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DCIS - ductal carcinoma in situ

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This page tells you about DCIS (ductal carcinoma in situ). DCIS means that some cells in the lining of the ducts of the breast tissue have started to become abnormal. You can find information about

 

A quick guide to what's on this page

DCIS – ductal carcinoma in situ

If you have ductal carcinoma in situ (DCIS), it means that cells inside some of the ducts of your breast have started to turn into cancer cells. These cells are all inside the ducts and have not started to spread into the surrounding breast tissue. So, there is very little chance that any of the cells have spread to the lymph nodes or elsewhere in the body.

Invasive ductal breast cancer and DCIS are not the same thing. In invasive ductal breast cancer, the cells have broken out of the ducts and so there is a chance they can spread into nearby lymph nodes or to other parts of the body.

Grade of DCIS

Doctors classify DCIS into high grade (more quickly growing) and low grade (more slowly growing). There is also an intermediate grade, that is in between high grade and low grade. The high grade DCIS is more likely to spread into the surrounding breast tissue and more likely to come back after treatment. Knowing the grade helps doctors to know which treatment you need.

Treatment for DCIS

The main treatment for DCIS is surgery. Many women have removal of just the area of DCIS with a border of healthy tissue around it (local excision). But some women have removal of the whole breast (mastectomy). After local excision, you may have radiotherapy to the rest of the breast tissue if the DCIS is high grade.

You might have tamoxifen (a type of hormone therapy) to try to reduce the risk of developing an invasive breast cancer in the future. Trials are looking at using other types of hormone therapy to see if they can also help to reduce the risk of DCIS coming back or developing into an invasive breast cancer. 

Whichever treatment you have, you will have regular follow up appointments to make sure that if DCIS comes back, it is picked up as quickly as possible.

 

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What DCIS is

If you have ductal carcinoma in situ (DCIS), it means that cells inside some of the ducts of your breast have started to turn into cancer cells. These cells are all contained inside the ducts and have not started to spread into the surrounding breast tissue. So, there is very little chance that any of the cells have spread to the lymph nodes or elsewhere in the body. Doctors use various terms to describe DCIS, including pre invasive, non invasive, ductal intraepithelial neoplasia (DIN) or intra ductal cancer.

Diagram showing ductal cancer in situ (DCIS)

Your doctor may describe DCIS as a very early form of breast cancer. If it is not treated, in some women DCIS starts to spread into the surrounding breast tissue after some years. So it may become an invasive cancer. DCIS is being found more often than in the past. It is often picked up by mammograms when women are screened for breast cancer. Around 4,800 people are diagnosed with DCIS in the United Kingdom each year. Fewer than 30 cases of DCIS occur each year in men in the UK.

DCIS and invasive ductal breast cancer are not the same thing. In invasive ductal breast cancer, the cells have broken out of the ducts and spread into the surrounding breast tissue. There is then a chance that the cells can spread into nearby lymph nodes or other parts of the body.

 

DCIS grade

Doctors classify DCIS into high grade (more quickly growing) and low grade (more slowly growing). There is also an intermediate grade, that is in between high grade and low grade. Doctors think that the high grade DCIS is more likely to spread into the surrounding breast tissue and more likely to come back after treatment. Knowing the grade helps doctors to know which treatment you need.

 

Treatment for DCIS

Surgery is the main treatment for DCIS. Many women have removal of the area of DCIS, with a border of healthy tissue around it. This is called wide local excision or conservative surgery or sometimes lumpectomy. After wide local excision surgery, you may have radiotherapy to the rest of the breast tissue if the DCIS cells looked very abnormal (high grade). The radiotherapy treatment is to kill off any abnormal cells that may still be within the breast tissue. Your doctor will discuss with you the possible benefits and risks of radiotherapy.

Some women have removal of the whole breast (mastectomy). If you want to, you can choose to have a new breast made (breast reconstruction) at the time of the mastectomy or sometime afterwards. You may be advised to have a mastectomy if

  • The area of the DCIS in your breast is large
  • There are several areas of DCIS in your breast
  • You have small breasts and too much of the breast is affected by DCIS to make wide local excision possible

Some women prefer to have the whole breast removed rather than wide local excision as it makes them feel more confident that the DCIS is cured. 

If your DCIS cells have oestrogen receptors, your doctor may suggest that you have tamoxifen (a type of hormone therapy) to try to reduce the risk of developing an invasive breast cancer in the future. Doctors are still researching how well tamoxifen and other hormone treatments work in stopping DCIS from coming back. 

Some trial results suggest that tamoxifen may not give much extra protection if you've already had radiotherapy. You can find information about research into treatments for DCIS on our clinical trials database.

 

Follow up

Whichever treatment you have, you will have regular follow up appointments to make sure that if DCIS comes back in the treated breast it is picked up as quickly as possible. Your specialist will probably suggest yearly mammograms (breast X-rays). If your DCIS does come back, your specialist will probably suggest that you have a mastectomy.

 

DCIS trials

Results from the the IBIS 2 prevention trial have shown that taking the hormone therapy anastrozole (Arimidex) for 5 years reduces the risk of breast cancer in post menopausal women who are at high risk of getting the disease. 

The following trials have closed and we are waiting for the results:

The IBIS II DCIS trial is comparing tamoxifen with anastrozole to see which works best at stopping DCIS coming back after surgery. 

The FORUM trial is testing whether a type of internal radiotherapy (brachytherapy) works as well as conventional radiotherapy for DCIS and breast cancer.

The ICICLE trial is supported by Cancer Research UK. It is trying to find particular genetic changes that increase the risk of developing DCIS.

There is detailed information about these trials on our clinical trials database. Type 'DCIS' into the free text search box.

 

More information about DCIS

We have detailed information about breast cancer treatments in this section.

You can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.

Our breast cancer organisations page gives details of other people who can provide information about DCIS and its treatment. Some organisations can put you in touch with a cancer support group. 

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 30 July 2014