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- What is DCIS? Is it really a cancer?
- What causes DCIS?
- How is DCIS diagnosed?
- What treatments are used for DCIS?
- Is DCIS life-threatening?
- How quickly do I have to make a decision after diagnosis?
- What questions do I need to ask my doctor?
- Do I need a second opinion?
- What do I need to do when my treatment is over?
- What are some resources for information about DCIS?
- Did I cause my cancer?
- I have completed my treatment but I am still sad, scared and depressed. Am I wrong to feel this way? How can I get help?
- Can DCIS come back (recur) in the same breast?
- Should I have the gene test to see if I am likely to have breast cancer?
- What is the difference between DCIS, invasive, and metastatic cancer?
- What is chemoprevention?
- Should I participate in a clinical trial?
- How do I find support organizations? Other people who have had DCIS?
- What is reconstruction and how is it done?
- How do I decide which treatment is best?
- What kind of follow-up do I need after treatment for DCIS?
1. What is DCIS? Is it really a cancer?
DCIS is a relatively new diagnosis because mammography has become a routine part of medical care. It is a term used to describe breast duct cells that are growing inappropriately inside the ducts and look like cancer cells under the microscope. Something happens genetically to make DCIS cells change. Because some DCIS cells may become invasive cancer cells, women cannot ignore or dismiss a DCIS diagnosis.
Researchers don't know for sure what causes DCIS. We know that breast cancer is not contagious. Recent studies indicate that a healthy lifestyle is important, including a low fat diet, alcohol in moderation, regular exercise, sleep, and a low stress level. It is believed that breast cancer development is a complex interplay of genes, environment, and lifestyle that is not yet understood.
DCIS is usually detected on a screening mammogram. An additional mammogram, called a magnification mammogram, will provide a better look at the area of the breast that is in question. A biopsy, however, is the only way to diagnose a cancer. This is done by taking a sample of the suspicious tissue and having a cytopathologist study it under a special microscope. There are different kinds of DCIS and only a pathologist can determine which kind of DCIS it is.
Ultrasound may also be used, although DCIS does not usually present as a mass or distend the breast duct. For some DCIS cases, however, ultrasound is useful for defining size, shape, and extent. Ultrasound may be helpful, but it is not a substitute for a mammogram.
4. What treatments are used for DCIS?
The goals of treatment are to eliminate the DCIS, limit the risk of local recurrence, and eliminate the chance of developing an invasive breast cancer. The initial treatment for DCIS is surgery. There are different surgical approaches to breast cancer treatment: lumpectomy alone (removal of the lump and some surrounding tissue), lumpectomy and post-operative radiation therapy, or mastectomy (removal of the breast). Adjuvant hormonal therapy may be recommended to reduce the risk of recurrence in patients who choose lumpectomy with or without post-operative radiation.
In numerous recent studies, regardless of treatment, the long-term survival rate for women with DCIS is nearly 100%.
6. How quickly do I have to make a decision after diagnosis?
Many women want time to think about treatment options and get second opinions. This may take some time, but it is important not to wait months to come to a decision.
7. What questions do I need to ask my doctor?
You will want to know what kind of biopsy is recommended, how long it will take for the results, what treatment choices you have, the time frame and recovery for these, the risks and side effects for the treatment options, and what kind of follow-up care is required. You may also want to have a second opinion.
8. Do I need a second opinion?
Second opinions are common and may be requested for your mammogram, the pathology, and the treatment plan. The reason for a second opinion is to get a sense of peace about the treatment option you choose. If you are comfortable with your decision, a second opinion may not be necessary.
9. What do I need to do when my treatment is over?
Ask your physician what kind of follow-up care you will need – this will depend upon the kind of treatment you have selected. You will also want to know how often you will need to have a mammogram and whom to call if you have questions, problems, or symptoms.
10. What are some resources for information about DCIS?
There are many organizations with information about DCIS risk, detection, treatment, counseling and/or financial support:
- Cancer Information Service at www.cancer.gov or 800-4-CANCER
- American Cancer Society at www.cancer.org or 800-ACS-2345
- American College of Physicians at www.acponline.org
- breastcancer.org at www.breastcancer.org
- Cancer Care, Inc. at www.cancercare.org or 800-813-HOPE
- Living beyond Breast Cancer at www.lbbc.org or 610-645-4567
Many women blame themselves for the development of their cancer. Of all the thousands of research studies conducted, none points to an individual woman as the cause of her cancer.
12. I have completed my treatment but I am still sad, scared and depressed. Am I wrong to feel this way? How can I get help?
It is not uncommon to feel this way after you have completed treatment. You may wish to talk over your feelings with your doctor, a counselor, or a social worker. Many women find cancer support groups to be helpful. Your doctor, a local hospital, or your local American Cancer Society may have a list of support groups in your area.
13. Can DCIS come back (recur) in the same breast?
Yes, it can. Recurrence of DCIS is never in itself life threatening, but it means that you have to deal with it again.
14. Should I have the gene test to see if I am likely to have breast cancer?
Inherited risk is responsible for only 5% to 10% of female breast cancers. Genetic risk is sometimes determined by a blood test for genes called BRCA1 and BRCA2 that are linked to breast cancer called. Determining personalized risk should be done in consultation with experts and careful consideration to determine what you will do with the resulting information.
15. What is the difference between DCIS, invasive, and metastatic cancer?
- DCIS refers to a group of cells that are different from normal cells. It is the most common type of noninvasive breast cancer.
- Invasive cancer has spread beyond the area of tissue in which it developed and is growing into surrounding, healthy tissues.
- Metastatic cancer cells have left the original site and moved into healthy tissue and other sites in the body.
A drug (such as Tamoxifen or Raloxifene) that is used to prevent the development of cancer.
17. Should I participate in a clinical trial?
Patients who take part in clinical trials may have the first chance to benefit from improved treatment methods, and they make an important contribution to medical science. Clinical trials are research studies that involve patients.
18. How do I find support organizations? Other people who have had DCIS?
There are many organizations that provide counseling and support services. Most hospitals have a breast center or Social Work department. Call the American Cancer Society at 800-ACS-2345 for a list of groups. For information and suggestions on how to start a support group, contact Cancer Care, Inc. at www.cancercare.org or 800-813-HOPE
19. What is reconstruction and how is it done?
Breast reconstruction is surgery that recreates the breast after mastectomy. There are two main types of breast reconstruction available to most women after mastectomy: breast implants with saline or silicone, or muscle flap reconstruction. With implants, the implant is inserted underneath the skin and chest muscle. Muscle flap reconstruction involves using a woman's own tissue to rebuild a breast contour. Tissue may be taken from the back, stomach or buttocks.
Many women also need reduction or augmenting surgery on the opposite breast to achieve a symmetrical appearance. Women considering breast reconstruction should consult a plastic surgeon for their personal risks and benefits.
20. How do I decide which treatment is best?
There are different kinds of DCIS, and treatment recommendations are different for each. It is important to understand the pathology of your DCIS. Treatment consists of: lumpectomy; lumpectomy and radiation; or mastectomy; all with or without adjuvant chemoprevention. Treatment recommendations are related to many factors; size, grade, patient preference, and size of the woman's breasts.
21. What kind of follow-up do I need after treatment for DCIS?
All women who have had DCIS, regardless of treatment, need to follow up regularly with a physician. If lumpectomy or mastectomy was performed, then at least annual mammograms should be done on both breasts or the remaining breast/breasts as well as clinical breast examination.
