DCIS

Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means “in its original place.” DCIS is called “non-invasive” because it hasn’t spread beyond the milk duct into any normal surrounding breast tissue. DCIS isn’t life-threatening, but having DCIS can increase the risk of developing an invasive breast cancer later on.

When you have had DCIS, you are at higher risk for the cancer coming back or for developing a new breast cancer than a person who has never had breast cancer before. Most recurrences happen within the 5 to 10 years after initial diagnosis. The chances of a recurrence are under 30%.

Women who have breast-conserving surgery (lumpectomy) for DCIS without radiation therapy have about a 25% to 30% chance of having a recurrence at some point in the future. Including radiation therapy in the treatment plan after surgery drops the risk of recurrence to about 15%. Learn what additional steps you can take to lower your risk of a new breast cancer diagnosis or a recurrence in the Lower Your Risk section. If breast cancer does come back after earlier DCIS treatment, the recurrence is non-invasive (DCIS again) about half the time and invasive about half the time. (DCIS itself is NOT invasive.)

Here is an actual case:

43 year old with palpable breast mass biopsied in 2006 with results showing fibroadenoma. The mass has grown (now 3cm) and she is having a gyne surgery and wants the mass removed while in OR.

1st step: excisional biopsy, do pathology, send it out

2nd step: atypical fibroepithelial lesion with 2.5mm focus of DCIS? Margins negative for DCIS but positive for atypical cells? Do an MRI. Any enhancement pattern surrounding complete lumpectomy cavity consistent with atypia or DCIS?

3rd step: re-excision margins where atypical cells show, further excision to clear the margin, then XRT

4th step: no further radiotherapy, possible chemo

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