Shown is a drawing of a breast duct containing ductal carcinoma in situ. (Photo credit: Wikipedia)
Ductal Carcinoma in situ (DCIS) is an atypical proliferation of cells in the breast duct. It’s not a breast tumor, and it’s not invasive cancer. There are two ways to look at this: It is pre-invasive. It is non-invasive. So, it is pre-cancer?
I came across an article “Figuring out what DCIS diagnosis really means”, by Sue Rochman, MAMM Oct, 2000. The little I knew about DCIS, I presumed DCIS was pre-spread of cancer, and considered cancer. The one thing I am very clear on now is that there is lots of debate about DCIS.
What is agreed upon is that DCIS doesn’t have the same capabilities as a tumor. It doesn’t have the molecular genetics to invade and metastasize. Women with DCIS won’t necessarily progress to invasive cancer—however, in an overwhelming majority, women with invasive cancer also have DCIS.
If it could be determined what causes DCIS to potentially become invasive, then doctors could figure out what women require treatment, and what women don’t. Since that isn’t happening yet, all women with DCIS are treated. The question I have had for years, “How much is too much treatment?”
The shift in the last twenty years has been from seeing DCIS as a single disease and if left untreated was likely to invade, to seeing DCIS as having a risk of progressing, and invading, depending on other factors. There’s a spectrum within the DCIS diagnosis. The DCIS shift has also moved from mastectomy to lumpectomy, followed by radiation, and sometimes an anti-estrogen therapy (such as Tamoxifen) for hormone receptor breast cancer. Some women opt for a mastectomy over a lumpectomy. Some to avoid radiation, others require a mastectomy when the area in concern is too large for a lumpectomy in order to preserve the breast’s appearance.
Barbara Brenner, the then executive director or The San Francisco based advocacy group Breast Cancer Action, spoke about, “What’s too much treatment?” She said, “It’s clear that some women who get surgery and being over treated for DCIS. The problem is we don’t have any method to distinguish those who need treatment from those who don’t. I don’t think any doctor could safely tell a patient that she shouldn’t be treated for DCIS. But the net result is that we are doing way more surgeries and a lot more radiation than is probably necessary.”
Dr. Silverstein of USC, adamantly argued that some women are being over treated. “Low grade DCIS doesn’t come at you like a bull and not stop. There’s plenty of time to deal with this, and the majority of it never becomes invasive breast cancer. I believe that you can pick out patients who are not going to benefit from radiation therapy. And that’s what the debate is all about.”
Progress has been made. Now, DCIS is technically classified as a cancer. The cells are just like invasive cancer—except they haven’t spread beyond the ducts of the breast. Can you imagine having surgery—a lumpectomy or mastectomy, having radiation, and taking medication—and not having statistics kept, or being considered as having cancer? Now DCIS patients do fit into the category of cancer, which I hope helps them through the process of support, gathering information, and receiving the right treatment, or non-treatment to fit their needs best.
Related Posts: DCIS To Treat or Not to Treat