Ductal Carcinoma in Situ: The 'Non' Breast Cancer, Cancer

Ductal carcinoma in situ (DCIS) is a type of breast cancer. In people with a new breast cancer diagnosis, 1 in 5 will be DCIS, according to the American Cancer Society.

There are different kinds of breast cancer. Paget's disease, inflammatory breast cancer, medullary and mucinous are a few of the rarer forms. But the majority of cases fall into two groups:

• invasive ductal carcinoma
• invasive lobular carcinoma

But DCIS is different. It's considered noninvasive or pre-invasive breast cancer. The cancerous cells are located only in the milk ducts and haven't spread to other parts of the body. However, while it tends to stay in one spot, DCIS could potentially turn into invasive breast cancer. Even though DCIS is classified as a noninvasive, stage 0 breast cancer, it still requires treatment.

Certain people are more at risk for DCIS. Having a genetic mutation for BRCA1 and BRCA2 genes, a family history of breast cancer and getting older can increase your chances of DCIS. Other factors include getting your period before age 12, having your first baby after age 30 or entering menopause after age 55.

Is DCIS a real cancer?

Most people who have DCIS don't know they have it. Unlike other types of breast cancer, most of the time, you won't feel a lump.

"DCIS is technically not a real cancer and may never turn into a cancer that threatens one's life," said Felice Gersh, M.D., an OB-GYN and the founder of the Integrative Medical Group of Irvine in California.

Ductal carcinoma in situ is sometimes referred to as a precancer. While it looks like true cancer under a microscope, DCIS doesn't act like true cancer by invading other tissues, Gersh said.

"This is why it's called ductal carcinoma in situ. The term 'in situ' specifically means it hasn't spread," Gersh said.

But to anyone who has been diagnosed with DCIS and is getting treatment, it can very much feel like cancer, explained Monique Gary, D.O., M.Sc., a breast surgical oncologist and medical director of the Grand View Health/Penn Cancer Network Cancer Program in Sellersville, Pennsylvania.

Side effects from cancer treatment can significantly impact your quality of life.

"To these patients, it certainly feels like breast cancer, and they have the scars to prove it," Gary said. "We are still learning how to help patients manage these [side effects] for a cancer that was never high in mortality in the first place."

Nonmetastatic invasive breast cancer survival rates at the 10-year mark are around 85 percent, meaning 85 of 100 people with this common form of cancer are still alive after 10 years. In contrast, the DCIS survival rate hovers at 98 percent.

While it's rare for DCIS to invade the surrounding breast tissue, many people still require treatment because there's no way to tell if it will become invasive in the future, Gary said.

How do you know if you have DCIS?

"There is no way a person can know if they have DCIS," Gersh said. "No symptoms or findings are present. The only way to find DCIS is through breast imaging."

Breast imaging, or getting a mammogram, is the standard in diagnosing DCIS. A mammogram uses X-rays to get a picture of the breast. Using this imaging, a doctor can tell if you might have DCIS because DCIS appears as a group of small, white dots. If these white areas are found, your healthcare provider may recommend a more detailed mammogram.

After a closer look, you may have a procedure known as a core needle biopsy. A doctor uses a hollow needle to take a sample of your breast tissue to be looked at under a microscope. This can tell your provider if cancer cells are present and, if so, how advanced the cancer is.

DCIS treatment

Breast-conserving surgery, or lumpectomy, is a common surgical recommendation. A doctor surgically removes the tumor along with a small bit of healthy breast tissue around it. Radiation therapy may be recommended to further decrease the chances of the cancer returning.

According to Gary, there might be situations where more aggressive treatment, such as a mastectomy, or removal of the entire breast, is needed. These situations include having DCIS in more than one area of the breast, being unable to have radiation therapy or if cancer cells are still present in the area where the tumor was removed.

Even without these factors, some people prefer a mastectomy for peace of mind.

As the medical community is learning more about DCIS, better ways of diagnosing and treating this condition are on the horizon. Currently, there are three clinical trials looking at DCIS treatment, Gary said.

"They ask the question of whether active surveillance in low-grade DCIS diagnosed on biopsy can be safely managed by nonsurgical means," Gary said.

In other words, low-grade cancer, which is cancer that grows slowly and isn't likely to spread, might be able to be managed in the future without surgery.

"Studies are underway to determine the risk of invasive disease in the long term from these trials," Gary added.

The bottom line

A ductal carcinoma in situ diagnosis is scary, but you have many options. It's not exactly cancer and still requires treatment, but it also boasts a high survival rate a decade later. Don't hesitate to get the support you need as you navigate your new normal.

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