DCIS Breast Cancer Not Every Woman Needs Surgery

Ductal carcinoma in situ (DCIS) is the earliest form of breast cancer. DCIS is confined to the milk ducts of the breast, and it’s often considered “stage zero.” Each year, 51,000 women are diagnosed with DCIS during their mammogram.

Women naturally feel anxious when they learn they have DCIS breast cancer. However, DCIS is different from more aggressive cancers—it is highly treatable. For the majority of patients, the primary concern with DCIS is whether it returns after treatment and, if it does, whether it spreads beyond the milk ducts. It’s important to seek treatment for DCIS, and patients today have more options than ever.

Years ago, we treated most forms of breast cancer with mastectomy, which removed cancer cells but also removed the entire breast and required women to undergo chemotherapy and radiation therapy. Today, we know more about DCIS and can offer women a broader range of treatment options—including the potential to avoid surgery all together.

LISTEN: Dr. Patricia Wehner discusses DCIS breast cancer treatment in the Medical Intel podcast.

How is DCIS detected?

Age is the most important risk factor for developing breast cancer. The older a woman is, the greater her risk. As such, DCIS often is diagnosed later in life during a woman’s annual mammogram, which is a breast health check-up and a screening for potential breast cancer.

DCIS can appear as little white dots on the mammogram imaging. If the dots are new, increasing in size, or clustered together, it could indicate that DCIS is present. The doctor may recommend a minimally invasive needle biopsy, in which we numb the area of the breast that potentially contains DCIS and remove a small sample of breast tissue. Under a microscope, a pathologist will determine whether the dots indicate cancer or a benign condition such as calcium deposits.

If we diagnose DCIS, we will recommend a few more tests to help us start a conversation with patients about what type of treatment is best for them.

How is DCIS treated?

The standard treatment is a team approach. In the lab, we’ll test the breast tissue to determine whether the cancer has hormone receptors. If it does, patients have the option to take an anti-hormone medication to treat the cancer.

If the affected area of the breast is small, we generally can remove it by doing a partial mastectomy, or a lumpectomy, in which we remove only the cancerous tissue and a small portion of healthy tissue that surrounded the cancer. We generally recommend radiation therapy after a lumpectomy, which generally starts a month after surgery and continues for three to six weeks. Radiation is localized to treat just the cancer site and, in combination with surgery, can reduce the risk that the cancer will return.

We do not use chemotherapy to treat DCIS. It affects the whole body, and the negative side effects outweigh the benefits for this type of cancer. Radiation therapy reduces the risk of DCIS coming back by about 50 percent.

Observation alone might also be an option for patients with low-risk DCIS. We are involved in the COMET trial, in which women are given mammograms every six months to check for changes in the cancer. The goal is to determine whether more women can avoid breast surgery and effectively manage DCIS through monitoring only.

What can women expect during recovery?

Most patients who have a partial mastectomy can go home the day of surgery. Patients wear a bandage to cover the incision on their breast and a supportive bra that we recommend wearing for a week after surgery to support the breast. Many patients use prescribed pain medication for just a day or two after surgery, and patients have very few restrictions during recovery.

Being diagnosed with any type of cancer is scary. Thankfully, women with DCIS have several options to treat the cancer and reduce the risk that it will return.