Join Dr. Swati Kulkarni, FACS, Breast Surgery, Northwestern Medicine, and Professor of Surgery, Northwestern University, Feinberg School of Medicine, to learn about the management and treatment of Ductal Carcinoma in Situ (DCIS)—the presence of abnormal cells inside a milk duct in the breast.

DCIS is considered the earliest form of breast cancer. DCIS is noninvasive, meaning it hasn't spread outside of the milk duct. While DCIS isn't an emergency, it does require an evaluation and a consideration of treatment options.

According the American Cancer Society, "About 1 in 5 new breast cancers will be ductal carcinoma in situ (DCIS). Nearly all women with this early stage of breast cancer can be cured."

► For more information about "The Promise Study" for women with newly diagnosed Ductal Carcinoma in Situ (DCIS), which was mentioned by Dr. Kulkarni, visit Facebook.com/ThePromiseStudy.

► For a helpful visual of DCIS and IDC that corresponds with Dr. Kulkarni's presentation, visit http://bit.ly/LW_DCIS.

► Follow us on http://Facebook.com/livingwellcrc and http://livingwellcrc.org to keep up to date on all LivingWell online programming.

We teach you about DCIS and how it is treated. This pre-cancerous problem is also a risk factor for developing invasive cancer and is linked to the BRCA genetic mutation.

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Questions for your Breast Surgeon and Medical Oncologist:

1. Is DCIS a cancer or a pre-cancerous growth?
2. What exactly is the threat to my health from DCIS?
3. Are both surgery and radiation always needed for DCIS?
4. May I have a copy of my pathology reports?
5. Do I qualify for genetic testing if I have DCIS?
6. Will DCIS turn into an invasive cancer if not treated?

Ductal Carcinoma In-Situ (DCIS) refers to breast cells that are growing abnormally in an area of the breast, but have not yet evolved to the point where they are considered “invasive breast cancer” and can spread beyond the breast to other parts of the body. Even the medical field is unsure whether to call it “non-invasive” breast cancer or a “pre-cancerous” problem. By definition, DCIS is considered a Stage O breast cancer.

Important facts if you have DCIS:

*If left untreated, it can evolve into an invasive breast cancer
*You have a slightly higher lifetime risk of forming a new cancer in either breast in the future
*You may now qualify for BRCA genetic testing.

How is DCIS different from invasive cancer?

Invasive Breast Cancer can threaten your life because it mau have the capacity to spread (metastasize) to other organs of the body. DCIS does not yet have this ability to spread, but it might if it evolves into an invasive breast cancer in the future. So we treat DCIS very seriously in order to lessen the risk of it developing into an invasive, life-threatening problem. Learn more about “Invasive Breast Cancer“ with our video lesson (here).

What is the chance I will die of my DCIS?

The risk is very low. The most comprehensive study (here) on the subject in 2015 showed that the risk of dying from any type of breast cancer 20 years after having your DCIS treated with a lumpectomy and radiation is about 1%. One take home message from this study is that you have plenty of time to make decisions with your breast specialists about how to best treat your DCIS.

Lumpectomy or Mastectomy for DCIS?

Removal of the area of DCIS with surgery is usually the first treatment. A lumpectomy removes the area with a surrounding margin of normal tissue. It is a great surgery if the area of DCIS is small. Radiation is generally recommended after surgery to further lessen the risk of the DCIS or an invasive cancer growing back in that area of the lumpectomy. Some women who are older or have a lower-risk type of DCIS sometimes can avoid radiation after a lumpectomy.

A mastectomy is generally recommended only if DCIS involves a large area of the breast and thus would not be a good candidate for a lumpectomy and radiation. A mastectomy for DCIS does not make you live longer, but it does reduce the chance of cancer growing back in that breast. Radiation is generally not needed after a mastectomy for DCIS. Take our video lesson on “Lumpectomy or Mastectomy“ (here) to learn more. You and your breast surgeon must work closely together to decide what surgery is best for your unique cancer situation.

Should I take “anti-estrogen” medicines for DCIS?

When someone is diagnosed with DCIS, the pathologists will run special studies on the tumor cells to determine if Estrogen receptors and Progesterone receptors are present. If your DCIS is “Estrogen receptor positive,” taking anti-estrogen medications for 5 years can lessen the chance of developing a new breast cancer (either DCIS or invasive cancer) over the next 5 to 10 years if you had a lumpectomy. Taking “tamoxifen” or an “aromatase inhibitor” medication for this purpose is called “chemoprevention.” If a woman has bilateral mastectomies there is no need for chemoprevention because the breast tissue has been removed.

Women with DCIS are felt to have an increased risk for developing new cancers in both **** in the future. Taking these medications can reduce the risk of new breast cancers in these higher risk women, but these drugs are not without potential side effects and risks. That is why a “risk vs benefit” discussion with a medical oncologist is important.

You may qualify for genetic testing if you have DCIS.

DCIS is now known to be ****ociated with the BRCA gene mutation in as similar way as women with invasive breast cancer. The BRCA (Breast Cancer) gene is commonly referred to as “The Breast Cancer Gene.” If someone inherits a broken version (mutation) of this gene at conception, they carry a very high lifetime risk of breast cancer and ovarian cancer.

Dr. Christina Weltz shares the last #breastcancerfact of the month. Ductal Carcinoma in Situ (DCIS) is the earliest and most curable form of #breastcancer. If you have any concerns about your breast health, we would be happy to see you at one of our many locations. Make an appointment and call 844-MD-CANCER. #breastcancerawarenessmonth

A diagnosis of DCIS can be confusing. If you have DCIS, you have abnormal cells in your milk ducts which have not spread into your breast tissue. You may need treatment, but you do not have invasive breast cancer.

Find out more about ductal carcinoma in situ (DCIS) at the Breast Cancer Network Australia website:

https://www.bcna.org.au/unders....tanding-breast-cance

In this video from the National Comprehensive Cancer Network (NCCN), breast cancer surgeon Stephen Edge, MD, Chair of Breast and Soft Tissue Surgery at Roswell Park Cancer Ins****ute, explains how ductal carcinoma in situ (DCIS) is different from invasive breast cancer and why women with ductal carcinoma in situ usually do not get chemotherapy. The NCCN is a not-for-profit alliance of 21 leading cancer centers—including Roswell Park Cancer Ins****ute—dedicated to improving care for cancer patients. You can find more information on breast cancer in the NCCN Guidelines for Patients with Breast Cancer, available at www.NCCN.com. These guidelines, part of the NCCN Guidelines for Patients series, discuss most types of breast cancer along with treatment options.

Tari King, MD, and Elizabeth Ann Mittendorf, MD, PhD, co-directors of the Ductal Carcinoma in Situ (DCIS) Program at Dana-Farber Brigham Cancer Center, review treatment options for patients diagnosed with DCIS.

DCIS is the earliest form of breast cancer where the abnormal cells are confined within the milk duct of the breast. DCIS is sometimes referred to as stage 0 cancer, non-invasive breast cancer, or pre-cancer. Treatment options may include surgery, radiation therapy, and medication (hormone) therapy. It is generally safe for patients to take the time they need to evaluate all of their options and collaborate with their care team to decide what treatment is right for them.

To learn more about the DCIS Program, visit www.dana-farber.org/ductal-car....cinoma-in-situ-progr

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