In general, treatment for ductal carcinoma in situ (DCIS) involves surgery and possibly radiation therapy and/or tamoxifen. Depending on how far the DCIS has spread within the ducts, the surgery can be either a mastectomy (in which the entire breast is removed) or lumpectomy (in which only the abnormal tissue is removed). Usually, it will not include removal of any lymph nodes.
The first step in the treatment of DCIS is surgery to remove the affected portions of the breast. Women with DCIS that has spread throughout the ducts, and thus affects a large part of the breast, need a mastectomy to remove all the areas of DCIS. In cases where the spread of DCIS is less extensive, a choice can be made between mastectomy and lumpectomy. Before 1992, the majority of women in the U.S. with DCIS had mastectomies. Today, however, most women choose lumpectomy followed by radiation [62]. Select women with smaller, lower grade DCIS and clean surgical margins, may be candidates for surgery without radiation therapy. Women who are treated with lumpectomy plus radiation therapy for DCIS should consider taking tamoxifen for five years [63]. Tamoxifen can lower the risk of getting cancer in the opposite breast and, in women treated with lumpectomy and radiation therapy, the affected breast as well [64,65]. The benefits of tamoxifen are strongly related to the estrogen receptor-status of the tumor. Women with estrogen receptor-positive DCIS benefit from tamoxifen, while women with estrogen receptor-negative DCIS, appear to have little, if any, benefit [64,65]. For women who have a mastectomy to treat DCIS, the benefit of tamoxifen is likely to be very small, and such treatment is not usually recommended.
Studies are currently looking at aromatase inhibitors as potential alternatives to tamoxifen, but results aren't yet available [66,67]. For more on aromatase inhibitors, visit the Hormone Therapies section.
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For more information on treatment for DCIS, visit the American Society for Clinical Oncology’s website (www.cancer.net).
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To learn more about factors that affect treatment options, see Diagnosis.
To learn more about each type of surgery and its risks and benefits, see Surgery.
For more information about radiation therapy and its risks and benefits, see Radiation Therapy.
To learn more about taking tamoxifen and its risks and benefits, see Hormone Therapies.
Updated 09/12/09
