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Home > Research & Grants > Research and Scientific Programs > Is Ductal Carcinoma In Situ (DCIS) Breast Cancer? (March 2013)

  


Is Ductal Carcinoma In Situ (DCIS) Breast Cancer? (March 2013)

 

What is ductal carcinoma in situ (DCIS)?

Ductal carcinoma in situ (DCIS) is breast cancer, but it is non-invasive (stage 0). “Ductal” means “related to the milk ducts” and “in situ” means "in place." With DCIS, the cancer cells are contained within the milk ducts. Because the cancer cells have not invaded nearby breast tissue, DCIS is not invasive breast cancer.

 

 Ductal carcinoma in situ illustration 

 

Image source: National Cancer Institute (http://www.cancer.gov)

DCIS in the United States

It is estimated that there will be about 55,000 new cases of DCIS diagnosed among women in the U.S. in 2013.1
 

Treatment

Although DCIS is not invasive breast cancer, it can sometimes turn into invasive breast cancer. After treatment, there is still a small chance that cancer will return to the breast. About half the time, it returns as DCIS and about half the time it returns as invasive breast cancer.2

Treatment for DCIS is similar to treatment for invasive breast cancer. It involves surgery, with or without radiation therapy, and for some women, hormone therapy. One difference in treatment is that chemotherapy is not given for DCIS.

With treatment, prognosis is excellent.

Surgery

The first step in treating DCIS is surgery to remove it. Depending on how far the DCIS has spread within the milk ducts, surgery can be either lumpectomy or mastectomy. In most cases, surgery does not include the removal of any lymph nodes.

For women who have the option, lumpectomy plus radiation therapy and mastectomy are equally effective in lowering the risk of invasive breast cancer and DCIS recurrence.3

Learn more about lumpectomy and mastectomy.

Radiation therapy

After lumpectomy
Lumpectomy for DCIS is usually followed by radiation therapy. Overall survival appears to be similar for women with DCIS who have lumpectomy with or without radiation therapy.4-3 However, radiation therapy after lumpectomy can:2,4-8  

  • Lower the risk of invasive breast cancer in the breast treated for DCIS 
  • Lower the risk of DCIS recurrence in the breast treated for DCIS

Select older women with DCIS may be candidates for lumpectomy without radiation therapy. This may be an option when:2,10  

  • DCIS is small and low grade (the DCIS cells look much like normal cells) 
    and 
  • The surgical margins are clean (the area of tissue surrounding the tumor removed during surgery contained no DCIS cells)

After mastectomy  

Radiation therapy is not given to women treated with mastectomy for DCIS.

Learn more about radiation therapy.

Find a summary of research studies on lumpectomy plus radiation therapy in the treatment of DCIS.

Hormone therapy with tamoxifen

The hormone therapy drug tamoxifen can be used to treat estrogen receptor-positive DCIS.

The use of hormone therapy with aromatase inhibitors (instead of tamoxifen) for DCIS is under study. Although aromatase inhibitors are used to treat estrogen receptor-positive invasive breast cancer, data on their use in treating DCIS are limited. So, at this time, tamoxifen is more commonly used to treat estrogen receptor-positive DCIS.

After lumpectomy  

 

Women who are treated with lumpectomy plus radiation therapy for estrogen receptor-positive DCIS, however, may consider taking tamoxifen for five years.2 Although tamoxifen has not been shown to increase overall survival for DCIS, studies have shown tamoxifen can:7-8  

  • Lower the risk of invasive breast cancer in both the breast treated for DCIS and the opposite breast 
  • Lower the risk of DCIS recurrence in both the breast treated for DCIS and the opposite breast

After mastectomy  

Tamoxifen is not usually recommended for women who have a mastectomy for estrogen receptor-positive DCIS. These women have an excellent prognosis with a low risk of invasive breast cancer or DCIS recurrence, so the benefit of tamoxifen is likely very small.

Learn more about hormone therapy.

Find a summary of research studies on tamoxifen in the treatment of DCIS.

Race/ethnicity and DCIS

Among women with the same treatments for DCIS, race and ethnicity do not seem to impact rates of DCIS recurrence or invasive breast cancer.9  

Should all DCIS be treated the same?

The good news is that most DCIS will not progress to invasive breast cancer.11 However, health care providers cannot yet predict which cases of DCIS will turn into invasive breast cancer and which will not. So, every case of DCIS is treated. Unfortunately, this means some women are “over-treated” for DCIS. They get little benefit (beyond peace of mind) from treatment because they would never develop invasive breast cancer with or without treatment for DCIS.

Choosing the appropriate treatment for DCIS is a major research challenge. Researchers are studying ways to identify the cases of DCIS most likely to turn into invasive breast cancer. This would allow treatment to be targeted to those who are at higher risk.

Clinical trials for DCIS

If you have been diagnosed with DCIS, discuss the benefits and risks of joining a clinical trial with your health care provider. BreastCancerTrials.org in collaboration with Susan G. Komen for the Cure® offers a custom matching service that can help you find a clinical trial that fits your health needs.

Summary

In conclusion, Dr. Lori Pierce, Vice Provost for Academic and Faculty Affairs and Professor of Radiation Oncology at the University of Michigan, says “this article has summarized nicely the major challenges facing breast cancer patients and their physicians in the management of ductal carcinoma in situ (DCIS). DCIS is not an invasive disease but can progress to invasive breast cancer, and potentially impact survival, in a significant number of women if not adequately treated when diagnosed. And we know that for those patients treated with lumpectomy, radiation to follow will reduce the chance of DCIS returning and/or invasive disease developing by at least 50%. We also know, however, that in some patients, the likelihood that DCIS will progress to invasive disease is very low even in the absence of treatment. Unfortunately, we have not found a reproducible way to predict those who need to be treated and those who don’t but many researchers are working on this very question. For now, clinicians should have detailed discussions with patients diagnosed with DCIS regarding the pros and cons of treatment to help them make well-informed decisions regarding therapeutic options and outcomes.”

What is Komen doing?

In the past six years (2007-2012) Komen has funded 29 grants that focus on DCIS. Most of these projects focus on the basic biology of how DCIS develops or on indentifying biomarkers that predict which women with DCIS will go on to develop invasive breast cancer. Eleven of these grants support clinical trials that include women with DCIS.

KPDCISChart.png 

References

  1. American Cancer Society. Cancer Facts and Figures 2013. Atlanta, GA: American Cancer Society, 2013. 
  2. National Comprehensive Cancer Network. NCCN Clinical practices guidelines in oncology: Breast cancer. V.3.2012. http://www.nccn.org, 2012. 
  3. Kane RL, Virnig BA, Shamliyan T, Wang SY, Tuttle TM, Wilt TJ. The impact of surgery, radiation, and systemic treatment on outcomes in patients with ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):130-3, 2010. 
  4. Goodwin A, Parker S, Ghersi D, Wilcken N. Post-operative radiotherapy for ductal carcinoma in situ of the breast. Cochrane Database Syst Rev. (3):CD000563, 2009. 
  5. Correa C, McGale P, Taylor C, Wang Y, et al. for the Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010(41):162-77, 2010. 
  6. Holmberg L, Garmo H, Granstrand B, et al. Absolute risk reductions for local recurrence after postoperative radiotherapy after sector resection for ductal carcinoma in situ of the breast. J Clin Oncol. 26(8):1247-52, 2008. 
  7. Cuzick J, Sestak I, Pinder SE, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol. 12(1):21-9, 2011. 
  8. Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 103(6):478-88, 2011. 
  9. Bailes AA, Kuerer HM, Lari SA, Jones LA, Brewster AM. Impact of race and ethnicity on features and outcome of ductal carcinoma in situ of the breast. Cancer. 119(1):150-7, 2013. 
  10. Hughes LL, Wang M, Page DL, et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 27(32):5319-24, 2009. 
  11. Morrow M and Harris JR. Chapter 26: Ductal carcinoma in situ and microinvasive carcinoma, in Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast, 4th edition. Lippincott Williams and Wilkins, 2010. 

 Posted February 28, 2013