molecular receptors and breast cancer.
If you’ve been diagnosed with ductal carcinoma in situ, or DCIS, you might have questions. For instance, is DCIS the same thing as stage 0 breast cancer? If so, what does that mean for you in terms of treatment? Will you need to have chemotherapy? What about surgery or radiation therapy?
To learn more, we spoke with cancer prevention specialist Priya Thomas, M.D. Here are seven things she wants you to know.
What is ductal carcinoma in situ (DCIS)?
DCIS is the same thing as stage 0 breast cancer. That means it is not invasive, and it hasn’t spread beyond the borders of its original location. “In situ” is Latin for “in its original place.” Anything invasive is considered at least stage I.
DCIS develops in the breast ducts, or the thin tubes that carry milk from the lobules to the nipples. Sometimes, the cells lining these structures become cancerous. When that happens and it’s caught early enough, it’s called DCIS.
Does DCIS have any symptoms?
Not usually, no. But rarely, someone might see discharge from a nipple or feel a lump.
How is DCIS usually diagnosed?
DCIS is usually picked up during a routine screening mammogram. When a radiologist sees something abnormal, they order a diagnostic mammogram and/or an ultrasound to get a clearer view. In some cases, a breast biopsy might also be needed.
Once a DCIS diagnosis is made at MD Anderson, patients will typically see both a surgeon and an oncologist, often on the same day. They’ll discuss whether surgery is necessary, as well as the pros and cons of it. They’ll also explore any possible adjuvant therapies.
What is comedo necrosis?
Comedo necrosis is an area of dead cancer cells that has built up inside a tumor. It’s a Latin term that describes how it looks under a microscope. It won’t affect your diagnosis or treatment plan at all.
How is DCIS usually treated?
The standard of care for DCIS is to do surgery first. So, surgeons may offer you a lumpectomy or a mastectomy. If you have a lumpectomy, you’ll also need radiation therapy.
Typically, you shouldn’t need chemotherapy after a DCIS diagnosis, since surgery alone is usually enough to render someone cancer-free.
Why is it important to come to a place like MD Anderson, even for early-stage DCIS?
First of all, our doctors are extremely specialized. We have 20 pathologists who look exclusively at breast tissue, so they can identify the nuances between benign lesions and cancer. That’s important, because it means you’re going to get a more accurate diagnosis. And that, in turn, will affect your treatment plan.
Second, the imaging we do here is very sensitive, so our radiologists often pick up on things that others miss. And that can lead to a change in diagnosis. If we see something different than an outside facility does, we may recommend a different surgery or treatment plan for you. That’s why it’s critical to go somewhere that can distinguish between harmless calcifications and cancerous masses.
Third, any time you’re diagnosed with cancer, it automatically increases your odds of developing another cancer later on. We have a cancer prevention center here that can help you identify ways to reduce your risk, including lifestyle and screening protocols.
The most compelling reason to come to MD Anderson, though, may be our clinical trials program. We offer patients treatment options through our clinical trials that they can’t find anywhere else.
What clinical trials are currently available for DCIS?
One of the biggest questions right now regarding DCIS is, “Are we overtreating this?” Our own Nina Tamirisa, M.D. is trying to answer that through the COMET study.
This clinical trial — which stands for “Comparing an Operation to Monitoring, With or Without Endocrine Therapy”— is looking at whether patients with low-risk DCIS can delay or avoid surgery altogether with medication or endocrine therapy, plus closer observation. We want to see if they can get the same results as patients who are offered surgery right away.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
DCIS risk factors
A risk factor is anything that increases the chances of developing a specific disease. DCIS has the same risk factors as other breast cancers. They include age, genetic mutations, a family history of breast cancer and having a previous breast cancer. Learn more about breast cancer risk factors.
Some types of breast cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more in our Family History section.
DCIS symptoms
DCIS usually has no symptoms because it is so early in the disease’s development. In most cases, it cannot be felt during a self-exam or doctor’s examination of the breast. When there are symptoms, they include a small lump in the breast or bloody discharge from the nipple.
DCIS diagnosis
Getting an accurate diagnosis is the first step in successfully treating DCIS. MD Anderson has physicians who specialize in breast imaging and identifying suspected breast cancer cells.
The following exams can be used to diagnose DCIS. They can also be used to monitor how the cancer is responding to treatment.
Imaging exams: Imaging exams are used to look for cancer inside the body. They can help locate tumors and track how the body is responding to treatment. There are many types of imaging exams.
Most cases of DCIS are found during a routine screening mammogram. A mammogram is an X-ray of the breast. Mammograms can detect tumors that are too small to be felt during a breast exam.
Biopsy: If an imaging exam shows a possible tumor, doctors will perform a biopsy. During a biopsy, a small tissue sample is removed and examined under a microscope for cancer cells. For suspected breast cancers, these cells are usually retrieved with a needle.
Blood and urine tests: Blood and urine tests are not used to diagnose DCIS, but they can help monitor the patient’s health during treatment.
DCIS treatment
Treatments for DCIS include the following:
Surgery
Most women diagnosed with DCIS get surgery to remove the growth. Patients undergo one of the following procedures:
- Lumpectomy: In a lumpectomy surgery, the tumor and a small amount of surrounding healthy tissue are removed. This procedure may be used for early breast cancer cases where the tumor is still small. Lumpectomies are usually outpatient procedures and have shorter recovery times.
- Mastectomy: In a typical mastectomy, the entire breast with the tumor is removed. There are several different types of mastectomies, including procedures that let the patient keep the breast’s skin and nipple/areola. Often a mastectomy and breast reconstruction can be performed in the same procedure.
Radiation therapy
Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue.
DCIS patients who undergo a lumpectomy usually get radiation therapy after the surgery. Mastectomy patients usually do not need radiation therapy.
Learn more about radiation therapy.
Active surveillance
Because DCIS may never develop into a more advanced breast cancer, some women choose not to get treated. Instead, they enter active surveillance. During this time, they get frequent screening tests and exams to look for signs that the cancer is advancing. Treatment begins only if these signs appear.
Doctors are studying the use of active surveillance in DCIS patients.
Why choose MD Anderson for your DCIS treatment?
Choosing the right hospital may be the biggest decision you make as a breast cancer patient. At MD Anderson you’ll get treatment from one of the nation’s top-ranked cancer centers. Our core mission is to eliminate cancer.
Surgeons, radiation oncologists and medical oncologists with the Nellie B. Connally Breast Center and the Cancer Prevention Center are focused exclusively on curing breast cancer, extending the life of breast cancer patients and maximizing their quality of life.
This allows them to develop a tremendous amount of experience and skill in treating breast cancer patients, including those with rare forms of the disease. Each doctor brings their skills to our multidisciplinary teams, where they work together to develop treatment plans that address each breast cancer case and patient.
This care is available beyond MD Anderson’s campus in the Texas Medical Center. At our Houston-area locations, patients throughout the region can get the same multidisciplinary care and personalized attention close to home.
And at MD Anderson you will also be surrounded by the strength of one of the nation's largest and most experienced cancer centers. From support groups to counseling to integrative medicine care, we have all the services needed to treat not just the disease, but the whole person.