Ductal carcinoma in situ can often be cured. Treatment for this very early form of breast cancer often involves surgery to remove the cancer. Ductal carcinoma in situ, also called DCIS, also may be treated with radiation therapy and medicines.
DCIS treatment has a high likelihood of success. In most instances, the cancer is removed and has a low chance of coming back after treatment.
In most people, treatment options for DCIS include:
- Breast-conserving surgery, called a lumpectomy, and radiation therapy.
- Breast-removing surgery, called a mastectomy.
In some people, treatment options may include:
- Lumpectomy only.
- Lumpectomy and hormone therapy.
Surgery
If you're diagnosed with DCIS, one of the first decisions you'll have to make is whether to treat the condition with lumpectomy or mastectomy.
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Lumpectomy. A lumpectomy is surgery to remove the breast cancer and some of the healthy tissue around it. The rest of the breast tissue isn't removed. Other names for this surgery are breast-conserving surgery and wide local excision. Most people who have a lumpectomy also have radiation therapy.
Research suggests that there is a slightly higher risk of the cancer coming back after lumpectomy compared to mastectomy. However, survival rates between the two treatment approaches are very similar.
If you have other serious health conditions, you might consider other options, such as lumpectomy plus hormone therapy, lumpectomy alone or no treatment.
- Mastectomy. A mastectomy is surgery to remove all breast tissue from a breast. Breast reconstruction to restore the appearance of the breast can be done at the same time or in a later procedure, if you desire.
Lumpectomy is a good option for most people with DCIS. But mastectomy may be recommended if:
- You have a large area of DCIS. If the area is large relative to the size of your breast, a lumpectomy may not produce acceptable cosmetic results.
- There's more than one area of DCIS. When there are multiple areas of DCIS, it is called multifocal or multicentric disease. It's difficult to remove multiple areas of DCIS with a lumpectomy. This is especially true if DCIS is found in different parts of the breast.
- Biopsy results show cancer cells at or near the edge of the tissue sample. There may be more DCIS than originally thought. This means that a lumpectomy might not be enough to remove all areas of DCIS. A mastectomy could be needed to remove all of the breast tissue.
- You're not a candidate for radiation therapy. Radiation is usually given after a lumpectomy. Radiation might not be an option if you're in the first trimester of pregnancy or if you've received radiation to your chest or breast in the past. It also might not be recommended if you have a condition that makes you more sensitive to radiation side effects, such as systemic lupus erythematosus.
- You prefer to have a mastectomy. For instance, you might not want a lumpectomy if you don't want to have radiation therapy.
Because DCIS is noninvasive, surgery typically doesn't involve the removal of lymph nodes from under your arm. The chance of finding cancer in the lymph nodes is extremely small.
If your healthcare team thinks the cancer cells may have spread outside the breast duct or if you are having a mastectomy, then some lymph nodes may be removed as part of the surgery.
Radiation therapy
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources.
For DCIS treatment, the radiation is often external beam radiation. During this type of radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body. Less often, the radiation can be placed inside the body. This type of radiation is called brachytherapy.
Radiation therapy is often used after lumpectomy to reduce the chance that DCIS will come back or that it will progress to invasive cancer. But it might not be necessary if you have only a small area of DCIS that is considered slow-growing and was completely removed during surgery.
Hormone therapy
Hormone therapy, also called endocrine therapy, uses medicines to block certain hormones in the body. It's a treatment for breast cancers that are sensitive to the hormones estrogen and progesterone. Healthcare professionals call these cancers estrogen receptor positive and progesterone receptor positive. Cancers that are sensitive to hormones use the hormones as fuel for their growth. Blocking the hormones can cause the cancer cells to shrink or die.
For DCIS, hormone therapy is typically used after surgery or radiation. It lowers the risk that the cancer will come back. It also reduces the risk of developing another breast cancer.
Treatments that can be used in hormone therapy include:
- Medicines that block hormones from attaching to cancer cells. These medicines are called selective estrogen receptor modulators. Examples include tamoxifen and raloxifene (Evista).
- Medicines that stop the body from making estrogen after menopause. These medicines are called aromatase inhibitors. Examples include anastrozole (Arimidex), exemestane (Aromasin) and letrozole (Femara).
Discuss the benefits and risks of hormone therapy with your healthcare team.