Coping With A Diagnosis Of Dcis
Being told you have DCIS can be a difficult and worrying time. Everyone reacts differently to their diagnosis and have their own way of coping.
Although DCIS is an early form of breast cancer with a very good prognosis, people understandably may feel very anxious and frightened by the diagnosis. People can often struggle to come to terms with being offered treatments such as a mastectomy, at the same time as being told their DCIS may never do them any harm.
Some people are reluctant to say theyre anxious about a diagnosis of DCIS because they worry others will see it as less important than other types of breast cancer. Because of this they might feel less able to ask for support. But there are people who can support you so dont be afraid to ask for help if you need it. By letting other people know how you feel, particularly your family and friends, they can be more supportive.
Some people find it helpful to discuss their feelings and concerns with their breast care nurse or specialist. If youd like to talk through your feelings and concerns in more depth over a period of time, a counsellor or psychologist may be more appropriate. Your breast care nurse, specialist or GP can arrange this.
Find out more about coping emotionally with breast cancer.
If you want to talk you can also call our Helpline on 0808 800 6000.
What Is The Prognosis For Dcis
Women with DCIS have an excellent prognosis. At Johns Hopkins Medicine, our pathologists are scrupulous at identifying DCIS and strive to reduce the risk that any invasive cancer was missed. By treating DCIS at a comprehensive breast center, you ensure your health is in the best possible hands.
It is important to maintain a rigorous screening schedule to monitor for local recurrence in the original breast and to monitor the healthy breast. By definition, there is no risk of distant recurrence since the cancer is noninvasive. For women having lumpectomy with radiation, the risk of local recurrence ranges from 5-15 percent. For women having mastectomy, the risk of local recurrence is less than 2 percent. Women who take hormonal therapy after surgery further reduce their risk of recurrence by half.
Breast cancer may develop in the womans other breast, so careful monitoring is important. This happens only to about five percent of women diagnosed with breast cancer. If a cancer develops in the patients other breast, it is not referred to as recurrence, but is a new primary breast cancer. It can also be a different type of breast cancer than the original cancer.
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Biomarkers Of Recurrence And Progression
Molecular biomarkers to predict recurrence after a DCIS diagnosis can be any of protein, RNA, or DNA molecules. To date, several studies have evaluated each in various DCIS cohorts however, none are in clinical practice, mostly due to a combination of lack of validation in independent cohorts and/or low predictive value. The majority of studies performed are underpowered for accurate detection of predictive value .
Protein biomarkers using IHC have been the most commonly assessed in DCIS, and as reviewed by Lari and Kuerer , many of the studies find associations with DCIS recurrence that are not validated by others . However, some of the strongest candidates also supported by more recent studies include HER2, COX2, Ki67 , and p16.
Table 2. Summary of results of IHC studies of ductal carcinoma in situ recurrence reviewed in Lari and Kuerer .
Several independent studies have also found COX2 to be predictive of recurrence however, most analyses did not differentiate between DCIS and IBC recurrence . One study only found COX2 positivity to be predictive of recurrence in combination with high Ki67 .
Two other studies have also found that tumors with p16+/Ki67+ have a higher risk of recurrence of either DCIS or IBC . Interestingly, Witkiewicz et al. also evaluated stromal p16 staining and found that high stromal expression was strongly correlated with disease recurrence. In particular, only a single case lacking stromal p16 expression had an invasive recurrence .
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Lumpectomy With Radiation Therapy
In this procedure, the surgeon will remove the tumor and some healthy breast tissue close by as a precaution.
Sometimes they may also remove the lymph nodes and request a biopsy to confirm that the cancer has not spread. Healthcare professionals call this a sentinel lymph node biopsy . They are more likely to do this if the tumor is large.
After surgery a person will receive radiation therapy to destroy any remaining cells.
Younger Age At Diagnosis Of Dcis
A medical study published in 2015 set out to estimate the 10 and 20-year mortality rate after an initial diagnosis of ductal carcinoma in-situ.
The statistics were taken from the Surveillance, Epidemiology and End Results from 108,196 women diagnosed with DCIS between the years of 1988 to 2011.
The study found that the average age of diagnosis for DCIS was 53.8 years. In general the overall breast cancer death rate over a 20 year period was only 3.3%.
However, the mortality rate at 20 years increased to 7.8% in women who were diagnosed with DCIS before the age of 35 years old.
A further 2014 research study concluded that after 10 years the rates of local recurrence after breast conservative therapy and radiotherapy were as follows:-
- Women over 50 years at diagnosis: 11% recurrence rate
- For women between 45 and 50 years: 15% recurrence rate
- Women under 45 years: 25% recurrence rate
We can see from the above figures that the younger the age at diagnosis, the higher the percentage likelihood of recurrence.
However, this is often because younger women present with a higher grade tumor and are not as rigorously followed up by mammogram screening.
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What Is Stage 0 Dcis
Stage 0 breast cancer, ductal carcinoma in situ is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk duct. In Stage 0 breast cancer, the atypical cells have not spread outside of the ducts or lobules into the surrounding breast tissue. Ductal Carcinoma In Situ is very early cancer that is highly treatable, but if its left untreated or undetected, it can spread into the surrounding breast tissue.
Hormonal Therapy After Surgery
If doctors know the cancer uses estrogen and progesterone to grow, they will likely suggest hormonal therapy.
This treatment blocks tumor receptors that bind to these hormones, or reduces the amount of estrogen and progesterone in the body. A person may continue hormonal therapy for 5 years after surgery.
high because people receive their breast cancer diagnosis early and begin treatment before the cancer progresses to a more invasive type.
The vast majority of people with DCIS can expect to have a normal life expectancy. However, they are at a higher risk of developing invasive breast cancer in the future in comparison with the general population.
In instances where a person does not receive treatment for DCIS, the cancer could progress to an invasive type and spread to other parts of the body.
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What Does It Mean If My In
There are 2 main types of in-situ carcinoma of the breast: ductal carcinoma in-situ and lobular carcinoma in situ . Intraductal carcinoma is another name for ductal carcinoma in-situ.
LCIS is discussed on a different page.
Sometimes DCIS and LCIS are both found in the same biopsy.
In-situ carcinoma with duct and lobular features means that the in-situ carcinoma looks like DCIS in some ways and LCIS in some ways , and so the pathologist cant call it one or the other.
If DCIS is left untreated, it can go on to become an invasive cancer, so it is often called a pre-cancer. Still, we dont really understand it well. We dont think that all DCIS would go on to become invasive cancer, but we cant tell which DCIS would be safe to leave untreated. Treatment is aimed at getting rid of all the DCIS, usually by surgery. In some cases, radiation or hormone therapy is given after surgery to lower the chance that it will come back later or that invasive carcinoma will occur.
Low And Intermediate Grade Dcis
Low and medium grade DCIS implies that the cancer cells are growing at a relatively slow rate. People with low-grade DCIS face an increased risk of invasive breast cancer compared to people without DCIS, but it is unlikely to appear until after five years. However, women with low-grade DCIS are less likely to have a recurrence of the breast carcinoma or to develop new cancers. Grade I or low-grade DCIS cells appear very much like normal breast cells or atypical ductal hyperplasia cells. Grade II or moderate-grade DCIS cells look less like unaffected cells and grow faster than normal.
In the image below, malignant cells have completely filled the lumen of the duct, but have regular-looking nuclei. This is considered low-grade DCIS. Note that the presence of microcalcifications is not necessarily a malignant indictor for the pathologist.
The image below also shows DCIS, in which malignant cancer cells have partially filled the duct. However there is noticeable variation in the size and shape of the cancer cells nuclei, with a probable intermediate-grade diagnosis. Also present in the duct are crushed-stone microcalcifications and various bi-products, which would not necessarily increase malignant criteria for the pathologist.
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What Is Stage 0 Lcis
Lobular carcinoma in situ at Stage 0 generally is not considered cancer. Although it has carcinoma in the name, it really describes a growth of abnormal but non-invasive cells forming in the lobules. Some experts prefer the name lobular neoplasia for this reason because it accurately refers to the abnormal cells without naming them as cancer. LCIS, however, may indicate a woman has an increased risk of developing breast cancer.
If you have been diagnosed with LCIS, your doctor may recommend regular clinical breast exams and mammograms. He or she may also prescribe Tamoxifen, a hormone therapy medication that helps prevent cancer cells from growing.
Treatment Of Ductal Carcinoma In Situ
Ductal carcinoma in situ means the cells that line the milk ducts of the breast have become cancer, but they have not spread into surrounding breast tissue.
DCIS is considered non-invasive or pre-invasive breast cancer. DCIS cant spread outside the breast, but it still needs to be treated because it can sometimes go on to become invasive breast cancer .
In most cases, a woman with DCIS can choose between breast-conserving surgery and simple mastectomy. But sometimes a mastectomy might be a better option.
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What If My Report On Ductal Carcinoma In Situ Mentions Margins Or Ink
When the entire area of DCIS is removed, the outside surface of the specimen is coated with ink, sometimes even with different colors of ink on different sides of the specimen. The pathologist looks at slides of the DCIS under the microscope to see how close the DCIS cells get to the ink . If DCIS is touching the ink , it can mean that some DCIS cells were left behind, and more surgery or other treatments may be needed. Sometimes, though, the surgeon has already removed more tissue to help make sure that this isnt needed. If your pathology report shows DCIS with positive margins, your doctor will talk to you about what treatment is best.
How Quickly Does Dcis Progress
Grade 1 DCIS is almost always ER and PR positive and is a very slow growing form of cancer. It can take years, even decades, to see progression of the disease. In some cases, it may take such a long time to spread beyond the breast duct that it is not an event that will happen during a persons lifetime.
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Ductal Carcinoma In Situ: Proliferating Cancer Cells Still Contained Within The Breast Duct
DCIS differs from Atypical Ductal Hyperplasia in that the atypical cell growth is now disturbing the stroma or supporting-framework cells of the duct, but has not yet penetrated the duct wall. Another way to look at it is that the new cell growth is occurring in a completely unpredictable way. This would suggest the presence of tumor cells to be the cause.
Sentinel Node Biopsy And Mastectomy For Dcis
A sentinel node biopsy is a procedure used to check whether or not invasive breast cancer has spread to the lymph nodes in the underarm area . The surgeon removes 1-5 nodes.
Having a sentinel node biopsy during a mastectomy helps some people with DCIS avoid an axillary dissection. Once a mastectomy has been done, a person cant have a sentinel node biopsy.
If it turns out theres invasive breast cancer in the tissue removed during the mastectomy, a sentinel node biopsy will have already been done.
If a sentinel node biopsy wasnt done and invasive breast cancer is found, an axillary dissection may be needed. An axillary dissection removes more axillary lymph nodes than a sentinel node biopsy. Because it disrupts more of the normal tissue in the underarm area, axillary dissection is more likely to affect arm function and cause lymphedema.
So, even though a sentinel node biopsy may not be needed with DCIS, most people who have a mastectomy for DCIS will have a sentinel node biopsy done at the same time.
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Inserting A Metal Marker
If you have a biopsy, sometimes a small metal clip called a marker is placed in the breast where the biopsy samples were taken. This is so the area can be found again if another biopsy or surgery is needed. It can safely be left in the breast and does not need to be removed, even if no further procedures are needed.
Can Dcis Develop Into Invasive Breast Cancer
If DCIS is not treated, the cancer cells may develop the ability to spread outside the ducts, into the surrounding breast tissue. This is known as invasive breast cancer. Invasive cancer has the potential to also spread to other parts of the body.
In some cases, DCIS will never develop further or grows so slowly that it would never cause harm during a persons lifetime. Although the size and grade of the DCIS can help predict if it will become invasive, there is currently no way of knowing if this will happen. is more likely to become an invasive breast cancer and to do so over a shorter time than low-grade DCIS.
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Diagnosis Of Ductal Carcinoma In Situ
Unlike other types of breast cancer, patients rarely have a noticeable lump, although they might. Often, doctors find the disease on a mammogram, where it looks like a shadow. If your doctor thinks you might have DCIS, a test called a biopsy might be needed.
During a biopsy, your doctor will use a needle to take a sample of the tissue from inside your breast. Doctors can look at it under a microscope to see if there’s evidence of cancer. Your doctor might also order imaging tests like MRI or ultrasounds to get a better look at the tumor. Imaging also lets a doctor see if it has spread.
Understanding Your Pathology Report: Ductal Carcinoma In Situ
When your breast was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from a breast biopsy, such as a needle biopsy or an excision biopsy.
In a needle biopsy, a needle is used to remove a sample of an abnormal area. An excision biopsy removes the entire abnormal area, often with some of the surrounding normal tissue. An excision biopsy is much like a type of breast-conserving surgery called a lumpectomy.
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How Is Dcis Diagnosed
DCIS is usually diagnosed by a stereotactic core needle biopsy. This is a biopsy of the breastthat is guided by mammography.
Same Day Results
At the Johns Hopkins Breast Center, we are sensitive to the anxiety a possible diagnosis of breast cancer creates for our patients. If the radiologist who read your mammogram suspects you have DCIS, he or she will arrange for you to have a stereotactic biopsy. The biopsy can sometimes be done the same day, but is always done within a week. On the day of your breast biopsy, you will be given the probability that the biopsy is a breast cancer. Firm confirmation will follow within 24 hours.
Treatment Options For Dcis: Lumpectomy Or Mastectomy
In most cases, the first line of treatment when DCIS is diagnosed is some form of breast surgery.
There are two basic surgical approaches for DCIS treatment:-
Lumpectomy is usually adequate if the area of breast abnormality is very small or only one abnormality is found on a mammogram.
Also, lumpectomy is usually recommended if the DCIS is of a less aggressive type such as non-comedo DCIS.
Lumpectomy is most effective for DCIS patients with small, low-grade DCIS which is easily identifiable on mammogram. In some cases the amount of DCIS is so small that the first exploratory biopsy is enough to remove all of the carcinoma and a subsequent lumpectomy is not required.
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The Good News About Dcis
DCIS is sometimes classified as Stage 0 of breast cancer, the earliest stage of the disease. The question for women with this diagnosis is not “Will I live?” but “How much treatment will I need?” One of the biggest risks today is overtreatment. That, too, is changing, as researchers get better at distinguishing the types of tumors that can be subdued without extensive surgery or radiation. DCIS is one cancer that can truly be considered curable.
If you have DCIS, you might consider entering a clinical trial. You would get the best available care and might benefit from a new type of therapy or approach. At the very least, you would be contributing to much-needed knowledge about this condition. Check the National Cancer Institute’s registry of clinical trials at www.cancer.gov/clinicaltrials for a site near you.