Invasive Ductal Carcinoma

DCIS Treatment – What Are My Options?

DCIS is a form of noninvasive breast cancer that occurs in the milk ducts of the breast. Despite a high cure rate of 98%, it can eventually develop into a malignant tumor. This is why seeking treatment early and understanding your treatment options is so important.

You have multiple options for DCIS treatment. The most common form of treatment is partial mastectomy with radiation therapy, though radiation isn’t always required. Total mastectomy is another option if you qualify and that doesn’t require radiation, either. Hormonal therapy is recommended to help decrease your risk of developing new cancers in the future.

To better understand DCIS, we’ll look at:

• What DCIS is
• Types of DCIS treatment

Knowledge is power. By understanding what DCIS is and your treatment options, you’ll be more knowledgeable and confident as you travel your road to recovery.

What is DCIS?

DCIS, short for ductal carcinoma in situ, is the earliest stage of breast cancer (stage 0 breast cancer). This is the stage in which healthy cells start to malfunction and begin to look like cancer cells under the microscope.

Fortunately, DCIS cells don’t metastasize, which means they don’t spread to other parts of the body. The cells are noninvasive and limited to the milk ducts of the breast. This means that there aren’t any cancerous cells outside of the ducts’ foundation layers or basement membranes.

The chances of DCIS breast cancer becoming invasive in 10 years is between 14-53%. Doctors are currently unable to accurately predict whether it will become invasive or not. 

Types of DCIS Treatment

The most common form of DCIS treatment is surgery via partial or total mastectomy with the goal of removing all detectable cancer. Partial mastectomy (lumpectomy) is the primary form of surgery if DCIS is located in a small portion of the breast. However, total mastectomy may be recommended if DCIS is located in a large area or multiple areas of the breast.

Radiation therapy is often implemented after a partial mastectomy or during the procedure. Hormone blocking therapy is also used in treatment to further prevent new cancers from forming in the breast.

You may have to undergo a diagnostic test before surgery to locate the tumor. This is usually due to not being able to pinpoint the tumor by feel. When this happens, DCIS can be identified with ultrasound, mammogram, or MRI. Your doctor will localize the tumor in order to remove it.

Partial Mastectomy with Radiation Therapy

Partial mastectomy followed by radiation therapy is the most common form of treatment for DCIS. This treatment is ideal if DCIS has been located in one area of your breast and can be completely removed while leaving plenty of healthy tissue. 

Occasionally, patients may have to undergo a second re-excision partial mastectomy to remove extra tissue surrounding the DCIS. This ensures that you have a clear margin of healthy, cancer-free tissue around the tumor.

Radiation for DCIS is used to lower the risk of cancer occurring again. Depending on your doctor, your options may include external radiation, internal partial-breast radiation, or external partial breast radiation. Radiation therapy for DCIS can reduce the chances of cancer returning by around 60%. 

External radiation is the current standard treatment for DCIS. Doctors use a machine called a linear accelerator to treat the entire breast with radiation and remove any remaining cancer. Treatments are usually daily, five days per week over the course of 5-7 weeks. 

Other radiation options include partial-breast irradiation. This new form of radiation treatment requires 5-10 days of treatment rather than the usual 5 to 7 weeks.

Internal partial-breast irradiation involves temporarily placing radioactive pellets or “seeds” inside the breast as a form of radiation treatment. External partial-breast irradiation pinpoints the area where the cancer was located for treatment.

Partial Mastectomy Without Radiation Treatment

You can forego radiation treatment if partial mastectomy alone will greatly reduce your chances of developing DCIS again. This is possible if you had a small, low-grade DCIS removed with a  wide negative margin of tissue. If you’re over 70 years old with other more serious medical problems, radiation treatment may not be your preferred choice.

The decision to not receive radiation treatment shouldn’t be made lightly and you should seek a second opinion if you choose this route. Close follow-ups and observation will be extremely important if you go without radiation treatment. Make sure to see your doctor on a regular basis for breast exams and procedures such as ultrasounds, MRIs, and mammograms.

Total Mastectomy

Mastectomy is a procedure that involves surgically removing the whole breast. Despite partial mastectomy and radiation being the go-to for DCIS cancer, there are times when a simple or total mastectomy may be necessary. This is when breast tissue, skin, the areola, and nipple are removed but the lymph nodes are left in place.

Mastectomy may become necessary when DCIS is found in a large portion of the breast or in multiple parts (multifocal disease). The procedure may also be recommended if a partial mastectomy would end with poor cosmetic results.

Your doctor may recommend total mastectomy if you have a family history of breast cancer, as well as if you have a gene mutation that heightens your risk. This can help prevent your body from developing new breast cancers in the future.

A total mastectomy may be the best choice if you are not a good candidate for radiation therapy. This could be due to:

• Having experienced radiation to your breast or chest before
• Being more sensitive to radiation 
• Being in your first trimester of pregnancy upon diagnosis

It’s recommended that you begin thinking about breast reconstruction surgery early if you’re getting a total mastectomy.

Hormonal Therapy

Those with DCIS have a slightly higher chance of developing another breast cancer than those who don’t. Hormonal therapy combined with surgery and radiation can lower your risk if tests reveal the tumor is positive for hormone receptors. Keep in mind that not all hospitals test DCIS for hormone receptors. Talk to your doctor to make sure that you get tested for them.

Tamoxifen (Noladex) is used to treat hormone-receptor-positive cancers in their early stages. It can be used following radiation treatment after a partial mastectomy or as a substitute for radiation. According to BreastCancer.Org:

Tamoxifen “pretends” to be estrogen and attaches to the receptors on the breast cancer cells, taking the place of real estrogen. As a result, the cells don’t receive the signal to grow. People with hormone-receptor-positive cancer who take tamoxifen can lower their risk of having an invasive cancer or a non-invasive cancer come back.

Aromatase inhibitors are currently going through clinical trials to learn if they can help reduce the recurrence of DCIS. They are able to lower the amount of estrogen your body produces post-menopause. 

Final Thoughts

DCIS is a non-invasive form of cancer found in the milk ducts of the breast. The recommended treatment is partial mastectomy to remove the cancer followed by radiation, though radiation isn’t required in some cases. Total mastectomy is recommended when DCIS is found in a large portion or multiple portions of the breast. Hormonal therapy is used to prevent other breast cancers from developing in the future. 

With Dr. Aaron Margulies, you receive treatment beyond what a general surgeon can provide. By specializing in breast cancer surgery, Dr. Aaron Margulies is able to provide compassion as he talks with you and establishes how to accomplish your goals. For him, it’s about more than treatment. It’s about developing a one-on-one relationship with his patients.

If you’ve had a positive experience receiving treatment from Dr. Aaron Margulies, please consider leaving a review on Google to let others know.

Dr. Aaron and Imelda Margulies are committed to serving patients at offices in Tennova Turkey Creek Medical Center in West Knoxville, at Tennova North Knoxville Medical Center in Powell, at Jefferson Memorial Hospital, and in Newport. To learn more, visit www.aaronmd.com or call 865-692-1610.