Treatment options for ductal carcinoma in situ
Treatment options for DCIS depend on a number of things, including the size of the DCIS compared to the size of the breast, the grade of DCIS, the woman’s age and whether she has a family history of breast cancer. Because ductal carcinoma in situ (DCIS) may develop into invasive breast cancer and invasive breast cancer can spread and cause death, it’s recommended that all women with DCIS have treatment. The aim of treatment for DCIS is to help prevent invasive breast cancer from developing and to help stop DCIS from coming back in the breast.
Why is DCIS treated?
The aim of treating DCIS is to prevent invasive breast cancer from developing. If DCIS is not treated it may develop into invasive breast cancer, which can spread outside the ducts into the breast tissue and then possibly to other parts of the body.
We don’t know for certain how many women with DCIS would develop invasive breast cancer if they were not treated. Also, it is not possible to predict which women with DCIS will develop invasive breast cancer if they were not treated or how long after the diagnosis of DCIS an invasive breast cancer would develop. Some women with DCIS may never develop any problems if they are not treated. However, some women with DCIS may develop invasive breast cancer.
Because DCIS may develop into invasive breast cancer and invasive breast cancer can spread and cause death, women with DCIS are generally recommended to have treatment. Treatment for DCIS aims to help prevent invasive breast cancer from developing and DCIS from coming back in the breast.
DCIS can be treated successfully and most women diagnosed and treated for DCIS will not later develop invasive breast cancer.
A focus of current research effort is to identify whether treatment for DCIS can vary dependent on the grade of the disease. There are currently two international clinical trials, (the LORIS trial and the LORD trial) that are investigating the “watch and wait” approach compared to immediate treatment for the management of low-grade DCIS. The LORIS trial is currently recruiting patients in the United Kingdom and the LORD trial is planned to soon start recruiting patients in Europe. The results from these trials will help to determine the best treatment options for women with low-grade DCIS. At this time, however, there are no national or international guidelines which recommend a “watch and wait” management option for low-grade DCIS.
Treatment for DCIS usually involves:
Treatment for DCIS may involve:
Surgery for DCIS usually involves breast conserving surgery.
For some women, the surgical biopsy to diagnose DCIS is the only surgery needed because all the DCIS is removed by the biopsy.
Radiotherapy is usually recommended after breast conserving surgery for women with DCIS. Radiotherapy is not usually recommended after mastectomy for women with DCIS.
Because DCIS cells are contained within the milk ducts and don’t spread into the breast tissue, most women with DCIS don’t need to have lymph nodes removed from the armpit.
Rarely, if the DCIS covers a large area of the breast or if the DCIS is high grade, removal of some lymph nodes may be recommended.
Hormonal therapies are drugs that change the level of female hormones in the body or stop cells from being affected by hormones. There are several different types of hormonal therapy. Hormonal therapies might be effective in women with DCIS. However, the long-term benefits and side effects of hormonal therapies for women with DCIS are not yet known. Clinical trials are continuing to test hormonal therapies for treating DCIS.