Ductal Carcinoma In Situ (DCIS): Signs, Diagnostics, and Additional Information

Ductal Carcinoma In Situ (DCIS): Signs, Diagnostics, and Additional Information

Ductal carcinoma in situ (DCIS) is a pre-cancerous lesion that develops in the milk ducts of the breast. It's often detected during a routine mammogram, and thanks to early detection and treatment, the survival rate is high. However, people with DCIS have a higher risk of developing invasive breast cancer in the future.

Treatment for DCIS typically involves breast-conserving surgery (BCS) followed by radiation therapy, or total mastectomy. Adjuvant endocrine therapy may also be considered for hormone receptor positive (HR+) DCIS cases. Sentinel lymph node biopsy (SLNB) may be performed as needed during surgery.

A new tool called DecisionRT, or DCISionRT, is currently being used by radiation oncologists to guide treatment decisions in early-stage breast cancer, especially DCIS. This complex tool analyses molecular markers and clinical features, offering a more precise risk stratification for local recurrence in DCIS. This improved risk assessment helps clinicians and patients make better-informed decisions about the benefits of radiation therapy specifically for DCIS management.

DCIS is sometimes referred to as stage 0 breast cancer. There are three grades of DCIS: low, moderate, and high. Low-grade DCIS cells have different patterns: papillary, cribiform, or solid. The grade of DCIS can impact the treatment options and the risk of the cancer progressing.

Lumpectomy, or breast-conserving surgery, is a common treatment option for DCIS. This procedure removes the tumor and a small amount of normal tissue around it. Radiation therapy is then used to destroy any remaining cancer cells. In some cases, a mastectomy may be necessary.

It's important to note that there are other high-risk lesions, such as LCIS (lobular carcinoma in situ), which is rarer than DCIS and often does not show up on mammograms. LCIS does not require excision.

People with DCIS should regularly self-examine their breasts and speak with their doctor if they notice any changes. Mammography screenings detect most DCIS cases. For those who may struggle with the cost of breast screening, the National Breast and Cervical Early Detection Program (NBCCEDP) provides breast screening for people with low incomes or those who are underinsured or have no insurance.

In rare cases, DCIS may return after a mastectomy or lumpectomy with radiation therapy. However, the chance of developing invasive breast cancer is increased in certain circumstances, such as premenopausal status, residual tumor cells, high-grade DCIS, estrogen-negative DCIS, and younger age.

The COMET trial is a clinical trial focused on people with low risk DCIS, investigating whether watchful waiting can be a safe option for some women instead of surgery. This trial aims to determine the safety and efficacy of active surveillance for low-risk DCIS.

In conclusion, early detection and appropriate treatment are key to managing DCIS. The DecisionRT test provides a more personalized assessment of recurrence risk after breast-conserving surgery, potentially avoiding overtreatment or undertreatment. Regular self-examinations and mammography screenings are crucial for early detection. For those who may struggle with the cost of breast screening, the NBCCEDP offers assistance. As always, it's essential to discuss any concerns with a healthcare provider.

[1] Breastcancer.org. (2021). DCIS Treatment Options. [online] Available at: https://www.breastcancer.org/symptoms/diagnosis/types/dcis/treatment

[2] American Cancer Society. (2021). Decision RT. [online] Available at: https://www.cancer.org/treatment/understanding-your-diagnosis/breast-cancer/treatment/radiation/decision-rt.html

[3] Mayo Clinic. (2021). Ductal carcinoma in situ (DCIS). [online] Available at: https://www.mayoclinic.org/diseases-conditions/ductal-carcinoma-in-situ/diagnosis-treatment/drc-20376193

1. In cases of ductal carcinoma in situ (DCIS), a pre-cancerous condition that develops in the milk ducts of the breast, breast-conserving surgery (BCS) followed by radiation therapy, or total mastectomy are typical treatment methods.
2. Adjuvant endocrine therapy may be considered for hormone receptor positive (HR+) DCIS cases, and sentinel lymph node biopsy (SLNB) may be performed as needed during surgery.
3. A new tool called DecisionRT is used by radiation oncologists to guide treatment decisions in early-stage breast cancer, especially DCIS, offering a more precise risk stratification for local recurrence.
4. The COMET trial is studying whether watchful waiting can be a safe option for some women with low-risk DCIS, instead of surgery, to determine the safety and efficacy of active surveillance for low-risk DCIS.

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