Ductal Carcinoma in Situ (DCIS)
What is ductal carcinoma in situ (DCIS)?
DCIS stands for ductal carcinoma in situ. This means the cancer cells are inside the milk ducts or ‘in situ’ (in place) and have not developed the ability to spread either within or outside the breast. DCIS is an early form of breast cancer and may be described as a pre-invasive, non-invasive or intraductal cancer. It may affect just one area of the breast, but can be more widespread and affect different areas at the same time.
A doctor explains what DCIS is.
A doctor explains what DCIS is.
Treatment, usually surgical removal of the affected area(s) of the breast, aims to prevent the development of invasive cancer. For most women this will mean removing only a small part of the breast (lumpectomy or wide local excision). However, about four out of ten women (40%) diagnosed with DCIS in the UK have their whole breast removed (mastectomy) because more than one part of the breast is affected (Thornton H, Edwards A, Baum M. Women need better information about routine mammography. BMJ 2003;327'101-3).
More information about wide local excision and mastectomy can be found on Macmillan Cancer Support's website.
A doctor explains why DCIS is treated by either wide local excision or mastectomy.
A doctor explains why DCIS is treated by either wide local excision or mastectomy.
And a lot of women also wondered why the different, in different hospitals women seemed to get treated in different ways for DCIS.
I suppose part of that is how people present, and every patient is different. And sometimes ladies will say, “I didn’t quite have that treatment, but this lady had a different treatment,” and that’s how it should be because I know there are a number of ways of treating somebody, many of which would be effective for different reasons. And the treatment the patient gets should be specific for them; it should be for the problem that they’ve come with. Much like we said earlier, some patients would have a small piece of the breast removed, others would have a mastectomy with a reconstruction because it was over a wider area.
So every lady’s treatment will differ, be it DCIS or be it invasive cancer. Now it is true that people then look on things differently from a clinician point of view and, as we said earlier, when you have a situation where the evidence isn’t cast iron that an extra treatment of radiotherapy or tamoxifen is always of use. And people have different beliefs as regards to the benefits that patients get, so there will be some variation.
And have you come across many women who didn’t want to have any treatment at all?
Very few actually, in essence, and we often say to patients that, for example when a lady goes to a breast screening unit for her mammogram, most will go in the belief that they’re going to be told that everything’s alright. They don’t go really thinking that this process may well find something that’s severe. They’ll think about it when the question’s asked, but the normal way of things to go is to be told they’re alright, it’s not part of the plan to be told that maybe things aren’t alright. And therefore patients when they come usually feel that something’s been found and it needs to be dealt with. Now they have the information, the diagnosis, it’s very difficult then not to do something about it. If they didn’t know, they would be alright. But once they know, they find it very difficult to ignore.
A doctor explains more about the different grades of DCIS.
A doctor explains more about the different grades of DCIS.
DCIS usually shows up on a mammogram as an area where tiny specks of calcium have collected in the breast ducts, known as micro-calcification. It is important to remember that most micro-calcification is not DCIS or cancer. A few women with DCIS, however, do have symptoms, such as a breast lump, fluid (discharge) coming out of the nipple, or a type of rash involving the nipple called Paget’s disease (see Diagnostic mammograms).
In the UK, non-invasive cancers such as DCIS about 3 in every 200 women screened, this adds up to about 4,000 women each year in the UK (NHS Breast screening programme July 2016). Only one of the women we spoke with had ever heard of DCIS before her own diagnosis. Many were unsure as to whether it was actually cancerous or not. Most wanted more information about DCIS and felt unprepared for the diagnosis because they’d had no symptoms. With hindsight, a few women wondered if they had actually had a symptom but one which hadn’t been noticeable enough for them to visit their GP.
Sue had not heard of DCIS before her own diagnosis.
Sue had not heard of DCIS before her own diagnosis.
Pam had only come across DCIS because her mother was diagnosed with it several years earlier.
Pam had only come across DCIS because her mother was diagnosed with it several years earlier.
Ann wondered if she'd had symptoms but had pushed them to the back of her mind. She thought she'd have a lump if there was anything wrong.
Ann wondered if she'd had symptoms but had pushed them to the back of her mind. She thought she'd have a lump if there was anything wrong.
Last reviewed July 2017.
Last updated July 2017.
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