Ductal Carcinoma in Situ (DCIS): Symptoms, Causes, Treatment

What are the symptoms of ductal carcinoma in situ (DCIS)?

Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer where abnormal cells are found in the lining of a breast duct but have not spread outside the duct to invade surrounding breast tissue. DCIS typically does not cause symptoms and is usually detected through mammograms or other imaging studies done for breast cancer screening.

In some cases, however, DCIS may cause symptoms such as:

1. Breast Lump: A lump or thickening in the breast that can be felt.
2. Nipple Discharge: Bloody or clear discharge from the nipple, which may occur spontaneously or when the nipple is pressed.
3. Changes in the Breast: Changes in the size, shape, or appearance of the breast, including redness, swelling, or dimpling of the skin.
4. Pain or Tenderness: While DCIS typically does not cause pain, some women may experience breast pain or tenderness.

It’s important to note that these symptoms are not specific to DCIS and can also be caused by other non-cancerous conditions. If you notice any changes in your breasts, it’s important to see a healthcare provider for further evaluation. Early detection and treatment of DCIS can help prevent it from progressing to invasive breast cancer.

What are the causes of ductal carcinoma in situ?

The exact cause of ductal carcinoma in situ (DCIS) is not known, but several factors are believed to contribute to its development. These include:

1. Genetic Mutations: Changes (mutations) in certain genes, such as the BRCA1 and BRCA2 genes, can increase the risk of developing breast cancer, including DCIS. However, most cases of DCIS are not linked to inherited genetic mutations.
2. Hormonal Factors: Hormones, particularly estrogen and progesterone, can play a role in the development of breast cancer. Women with higher levels of these hormones or who have been exposed to them for longer periods of time (e.g., early menstruation, late menopause, hormone replacement therapy) may have an increased risk of developing DCIS.
3. Age: The risk of developing DCIS increases with age, with most cases diagnosed in women over 50.
4. Personal History of Breast Cancer: Women who have previously been diagnosed with breast cancer in one breast have an increased risk of developing DCIS in the other breast.
5. Family History: A family history of breast cancer, particularly in a first-degree relative (parent, sibling, child), can increase the risk of developing DCIS.
6. Radiation Exposure: Previous radiation therapy to the chest, such as for the treatment of Hodgkin lymphoma, can increase the risk of developing breast cancer, including DCIS.
7. Race and Ethnicity: White women have a slightly higher risk of developing DCIS compared to women of other races and ethnicities.

It’s important to note that having one or more of these risk factors does not mean that a person will definitely develop DCIS. Many women with one or more risk factors never develop breast cancer, while some women with no known risk factors do develop the disease. Regular screening and early detection can help diagnose DCIS at an early stage when it is most treatable.

How is the diagnosis made for ductal carcinoma in situ?

The diagnosis of ductal carcinoma in situ (DCIS) is typically made through a combination of imaging tests, such as mammography, and a biopsy to examine the breast tissue. Here is an overview of the diagnostic process for DCIS:

1. Mammogram: DCIS is often detected during routine mammograms, which can show the presence of abnormal microcalcifications (tiny calcium deposits) or a suspicious area of dense tissue in the breast.
2. Diagnostic Mammogram: If a suspicious area is found on a screening mammogram, a diagnostic mammogram may be performed to provide more detailed images of the area in question.
3. Breast Ultrasound: An ultrasound may be used to further evaluate the area of concern. Ultrasound uses sound waves to create images of the breast tissue and can help determine if a lump is solid (potentially cancerous) or fluid-filled (cyst).
4. Magnetic Resonance Imaging (MRI): In some cases, an MRI may be recommended to provide additional information about the extent of the DCIS and to help guide treatment decisions.
5. Biopsy: A biopsy is the only definitive way to diagnose DCIS. During a biopsy, a small sample of breast tissue is removed and examined under a microscope by a pathologist to look for the presence of abnormal cells. There are several types of biopsies, including:

• Fine Needle Aspiration (FNA): A thin needle is used to remove cells from the suspicious area.
• Core Needle Biopsy: A larger needle is used to remove a small sample of tissue from the suspicious area.
• Surgical Biopsy: A surgical procedure is performed to remove a larger sample of tissue from the breast.

Once DCIS is diagnosed, further tests may be done to determine the extent (stage) of the disease and to help guide treatment decisions. These may include additional imaging tests, such as a breast MRI, and possibly other tests to evaluate the lymph nodes and other areas of the body for signs of cancer spread.

What is the treatment for ductal carcinoma in situ?

The treatment for ductal carcinoma in situ (DCIS) depends on various factors, including the size and location of the DCIS, the grade of the abnormal cells, the woman’s age and overall health, and her personal preferences. The primary goals of treatment for DCIS are to remove the abnormal cells and reduce the risk of recurrence or progression to invasive breast cancer. Treatment options for DCIS may include:

1. Surgery:

• Lumpectomy: Also known as breast-conserving surgery, a lumpectomy involves removing the area of DCIS along with a surrounding margin of normal breast tissue. This is often followed by radiation therapy to reduce the risk of recurrence.
• Mastectomy: In some cases, particularly if the DCIS is large or occurs in multiple areas of the breast, a mastectomy may be recommended. This involves removing the entire breast tissue.
• Sentinel Lymph Node Biopsy: In certain cases, particularly if the DCIS is high-grade or extensive, a sentinel lymph node biopsy may be performed to check for the presence of cancer cells in the nearby lymph nodes.

1. Radiation Therapy: Radiation therapy may be recommended after lumpectomy to reduce the risk of local recurrence. It involves using high-energy beams to target and destroy any remaining cancer cells in the breast.
2. Hormone Therapy: For DCIS that is hormone receptor-positive, hormone therapy may be recommended to reduce the risk of recurrence. This typically involves taking medications such as tamoxifen or aromatase inhibitors to block the effects of estrogen on breast tissue.
3. Clinical Trials: Participation in clinical trials may be an option for some women with DCIS. Clinical trials evaluate new treatments or treatment combinations aimed at improving outcomes for individuals with DCIS.
4. Close Monitoring: In some cases, particularly for low-grade DCIS or in women with significant comorbidities, close monitoring without immediate treatment (known as active surveillance) may be considered. This involves regular follow-up exams and imaging tests to monitor for any changes or progression of the DCIS over time.

It’s important for women with DCIS to discuss treatment options with their healthcare providers and to consider the potential benefits and risks of each approach. Treatment decisions should be individualized based on the woman’s specific situation and preferences, with a focus on achieving the best possible outcomes while minimizing the impact on quality of life.