Ductal carcinoma in situ (DCIS)

Ductal carcinoma in situ (DCIS) is non-invasive breast cancer but can become invasive – meaning it can spread into your surrounding breast tissue – if not promptly managed.

Our team of cancer specialists at Advocate Health Care are here to support you through your diagnosis and treatment. We also make it easy to get the care you need with convenient locations throughout Chicagoland.

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DCIS grading system

DCIS is graded based on the appearance of cancer cells under a microscope. Grades for DCIS are based on three factors:

• Nuclear grade: There are three levels of grades in this factor. The higher nuclear grade indicates more abnormal and aggressive cells, while a lower grade may appear as normal.
• Architectural pattern: This looks at the arrangement of abnormal cells within the breast ducts.
• Tumor size: This measures the extent of the DCIS in the milk ducts.

The combination of these factors helps determine the overall grade of the DCIS lesion. A lower grade means there’s less likelihood your DCIS will progress to invasive breast cancer.

DCIS risk factors

Several factors, such as age, family history and hormonal factors may increase the risk of developing DCIS.

If you have a family history of breast cancer, genetic testing might be a good option for you to determine your risk. Through genetic testing, you can find out if you have gene mutations that can increase your risk.

Other risk factors include:

• Age: Women over the age of 50 are more likely to develop DCIS, although it can occur at any age.
• Personal history of breast cancer: If you have previously been diagnosed with breast cancer in one breast, you may have an increased risk of developing DCIS in the other breast.
• Radiation exposure: If you've had radiation therapy to the chest, particularly during childhood or adolescence, it increases your risk of developing DCIS later in life.
• Hormonal factors: Factors that affect hormone levels, such as early menstruation, late menopause, never giving birth or having a first child after the age of 30, and using hormone replacement therapy for an extended period, may increase the risk of DCIS.
• Dense breast tissue: Women with dense breast tissue, as seen on mammograms, have a higher risk of developing both DCIS and invasive breast cancer.
• Lifestyle factors: Factors such as obesity, excessive alcohol consumption and a inactive lifestyle may also contribute to an increased risk of DCIS.

DCIS symptoms

DCIS typically doesn't cause any noticeable symptoms because it is confined to the milk ducts of the breast.

Most cases of DCIS are detected through self-exams or regular screenings with your doctor before any symptoms develop. However, in some cases, there might be signs that could indicate an issue, including:

• Breast lump or thickening: Although DCIS usually doesn't produce a palpable lump, some women may notice a lump or thickening in the breast.
• Nipple discharge: In rare cases, DCIS may cause nipple discharge, which may be bloody or clear. However, most nipple discharge is not due to breast cancer.
• Changes in breast appearance: DCIS may cause changes in the size, shape or contour of the breast. Skin changes such as redness, scaliness or dimpling may also occur, but these are more commonly associated with invasive breast cancer.
• Breast pain or tenderness: Some women with DCIS may experience breast pain or tenderness, although this is not a common symptom.

Regular breast self-exams and mammograms are crucial for early detection and treatment of DCIS and other types of breast cancer. If you notice any changes in your breasts or experience any concerning symptoms, schedule an appointment with your doctor for further evaluation.

Diagnosing DCIS

Diagnosing DCIS can be tricky since it typically doesn't have any noticeable symptoms. Instead, it's often discovered during routine breast exams or mammograms. Any abnormalities seen on a mammogram will be further evaluated with a stereotactic breast biopsy.

A stereotactic breast biopsy removes a small tissue sample through a hollow needle from an area where an abnormality was seen on a mammogram. A pathologist will then determine whether the tissue is benign or cancerous to confirm a diagnosis of DCIS.

What is the best treatment option for DCIS?

Your DCIS treatment will focus on eliminating the cancer cells and minimizing the chances of it returning. Your cancer specialist will consider several factors to tailor your treatment to your specific needs, including the size and grade of your DCIS, as well as your overall health and personal preferences.

Depending on your DCIS diagnosis, we often recommend both surgical and non-surgical methods, or a combination of both. A lumpectomy followed by radiation therapy is a common treatment option for DCIS.

Surgical treatment options include:

• Total mastectomy: A total mastectomy is needed when cancer is found in more than one area of your breast. If you have a deformed breast or your breast is small or shaped in such a way that removing the cancer will leave little breast tissue, or if you can’t have radiation therapy.
• Modified radical mastectomy: This is the removal of as much breast tissue as possible, including the nipple, skin and lymph nodes in the armpit.
• Lumpectomy: Also known as breast conserving surgery, this involves a surgeon removing cancerous and abnormal tissue, some healthy tissue and lymph nodes under the arm.
• Radiation therapy: After a modified radical mastectomy or lumpectomy surgery is completed, your surgeon will deliver radiation into an open incision. After the radiation treatment is done, the surgeon closes the incision.

Can DCIS be treated without surgery?

If surgery is not the best route for treatment, your cancer specialist may consider alternative approaches, particularly for low-grade DCIS.

Non-surgical methods may involve:

• Hormone therapy: Sometimes, your cancer may grow by feeding off certain hormones your body naturally produces. If tests show that your DCIS is receptive to estrogen or progesterone, medications may be prescribed to stop or slow your natural hormones from reaching the cancer cells.
• Regular check-ups: In cases of low-grade DCIS, your doctor may recommend closely monitoring your condition (active surveillance). You’ll have regular mammograms and checkups with your doctor, where any changes or growth will be tracked and noted. If your DCIS is advancing, treatment options can be reevaluated.
• Chemotherapy: While rarely used to treat DCIS, chemotherapy can deter cancer recurrence if you are newly diagnosed. It also serves to manage the disease if it spreads elsewhere in the body and controls the condition in cases of recurrence.
• Targeted therapy: Targeted therapy is the use of monoclonal antibodies to attack specific parts of a cancer cell to stop them from growing. Targeted therapy may be used with chemo medications to help the chemo reach the right place to do its work.