Ductal carcinoma in situ (DCIS) of the breast is an early, localized cluster of cancer cells that start in the milk passages (ducts) but have not penetrated the duct walls into the surrounding tissue. The term "in situ" refers to a tumor that has not spread beyond the place where it originally developed. By definition, DCIS is a non-invasive form of breast cancer because the cancer cells are confined to the milk ducts of the breast.

Ductal carcinoma in situ is sometimes described as "pre-cancerous", "pre-invasive", "non-invasive", or "intraductal carcinoma". Although, by definition, DCIS is a non-invasive form of breast cancer, if left untreated, it may progress to 'true' breast cancer by spreading into and invading the surrounding healthy breast tissue. Because doctors cannot predict with any degree of certainty whether DCIS will develop into invasive breast cancer, early diagnosis and treatment is crucial. With appropriate treatment, the prognosis (outlook) for women with DCIS is excellent.

Fortunately, DCIS can often be detected on screening mammography before any symptoms develop. Ductal carcinoma in situ usually appears on mammography as an area of microcalcification (groups of small calcifications clustered together within the breast). With the increased availability of mammography, breast cancers are being detected earlier.

In the past, most women with ductal carcinoma in situ had a mass large enough to be felt or had nipple discharge before the diagnosis could be made. Since screening mammography became more widely available in the 1980s, many cases of DCIS are discovered before any symptoms develop and the average size of DCIS has been reduced to 10 mm at the time of discovery. It has been estimated that DCIS accounts for about 20% of all mammographically detected breast cancers.

When an abnormal area has been detected by mammography and ductal carcinoma in situ is suspected, the diagnosis must be confirmed by removing a sample from the suspicious area of the breast and examining the specimen under a microscope. This procedure is known as a diagnostic biopsy. Traditionally, most cases of mammographically detected, nonpalpable DCIS have been diagnosed by a procedure known as wire-localization open surgical biopsy. Recently, a more accurate diagnostic biopsy technique for women with suspected DCIS has been developed called directional vacuum-assisted biopsy (DVAB). Currently, there are three types of DVAB systems available:

• Mammotome
• Spirotome
• Minimally Invasive Breast Biopsy (MIBB)

The primary goals of treatment of DCIS is prevention of local recurrence and invasive breast cancer. When breast-conserving surgery is appropriate, the goals of treatment include the total surgical removal of the DCIS with minimal cosmetic deformity.

Current treatment options for women with DCIS include:

• Surgery alone (mastectomy or breast-conserving surgery)
• Breast-conserving surgery followed by radiation therapy
• Breast-conserving surgery followed by radiation therapy and hormonal therapy.

As noted, most women who are diagnosed with DCIS by screening mammography have no clinical symptoms of the disease (such as a palpable breast mass). Because most DCIS lesions that are detected mammographically are small, there has been a shift in recent years from mastectomy to breast-conserving surgery. In fact, at the present time, in the United States most women with DCIS are treated with breast-conserving surgery.

The rate of tumor recurrence in women with ductal carcinoma in situ has been estimated to be approximately 0.5% to 1% per year. Although research suggests that the rates of local or regional recurrence are significantly lower after mastectomy than after breast-conserving surgery, the 10-year survival rate is approximately 98% with each of these surgical procedures.

Knowledge is Critical when Dealing with a Life-Altering Condition such as Ductal Carcinoma in Situ of the Breast

If you or a loved one has been diagnosed with DCIS, it's critical to learn everything you possibly can about this condition so that you can make informed decisions about your treatment. That's why we created the Medifocus Guidebook on Ductal Carcinoma in Situ of the Breast, a comprehensive 158 page patient Guidebook that contains vital information about DCIS that you won't find anywhere in a single source.

The Medifocus Guidebook on Ductal Carcinoma in Situ of the Breast starts out with a detailed overview of the condition and quickly imparts fundamentally important information about DCIS, including:

• The relationship between DCIS and other adenocarcinomas of the breast, such as lobular carcinoma in situ (LCIS).
• The various types of DCIS that can be distinguised on the basis of histological features, genetic mutations, clinical symptoms, and radiographic appearance on mammography.
• The classification system that is used to group patients with DCIS into different subgroups and is useful for planning treatment and predicting the long-term outcome.
• The role of nuclear grade and specific genetic mutations, such as mutation of the p53 gene, in predicting the likelihood of DCIS developing into invasive breast cancer.
• The signs and symptoms of DCIS and other forms of breast cancer.
• Why screening mammography is the first line of defense in the battle against DCIS.
• How DCIS is diagnosed based on factors such as signs/symptoms, patient history, physical examination, and mammography.

• The role of diagnostic breast biopsy in confirming the diagnosis of DCIS, including biopsy techniques such as:

  • Wire-localization open surgical biopsy
  • Directional vacuum-assisted biopsy

Understanding the Standard Treatments... and the Treatment Options

The primary goals of treatment for women with DCIS are to:

• Prevent local recurrence of DCIS after initial treatment has been completed.
• Prevent DCIS from developing into invasive breast cancer.

Understanding the standard treatments - and the treatment options - is critical for successfully achieving both of the major goals of treatment for DCIS. As you read through the section of the Guidebook that focuses on the treatments for DCIS, you will specifically learn about:

• The surgical treatment options that are available for the management of DCIS, including:

  • Simple mastectomy
  • Skin-sparing mastectomy
  • Breast-conserving surgery

• Why some women with DCIS are not considered as good candidates for breast-conserving surgery.

• The role of sentinel lymph node biopsy in the management of women with DCIS.
• The role of radiation therapy in the management of women with DCIS.
• New, ongoing research that focuses on identifying subgroups of women with DCIS who may not require radiation therapy after undergoing breast-conserving surgery.
• The risk factors that increase a woman's chances for developing local recurrence of DCIS or invasive breast cancer after undergoing breast-conserving surgery.
• The treatment options that are currently available for the management of recurrent DCIS.
• The role of complementary and alternative therapies in the management of women with DCIS.
• The prognosis (outlook) for women with DCIS and the important factors that have a significant impact in predicting the overall chances of recovery and survival.
• Quality of life issues such as sleep disorders, fatigue, weight loss, and psychological stress that can negatively affect women with DCIS and how to minimize their impact and cope better with these issues.
• Important questions to ask your doctor about DCIS.

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Updated: January 17, 2023
158 Pages