Ductal carcinoma in situ (DCIS) Factsheet

Ductal carcinoma in situ (DCIS)
Factsheet
This factsheet is for people who
would like more information about
ductal carcinoma in situ, also
known as DCIS. It describes what
DCIS is, the possible symptoms,
how a diagnosis is made and how it
may be treated. We hope that this
information helps you to discuss
any questions you may have with
your specialist or breast care nurse
and to be involved in any decisions
about your treatment. You may
also find it useful to read our
Treating breast cancer booklet.
2 | What is DCIS?
What is DCIS?
The breasts are made up of lobules (milk-producing glands) and
ducts (tubes that carry milk to the nipple), which are surrounded
by glandular, fibrous and fatty tissue. Breast cancer starts when
cells in the breast begin to divide and grow in an abnormal way.
DCIS is an early form of breast cancer, where cancer cells have
developed within the milk ducts but remain there – ‘in situ’ – and
have not yet developed the ability to spread outside the ducts
into the surrounding breast tissue or to other parts of the body.
Because of this you may hear DCIS described as a pre-invasive,
intraductal or non-invasive cancer. Occasionally you may also
hear it incorrectly described as pre cancerous. Both men and
women can develop DCIS. However, it is very rare in men.
As a result of being confined to the breast ducts, a diagnosis of
DCIS has a very good prognosis (outlook).
What are the symptoms?
Most people with DCIS have no symptoms. However, some
people may notice a change in the breast such as a lump,
discharge from the nipple or more rarely, a type of rash involving
the nipple known as Paget’s disease of the breast. For more
information see our Paget’s disease of the breast factsheet.
How is a diagnosis made?
As DCIS tends not to produce symptoms, most people only
find out they have it when it is seen on a mammogram (breast
x-ray). This is why DCIS has been diagnosed more frequently
since routine breast screening was introduced. It accounts for
approximately 20% of breast cancers that are diagnosed by
screening mammograms.
DCIS may be present in the breast if small white dots are seen
on a mammogram. These white dots are small spots of calcium
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Ductal carcinoma in situ (DCIS) | 3
salts and are known as microcalcifications. However, not all areas
of microcalcification are found to be DCIS, and many women
develop benign (not cancer) calcifications in their breasts naturally
as the breast tissue ages.
If you have symptoms such as a lump or nipple discharge, tests
including a clinical (breast) examination, a mammogram and/or
ultrasound scan, and a core biopsy and/or fine needle aspiration
(FNA) may be carried out. Together these investigations are
known as ‘triple assessment’. See our booklet Your breast
clinic appointment for more information about these tests.
If you do not have any symptoms, but calcifications are present
on the mammogram you may have a stereotactic core biopsy.
This is where samples of tissue are taken using a needle
biopsy device connected to a mammogram machine and
linked to a computer. This helps locate the exact position of
the microcalcifications to be biopsied. Images of the breast are
taken from two different angles to help guide the needle to the
precise location. It may feel a little uncomfortable, as the breast is
compressed throughout the procedure. This procedure is done
using a local anaesthetic in a sitting position or lying down on a
specialised examination couch. It’s performed in the outpatient
clinic and takes approximately 30 minutes.
The samples taken are x-rayed to ensure they contain the
microcalcifications before being sent to the laboratory where they
are examined under a microscope to establish a diagnosis.
Are there different types (grades) of DCIS?
DCIS is graded based on what the cells look like under the
microscope. A system is used to classify cancer cells according
to how different they are to normal breast cells and how quickly
they are growing. It can be graded as high, intermediate or low
grade DCIS.
If DCIS is left untreated, the cancer cells may develop the ability
to spread outside the ducts into the surrounding breast tissue
Call our Helpline on 0808 800 6000
4 | What are the treatments?
and possibly to other parts of the body. This is known as invasive
ductal breast cancer. It is thought that high-grade DCIS is
more likely to become an invasive ductal breast cancer than
low-grade DCIS.
What are the treatments?
The aim of treatment is to remove all the DCIS from within the
breast, as some cases of DCIS will recur (come back) if they are
not completely removed or become invasive if left untreated.
However, in some cases DCIS may never develop further or
may grow so slowly that it would never cause any harm during a
person’s lifetime.
The type, size and grade of the DCIS can help predict if it will
become invasive but currently there is no way of knowing for
certain in each individual case. For this reason, treatment is
usually recommended, but for some people this may not be
necessary and might be seen as over-treatment of their condition.
Research is ongoing into DCIS and there may be clearer
guidance available in the future on how best to manage it. If
you have any questions or concerns about your diagnosis and
treatment, talk to your specialist team.
Surgery
Surgery is usually the first treatment for DCIS. This may be
breast-conserving surgery, usually referred to as a wide local
excision or lumpectomy. This is the removal of the DCIS with a
margin (border) of normal breast tissue around it. Alternatively,
this may be a mastectomy (the removal of all of the breast tissue).
Occasionally your nipple can be preserved if you are having
breast reconstruction, but mastectomy usually means removal of
the whole breast including the nipple area.
You may be offered a choice between these two types of surgery,
depending on the size and location of the area affected. Your
breast surgeon will discuss this with you. However, a mastectomy
is usually recommended if the DCIS affects a large area of the
breast; or if there is more than one area of DCIS; or if it hasn’t
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Ductal carcinoma in situ (DCIS) | 5
been possible to get a clear margin of normal tissue around the
DCIS using breast-conserving surgery.
As most cases of DCIS can’t be felt, a procedure called
localisation is often used before breast-conserving surgery. This
helps mark the exact area to be removed during surgery and
may involve using a mammogram as a guide to insert a very
fine wire into the area of concern. This procedure usually takes
about 30 minutes. You will be given a local anaesthetic to numb
the area but may still feel a little uncomfortable as the breast is
compressed during the procedure. Once the wire is in the correct
place, it’s covered with a padded dressing and left there until
surgery when the wire is removed. Surgery usually takes place
on the same day as the localisation but may be the day after. The
wire won’t move during this time as it’s secured.
If you are going to have a mastectomy you will usually be able to
consider breast reconstruction. This can be done at the same
time as your mastectomy (immediate reconstruction) or months or
years later (delayed reconstruction). If you’d like more information
please see our Breast reconstruction booklet.
Generally the lymph nodes (glands) under the arm (the axilla)
don’t need to be sampled (tested) in cases of DCIS – as they
are for invasive breast cancer. This is because the cancer cells
haven’t developed the ability to spread outside the ducts into
the surrounding breast tissue. However, if you are having a
mastectomy and immediate reconstruction your specialist may
discuss sampling the lymph nodes at the same time.
The breast tissue removed is examined following surgery by a
pathologist (a specialist in analysing tissue and cells). Sometimes
an area of invasive breast cancer is found as well as DCIS. Your
consultant will let you know if any invasive breast cancer was
found as well as the DCIS. If invasive cancer is found, this will
affect the treatment you are offered and you may need surgery to
remove lymph nodes from the axilla to check for possible spread
of the cancer to this area. For more information see our Treating
breast cancer booklet.
Call our Helpline on 0808 800 6000
6 | What are the adjuvant (additional) treatments?
What are the adjuvant (additional) treatments?
After surgery you may need further treatment. This is called
adjuvant (additional) treatment and may include radiotherapy and
in some cases hormone therapy. The aim of these treatments
is to reduce the risk of DCIS coming back or an invasive cancer
developing. Chemotherapy is not used as a treatment for DCIS.
Radiotherapy
Radiotherapy is usually recommended after breast-conserving
surgery to reduce the chance of the DCIS recurring (coming
back) in that breast. Your specialist will explain the likely benefits
of radiotherapy for you and also tell you about any possible side
effects. For more information see our Radiotherapy for primary
(early) breast cancer booklet.
Hormone (endocrine) therapy
All cancers are tested using breast tissue from a biopsy or
after surgery to see if they are hormone sensitive (oestrogen
receptor positive or ER+). Cancers that are hormone sensitive
have receptors within the cell that bind to the female hormone
oestrogen which stimulates the cancer cell to grow.
Tamoxifen is a hormone therapy drug used to treat oestrogen
receptor positive invasive breast cancer. However, its benefits in
DCIS are much less clear and may not outweigh the possible side
effects. There are ongoing trials evaluating the use of hormone
therapy in DCIS. Your specialist will discuss whether taking
tamoxifen is appropriate for you.
If you would like more information, please see our Tamoxifen
factsheet and Treating breast cancer booklet.
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Ductal carcinoma in situ (DCIS) | 7
Further support
Being told you have DCIS can leave you feeling different
emotions. Fear, shock, sadness and anger are all common
feelings at this time. Although DCIS is an early form of breast
cancer with a very good prognosis, some people understandably
still feel very anxious and frightened. People can often struggle
to come to terms with being offered treatments such as
mastectomy, at the same time as being told their DCIS may never
do them any harm.
Some people feel less able to express their anxiety and concerns
about their diagnosis of DCIS because they have not needed
treatment such as chemotherapy and may not face a high risk of
problems in the future. Because of this they might feel less able
to ask for support. But do remember that there are people who
can support you so don’t be afraid to ask for help. You can let
other people know how you’re feeling, particularly your family and
friends, so that they can be more supportive. It can also help to
discuss your feelings or worries with your breast care nurse or
specialist. Alternatively, a professional counsellor might be more
appropriate if you want to talk through your feelings in more depth
over a period of time. Your breast care nurse, specialist or GP
(local doctor) can usually arrange this.
You might find it easier to share your feelings with someone who’s
had a similar experience to you. You can do this either one to one
or in a support group. For more information on individual support
or support groups in your area call our Helpline on 0808 800
6000 (Text Relay 18001).
Breast Cancer Care
From diagnosis, throughout treatment and beyond, our services
are here every step of the way. Here is an overview of all the
services we offer to people affected by breast cancer. To find out
which may be suitable for you call our Helpline on 0808 800
6000 or contact one of our centres (details in the inside back of
this factsheet.
Call our Helpline on 0808 800 6000
8 | Further support
Our free, confidential Helpline is here for anyone who has
questions about breast cancer or breast health. Your call will be
answered by one of our nurses or trained staff with experience
of breast cancer. If you prefer, we can answer your questions by
email instead through the Ask the Nurse service on our website.
Our website gives instant access to information when you need
it. It’s also home to our Discussion Forums, the largest online
breast cancer community in the UK, where you can share your
questions or concerns with other people in a similar situation.
Through our professionally hosted forums you can exchange tips
on coping with the side effects of treatment, ask questions, share
experiences and talk through concerns online. If you’re feeling
anxious or just need to hear from someone else who’s been
there, this is a way to gain support and reassurance from others
in a similar situation.
We host weekly Live Chat sessions on our website offering you
a private space to discuss your concerns with others – getting
instant responses to messages and talking about issues that are
important to you.
Our map of breast cancer services is an interactive tool, designed
to help you find breast cancer services in your local area
wherever you live in the UK. Visit
www.breastcancercare.org.uk/map
Our One-to-One Support service can put you in touch with
someone who knows what you’re going through. Just tell us
what you’d like to talk about and we can find someone who’s
right for you.
We run Moving Forward Information Sessions and Courses
for people living with and beyond breast cancer. These cover a
range of topics including adjusting and adapting after a breast
cancer diagnosis, exercise and wellbeing, and managing side
effects. In addition, we run Lingerie Evenings where you can
learn more about choosing a bra after surgery.
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Ductal carcinoma in situ (DCIS) | 9
Our HeadStrong service can help you prepare for the possibility
of losing your hair during treatment – find out how to look after
your hair and scalp and make the most of alternatives to wigs.
We offer specific, tailored support for younger women through
our Younger Women’s Forums, and for people with a diagnosis
of secondary breast cancer through our Living with Secondary
Breast Cancer meet-ups.
Our free Information Resources for anyone affected by breast
cancer include factsheets, booklets and DVDs. You can order
all our publications from our website or by using an order form
available from the Helpline.
Other organisations
Macmillan Cancer Support
89 Albert Embankment
London SE1 7UQ
General enquiries: 020 7840 7840
Helpline: 0808 808 00 00
Website: www.macmillan.org.uk
Textphone: 0808 808 0121 or Text Relay
Macmillan Cancer Support provides practical, medical, emotional
and financial support to people living with cancer and their
carers and families. It also funds expert health and social care
professionals such as nurses, doctors and benefits advisers.
Call our Helpline on 0808 800 6000
Breast Cancer Care is here for anyone affected
by breast cancer. We bring people together,
provide information and support, and campaign
for improved standards of care. We use our
understanding of people’s experience of breast
cancer and our clinical expertise in everything we do.
Visit www.breastcancercare.org.uk or call our
free helpline on 0808 800 6000 (Text Relay 18001).
Interpreters are available in any language. Calls may be monitored for
training purposes. Confidentiality is maintained between callers and
Breast Cancer Care.
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© Breast Cancer Care, December 2012, BCC39
Edition 4 Next planned review 2014
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