DCIS Breast Cancer

What is DCIS breast cancer?

DCIS (Ductal carcinoma in situ) breast cancer is a non-invasive breast cancer. Ductal carcinoma refers to cancerous growth initiates from milk duct and surrounded breast tissue that covers the internal organs. The term in situ refers to “in its original place”.

The growth of Ductal carcinoma in situ is restricted only in the milk duct and does not spread to internal organs. therefore the risk of a fatal outcome is negligible. But there is always a risk of progression of an invasive breast cancer later stage of life¹.

Staging

Stage 0

In stage 0 no cancerous cell growth spread to the outside of the milk duct or lining of the surrounded tissues. This is an early stage and treatment prognosis is very good. But undetected or untreated cases are causing of expanding of breast cancer to the surrounded breast tissues.

Stage 1

Stage 1 is further divided into stage 1A and stage 1B for better understanding. The distinction is based upon tumor size and cancer evidence at the lymph node.

Stage 1A

Small tumor size (less than 2cm) with no spreading evidence to the lymph nodes.

Stage 1B

Rice grain sized tumor(cluster of tumor size range between .2mm to 2.0 mm) with evidence of finding of the cancerous growth in the lymph nodes ⁴

DCIS breast cancer Prevalence

The primary problem of development of DCIS is a higher risk of developing new cancer or recurrence of the condition. Usually, the progression of new breast cancer is common in the development of the Ductal carcinoma in situ, specifically who has never suffered from breast cancer before. Approximately 30% of Ductal carcinoma in situ is recurred within 5 to 10 years time period.

Almost 25% to 30% women have the risk of recurrence of the condition in future after lumpectomy (breast-conserving surgery) for DCIS without radiation therapy. But this risk becomes drop to about 15% by the inclusion of radiation therapy in the patient’s treatment plan.

The breast cancer recurrence after completion of DCIS treatment may occur as DCIS again (non-invasive)or other cancer (invasive). This risk can be measured by half-half or 50-50 chances. American Cancer Society estimated that every year 60,000 DCIS cases are diagnosed in the USA and that denoting almost 1 out of every 5 new breast cancer cases. This means a huge number of women suffer from DCIS breast cancer. There is two main cause of increasing trend of DCIS breast cancer incidence rate.

The risk of breast cancer development is increasing with increasing age. In present century people have a long life and that can be a cause.

The mammograms test is frequently conducted and that helps to screen patients suffering from breast cancer. Therefore identified cases are more in this present era. This advancement is beneficial for patients to treat them at the initial stage².

DCIS Diagnosis

Oncotype DX DCIS test

It is required to detect the genetic involvement of the development of the DCIS. The doctor usually prefers to conduct the Oncotype DX DCIS test, which is a genomic test that helps to detect the risk of recurrence of DCIS and/or also the risk of a new invasive cancer developing in the same breast.

If any positive findings need to recommend the application of radiation therapy after lumpectomy. A range of score is obtained in Oncotype DX DCIS test result, which is estimated as a Recurrence Score and the noted numbers are ranged between 0 and 100 — to the DCIS.

• Recurrence Score lower than 39

If the test result finding shows the recurrence score lower than 39, then the radiation therapy is small and has reduced side effects.

• Recurrence Score between 39 and 54

If the test result finding shows the recurrence score in between 39 to 54, then the risk of recurrence is intermediate and may side effects of high intensity of radiation therapy interfere with the benefits.

• Recurrence Score greater than 54

If the test result finding shows the recurrence score in between 39 to 54, then the risk of recurrence is high and the provided radiation therapy become beneficial in comparison to its risk of side effects.

Other Laboratory and Imaging tests

Other diagnostic tests are required to conduct for knowing the position of the tumor. Mammogram or ultrasound can only detect the presence of DCIS but exact location cannot be determined through these tests. A localizing needle is positioned close to the region of concern and then channelize with the help of mammogram or ultrasound to localize cancer. If MRI is the only option to detect the DCIS then it may require being confined with the aid of an MRI machine³.

DCIS breast cancer Treatment

The treatment plan is not same for every individual. The considerable options for standard treatment of DCIS are as follows:

• Lumpectomy followed by radiation therapy:

In a lumpectomy, only a portion of the breast where the cancerous lump is sited is removed out, without surgical removal of the whole breast. After a lumpectomy, radiation therapy is prescribed to complete destruction of cancerous cells and reduce the risk of recurrence.

• Mastectomy:

DCIS breast cancer is non-invasive. But rare cases mastectomy (removal of the whole breast), may need to recommend.

• Lumpectomy alone
• Hormonal therapy after surgery

If involvement of hormone receptors is found out during DCIS lab tests, then estrogen receptor blocking hormonal therapy is recommended for lowering the estrogen level in the blood.

Chemotherapy

Chemotherapy acts as a cytotoxic drug and reduces the chance of spreading the cancerous growth to the surrounded tissues. But, DCIS is a non-invasive and usually, growth is restricted to the milk duct, therefore chemotherapy is not included in the therapy. But this is not universal for all the cases. the clinician can only decide which is the best treatment option for the patient depending upon the patient’s condition. In the case of comedo type, high-grade or large sized lump then may more extensive treatment plan require customizing for the patient. In the case of early aged onset of DCIS also require broad spectrum treatment to prevent recurrence.

DCIS breast cancer Prognosis

DCIs breast cancer prognosis depends upon the stage of the DCIS. There are two stages present in breast cancer, but usually, DCIS is considered as stage 0 and prognosis is good.

DCIS breast cancer Survival Rate

The DCIS breast cancer treatment prognosis is very good as it is non-invasive. The survival rate usually not depends upon selected treatment option, as treatment is totally depended upon patient condition, means the size of the tumor. The usual finding shows that the general mortality rate from breast cancer after at 20 years of diagnosis is 3.3% ^5,6.

Pictures

References

1. Ductal carcinoma in situ; National Breast Cancer Foundation, Inc; Online available at http://www.nationalbreastcancer.org/dcis
2. DCIS — Ductal Carcinoma In Situ; Breast Cancer. Org; Online available at http://www.breastcancer.org/symptoms/types/dcis
3. Treatment for DCIS (2016); Breast Cancer .org ; http://www.breastcancer.org/symptoms/types/dcis/treatment
4. Breast cancer, National Breast Cancer Foundation, Inc; Online available at http://www.nationalbreastcancer.org/breast-cancer-stage-0-and-stage-1
5. Steven Halls (2016); Moose & Doc Breast Cancer; Online available at http://breast-cancer.ca/progfacts-dcis/
6. Risk of Breast Cancer Death is Low After a Diagnosis of Ductal Carcinoma in Situ (2015), National cancer Institute; Online available at https://www.cancer.gov/news-events/cancer-currents-blog/2015/dcis-low-risk

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