Ductal carcinoma in situ (DCIS)

Ductal carcinoma in situ (DCIS) is an early and non-invasive form of breast cancer found in your milk ducts. It’s commonly treated with surgery and radiation therapy to prevent it from progressing into invasive cancer.

Our care team at Aurora Health Care is here for you every step of the way from DCIS diagnosis through treatment. We offer the latest radiologic and cancer care technology, from genetic counseling to better determine your risk to cancer research that may give you access to the latest treatments.

Find a cancer treatment clinic location

Understanding the grading system for DCIS

DCIS grading helps your care team find the best treatment plan for you. When grading DCIS, three primary factors come into play:

• Nuclear grade: Divided into three levels, this factor looks at the degree of abnormality and aggressiveness in cancer cells. Higher grades indicate more noticeable abnormalities, while lower grades may resemble normal cells.
• Architectural pattern: This factor examines how abnormal cells are arranged within the breast ducts.
• Tumor size: This gauges the extent of DCIS within the milk ducts.

A combination of these elements determines the overall grade of the DCIS lesion. Lower grades often indicate you have a less aggressive DCIS and the potential to progress into invasive breast cancer is less.

DCIS risk factors

Multiple factors contribute to the risk of developing DCIS, ranging from family history, genetic mutations and lifestyle factors. If you have a family history of breast cancer, genetic testing can help assess your risk, especially for gene mutations associated with increased risk of breast cancer.

Other risk factors for DCIS include:

• Age: While DCIS can occur at any age, women over 50 are more likely to develop it.
• Dense breast tissue: Women with dense breast tissue on mammograms face an increased risk of both DCIS and invasive breast cancer.
• Hormonal factors: Factors that affect hormone levels, like early menstruation, late menopause, childbirth after 30 and prolonged use of hormone replacement therapy may escalate DCIS risk.
• Lifestyle factors: Obesity, excessive alcohol consumption and a lack of exercise can also contribute to a higher DCIS risk.
• Personal history of breast cancer: A prior diagnosis of breast cancer in one breast increases your risk of developing DCIS in the opposite breast.
• Radiation exposure: Past radiation therapy to the chest, especially during childhood or teenage years, increases the likelihood of DCIS later in life.

DCIS symptoms

DCIS often has no symptoms, since it’s restricted to the breast’s milk ducts. Self-exams and regular screenings are vital for early detection.

However, there are instances where signs may indicate a potential issue, including:

• Breast lump or thickening
• Nipple discharge
• Changes in breast appearance
• Breast pain or tenderness

Should you notice any changes in your breasts or experience concerning symptoms, schedule an appointment with your provider for further evaluation.

Diagnosing DCIS

Diagnosing DCIS poses a challenge due to its nature of not showing any symptoms. Often, it's found during routine breast examinations or mammograms. When abnormalities are found on a mammogram, a DCIS diagnosis is confirmed through a stereotactic breast biopsy.

During a stereotactic breast biopsy, a small tissue sample is removed with a hollow needle from the area where the abnormal cells were identified on the mammogram. A pathologist will look at the tissue to confirm a diagnosis of DCIS.

What is the best treatment for DCIS?

Treatment for DCIS is focused on removing the cancer cells and reducing your risk of it coming back. Your Aurora cancer specialist will consider various factors, including the size and grade of the DCIS, and your overall health and personal preferences.

Treatment for DCIS may include surgical or non-surgical approaches, or both.

Surgical treatment options include:

• Lumpectomy: Also known as breast conserving surgery, during this surgery your surgeon removes any cancerous and abnormal tissue, some healthy tissue and lymph nodes under the arm.
• Total mastectomy: A total mastectomy is needed when cancer is found in more than one area of your breast, if you have a deformed breast or your breast is small or shaped in such a way that removing the cancer will leave little breast tissue, or if you can’t have radiation therapy.
• Modified radical mastectomy: This is the removal of as much breast tissue as possible, including the nipple, some of the skin and lymph nodes in the armpit.
• Radiation therapy: After the surgery is completed, your surgeon will deliver radiation into an open incision. Once the radiation treatment is done, the incision is closed.

Can DCIS be treated without surgery?

While surgery is the most common treatment for DCIS, it's not the only option. In some cases, especially for low-grade DCIS or when surgery isn't recommended due to other health concerns, the best treatment for DICIS will depend on several factors unique to your situation.

Non-surgical treatments may include:

• Active surveillance: Sometimes active surveillance may be an option for low-grade DCIS. This involves closely monitoring the condition with regular mammograms and checkups with your doctor to ensure that it doesn't progress. If there are any signs of changes or progression, treatment may be reconsidered.
• Chemotherapy: Chemotherapy can prevent cancer from coming back if you are newly diagnosed, help control the disease when found in other places in the body and control the disease in women whose cancer has come back. However, it is rarely used as treatment for DCIS.
• Hormone therapy: If tests determine if the cancer is sensitive to estrogen or progesterone, you may be given medication that prevents your body’s natural hormones from reaching the cancer. While it may not eliminate the cancer cells entirely, it can reduce the risk of recurrence and potentially prevent the need for surgery in some cases.