Is Ductal Carcinoma in Situ Cancer Curable? Risks and Symptoms

Reviewed on 3/15/2022
ductal carcinoma in situ (DCIS)
Most patients with ductal carcinoma in situ (DCIS) can be cured with proper and timely treatment.

Treatment often has a high success rate in cases of ductal carcinoma in situ (DCIS). Most patients with DCIS can be cured with surgery with or without radiation or hormonal therapy.

The goal of DCIS treatment is to ensure that the abnormal cells in the milk ducts do not move to the breast tissue and develop into invasive breast cancer, as well as to keep it from recurring. Treatment will be tailored to each patient's specific needs.

Each treatment modality of DCIS has its benefits and drawbacks.

What are the common symptoms of DCIS?

Ductal carcinoma in situ (DCIS) usually does not cause any symptoms. It has not penetrated the duct wall or involved other breast tissues. Screening mammograms detect the great majority of DCIS malignancies. Many invasive ductal carcinomas are discovered during screening mammography.

Common symptoms of DCIS include:

  • Lump or mass in or surrounding area of breast
  • Bloody discharge or fluid discharge other than milk from the nipple

Other breast diseases, such as an infection or a plugged milk duct, can cause these symptoms. Seeing a doctor is the only way to be certain. If you have any of these symptoms, get immediate medical attention.

13 common causes and risk factors of DCIS

Ductal carcinoma, like all malignancies, begins when cells proliferate uncontrollably. However, scientists could not fully comprehend why this occurs. They are aware that genetic, environmental, and personal lifestyle factors play a part.

Gene mutations, which you either inherit from your parents or acquire over your lifetime, can dramatically raise the likelihood of a breast cell becoming a cancer cell and eventually creating a tumor.

Certain environmental and other factors increase the likelihood of genetic alterations, such as:

  1. Early menarche (getting the first period before turning 12 years old)
  2. Late age at menopause (after 55 years)
  3. Childbirth at a later age (after 30 years)
  4. A family history of breast cancer
  5. Having a family or personal history of cancer
  6. Obesity
  7. Older age
  8. Hormone replacement therapy
  9. Dense breast tissue
  10. A history of benign breast diseases
  11. Women are more prone to ductal carcinoma in situ (DCIS) than men (rarely seen in men)
  12. BRCA1 and BRCA2 gene mutations
  13. Previous exposure to diethylstilbestrol (DES) or chest radiation therapy increases the risk of gene mutations

DCIS risk can be influenced by lifestyle factors. This involves not working out, drinking alcohol, and being overweight. Carrying excess weight is a particularly dangerous risk factor for women who have gone through menopause. For these women, fatty tissue is the primary source of estrogen.

Higher estrogen levels are associated with having more fat. This increases the risk of breast cancer and the likelihood that it will recur. It fuels estrogen receptor-positive cancers, which are more common in this population.

QUESTION

A lump in the breast is almost always cancer. See Answer

7 treatment options for DCIS

  1. Wide local excision (breast conservation surgery) and radiotherapy (radiation therapy)
    • The ductal carcinoma in situ (DCIS) and a tiny region of healthy tissue surrounding it (the “surgical margin”) are removed by the surgeon.
    • Following surgery, radiation (radiation treatment) is administered to the breast. This treatment kills cancer cells and reduces the likelihood of DCIS or invasive breast cancer forming in the residual breast tissue in the future greatly.
    • Advantages
      • The entire breast is not removed
      • The procedure is less invasive, and the recuperation time is shorter
      • The operation usually yields a satisfactory cosmetic outcome
      • Radiotherapy reduces the chance of DCIS or invasive cancer in the future greatly
    • Disadvantages
      • Cancerous tissue may be missed during surgery
      • A 10 to 20 percent possibility of a second procedure, which may be required to obtain clear margins (This cannot be determined until the pathology results are available.)
      • Radiotherapy necessitates frequent hospital visits
      • Radiotherapy can negatively affect the skin, breast tissue, and other adjacent tissues
      • There is a slight chance that DCIS will recur or invasive cancer will occur in the future
      • Mammograms are required every year for both the treated and unaffected breasts
  2. Wide local excision without radiotherapy
    • For women with modest patches of low-grade DCIS, wide excision alone may be sufficient. However, in most situations, surgery is paired with a course of radiotherapy because treatment has been shown to dramatically minimize the odds of DCIS or invasive cancer impacting the breast in the future.
  3. Total mastectomy
    • The surgeon removes the entire breast and the nipple. This is sometimes the only choice for treating vast regions of DCIS or little clusters of DCIS spread across the breast.
    • Advantages
      • In most cases, radiotherapy is not required following a mastectomy for DCIS
      • The likelihood of DCIS recurrence or the development of invasive cancer in the future is quite low
      • Mammograms are indicated once a year for the unaffected breast
    • Disadvantages
      • The breast is removed, which affects the body’s shape and image
      • The procedure is more extensive than a wide local excision
      • It takes longer to recuperate following surgery, especially if mastectomy is accompanied by breast reconstruction
  4. Total mastectomy with breast reconstruction
    • Almost all women who have a mastectomy for DCIS have the option of having their breasts rebuilt. Following a mastectomy, the breast can be reconstructed in a variety of methods.
      • Reconstruction with a breast implant or reconstructions with a flap are two options (using your natural tissue from other areas of your body)
      • If your DCIS is not near your nipple, you may be able to have a mastectomy that preserves your nipple
      • Breast reconstruction can be done immediately (at the same time as the mastectomy) or delayed (months or years later)
      • Breast reconstruction may be performed by a breast cancer surgeon, plastic surgeon, or both surgeons (This will depend on the individual situation and chosen type of reconstruction.)
  5. Nipple-sparing mastectomy
    • The nipple can be preserved in some mastectomy situations if all the breast tissue and ducts behind it are removed.
      • This is feasible if DCIS has located some distance from the nipple.
      • Nipple-sparing is typically considered when breast reconstruction is performed concurrently with mastectomy.
  6. Hormone-blocking (endocrine) therapies
    • Tamoxifen and aromatase inhibitors are hormone-blocking treatments that are frequently used in the treatment of invasive breast cancer.
    • They can lower the likelihood of DCIS returning in those who chose breast conservation over mastectomy.
    • Hormone-blocking medicines can be used in conjunction with surgery and radiotherapy.
  7. Surgery to remove lymph nodes
    • Most women with invasive breast cancer undergo surgery to remove some of their axillary (armpit) lymph nodes.
      • Because aggressive cancer spreads to the nearest lymph nodes first, these are removed for testing.
      • Cancer cells in DCIS are isolated in the milk ducts and do not infiltrate the breast tissue or spread to the lymph glands, hence removing the glands is frequently unnecessary.
      • However, if there is a significant area of DCIS or several little clusters of DCIS, the odds of detecting invasive cancer in the DCIS are increased, and the surgeon may consider a lymph node biopsy.
      • A sentinel node biopsy is typically advised when a mastectomy is recommended for DCIS.

DCIS is not a life-threatening condition. You have enough time to carefully study your treatment options and decide. If you are unsure what to do, seek a second opinion.

DCIS is not considered life-threatening if it has not progressed beyond the milk ducts into any normal surrounding breast tissue. The five-year survival rate for women with DCIS is over 98 percent.

Can DCIS reoccur?

The likelihood of the ductal carcinoma in situ (DCIS) returning is determined by several factors. However, DCIS nearly never returns following a mastectomy.

The probability of DCIS recurrence is slightly higher in women who have only the area of DCIS removed. It depends on the grade and kind of DCIS. However, in some patients after treatment, DCIS may return.

The following factors increase the chance of local recurrence after breast conservation:

  • Age at diagnosis
  • Tumor size
  • Positive margins
  • High-grade tumors
  • Omission of radiotherapy

After DCIS therapy, half of the recurrences after surgery with or without radiation are invasive carcinoma, whereas the other half is DCIS.

How can I prevent DCIS?

Reducing the risk of breast cancer entails modifying risk factors that you can influence, such as:

  • Maintaining a healthy weight
  • Regularly exercising
  • Avoiding drinking alcohol

However, the biggest risk factor, the female gender, as well as age and thick breast tissue are unchangeable. As a result, screening mammograms are an important aspect of every woman's health care.

Screening mammograms

They are the most effective method to detect breast cancer in its early stages. Discuss your risk with your doctor and find out when you should start receiving screening mammograms.

If you are at high risk of developing breast cancer, your doctor may discuss prevention strategies with you. Chemoprevention using drugs inhibits the action of estrogen on breast tissue. Women with risk factors may be in less danger as a result of this.

Double mastectomy

  • Entails to remove both breasts
  • Women with known genetic mutations may want to consider this option

Ductal carcinoma in situ (DCIS) has a quite high five-year survival rate, with virtually all women still alive five years following diagnosis. The survival rate of invasive ductal carcinoma varies according to the stage.

Other factors, however, have an impact on treatment outcomes. Age, general health, and response to treatment are factors to consider. The doctor can explain how survival estimates apply to a specific case. Consult the doctor for the most up-to-date information.

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References
Image Source: iStock Images

Cleveland Clinic. Ductal Carcinoma in Situ (DCIS). https://my.clevelandclinic.org/health/diseases/17869-ductal-carcinoma-in-situ-dcis#:

American Cancer Society. Treatment of Ductal Carcinoma in Situ (DCIS). https://www.cancer.org/cancer/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-ductal-carcinoma-in-situ-dcis.html

Breastcancer.org. Ductal Carcinoma In Situ (DCIS). https://www.breastcancer.org/types/ductal-carcinoma-in-situ

Moffitt Cancer Center. Ductal Carcinoma in Situ Survival Rates. https://moffitt.org/cancers/ductal-carcinoma-in-situ/survival-rates/

Oncolink. Ductal Carcinoma In Situ (DCIS). https://www.oncolink.org/cancers/breast/ductal-carcinoma-in-situ-dcis

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