Ductal carcinoma in situ: A highly treatable breast cancer
Questions Remain on how Aggressively to Treat
Doctors and their patients with a specific type of breast cancer called ductal carcinoma in situ (DCIS) are successfully employing treatments to beat the disease, with 10-year survival rates approaching nearly 100 percent.
But questions remain on how aggressively to treat this cancer. The October issue of Mayo Clinic Women’s HealthSource lays out the issues and treatment choices.
DCIS occurs when abnormal cells multiply and form a growth within a breast’s milk duct. The cells are considered cancerous but have remained in place within the milk duct. “In situ” means “in place.”
More than 62,000 cases of DCIS are diagnosed in the United States annually, making it the most rapidly increasing type of noninvasive cancer. The majority of DCIS cases — about 90 percent — are discovered during routine mammograms. DCIS usually has no outward signs or symptoms.
DCIS isn’t considered life threatening, but, if not detected and treated, it can progress to a more serious form of invasive cancer. The best treatment approach is still being debated.
Lumpectomy or mastectomy: Most women with DCIS are good candidates for a lumpectomy, where a portion of breast tissue is removed. However, there’s a slightly higher chance that the cancer will return after a lumpectomy than after a mastectomy, which involves removal of breast tissue, skin, areola and nipple.
Mastectomy is commonly recommended when the area of DCIS is large or in several parts of one breast. Women may choose this option if they can’t have or don’t want radiation. Some women choose to have both breasts removed to prevent recurrence or a new cancer.
Radiation therapy: Radiation therapy is almost always recommended after a lumpectomy. Research has shown that it significantly reduces the chances that DCIS will recur or progress to an invasive form of cancer. Radiation is usually given five days a week for five to six weeks. Some research has questioned whether this approach is overly aggressive, particularly for older women with small, slow-growing tumors.
Tamoxifen therapy: Tamoxifen is a synthetic hormone that can be used to help treat or prevent the development of breast cancers. It’s approved as therapy after surgery or radiation to prevent recurrence of DCIS or a new cancer in the opposite breast. But, some doctors don’t recommend it because no evidence shows that tamoxifen improves long-term survival with this type of cancer. Taking tamoxifen can result in side effects such as hot flashes. And tamoxifen may increase the risk of blood clots and cancer of the uterus.
Researchers are attempting to better understand which women with DCIS are at highest and lowest risk of recurrence. That information would help in determining the most appropriate treatment. In the meantime, patients and their care providers should discuss the pros and cons of all treatment approaches.
Source: Mayo Clinic
