DUCTAL CARCINOMA IN SITU (DCIS)

DCIS is an early and non-invasive form of breast cancer, where very abnormal cells have developed within the milk ducts but are unable to invade tissue locally and therefore cannot spread to other sites within the body. As a result of being confined to the breast ducts, a diagnosis of DCIS has an excellent outlook or prognosis following treatment.

DCIS often has no accompanying symptoms and it is usually identified incidentally on a mammogram as small white flecks or calcifications. A small number of patients may notice a change in the breast such as a lump, discharge from the nipple or skin change involving the nipple (called Paget’s disease).

If the radiologist who looks at your mammogram suspects you have DCIS they will arrange for you to have an X-ray guided (stereotactic) biopsy. The biopsy report will follow within a few days and be discussed within the breast cancer MDT.

The current national treatment recommendations for DCIS involve surgical removal and sometimes radiotherapy to the breast afterwards.

• Wide Local Excision with radiation therapy. For small areas of DCIS, removal of the affected breast tissue with breast conserving surgery and post-operative radiotherapy offers safe and successful treatment.
• Mastectomy. For women who have more extensive areas of DCIS, or DCIS involving more than one area of the breast, then a mastectomy may be necessary. This will depend upon the size of the area affected, the size of the patient’s breast and wherever possible the preference of the patient. This would normally be carried out with an axillary sentinel lymph node biopsy at the same time. Patients who undergo a mastectomy for DCIS are very unlikely to require radiotherapy afterwards, and are likely to be able to have a breast reconstruction carried out at the same time if they wish (immediate reconstruction).
• Anti-hormonal therapy. Anti-hormonal therapy is sometimes discussed for individual patients, with oestrogen sensitive DCIS
• Chemotherapy. Chemotherapy is not needed in the treatment DCIS.

Women with DCIS have an excellent prognosis, but patients treated for DCIS will be offered at least 5 years of surveillance with annual mammograms following completion of treatment.

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