Ductal carcinoma in situ (DCIS)

This section discusses the main aspects of ductal carcinoma in situ, commonly called DCIS. We recommend that you read it with our booklet Understanding Cancer of the Breast . We hope that it helps you to discuss any questions you may have with your cancer specialist or breast care nurse and to be involved in your treatment plan.

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What is DCIS?

DCIS is an early form of breast cancer. You may hear it described as a pre-cancerous, intraductal or non-invasive cancer, which means the cancer cells are inside the milk ducts or ‘in situ’ and have not developed the ability to spread either within or outside the breast.

What are the symptoms of DCIS?

Most women with DCIS have no symptoms. Some may have a lump, a discharge from the nipple or, rarely, a type of rash involving the nipple known as Paget’s disease of the breast. For further information call National Cancer’s Freefone Helpline on 1800 200 700 and ask for our factsheet on Paget’s disease of the Breast.
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How is DCIS diagnosed?

As DCIS does not usually have any symptoms, most cases are diagnosed from a mammogram breast x-ray . This is why DCIS has been diagnosed more frequently since two-yearly breast screening was introduced for women over 50.

The mammogram shows a cluster of small white dots. These white dots contain calcium and are known as microcalcifications. Not all microcalcifications turn out to be DCIS. If there is any doubt, a needle core biopsy removal of a piece of tissue will be taken using the mammogram to guide the radiologist to the area of microcalcification. This is called a stereotactic core biopsy.

If you have symptoms such as a lump or nipple discharge, you will be given a range of tests which may include a mammogram and a fine needle aspiration removal of cells using a fine needle and syringe . For further information about these tests, see our booklet Understanding Cancer of the Breast .

For DCIS that can’t be felt, a procedure called localisation is used before surgery. This helps the surgeon pinpoint the exact area to be removed during surgery. The radiologist specialist in reading x-rays and scans uses a mammogram or ultrasound as a guide to insert a fine wire into the area of microcalcification in the breast. This can take up to an hour and may be uncomfortable, as it means that the mammogram plates are pressed onto the breast for some time. Once the wire is in place, it is covered with a comfortable padded dressing and left there until surgery. This is usually on the same day as the localisation, but the wire will not move during this time as it is carefully secured.
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Are there different types of DCIS?

There are a number of different types of DCIS. Very simply they can be divided into high-, intermediate- and low-grade DCIS. This grading is based on what the cells look like under the microscope.
If DCIS is left untreated, the cells may eventually develop the ability to spread from the ducts into the surrounding breast tissue and become an invasive cancer cancer with the ability to spread to other parts of the body . It is thought that low-grade DCIS is less likely to become an invasive cancer than high-grade DCIS.
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What treatment will I be offered?

The aim of treatment is to prevent the development of invasive cancer. Currently, there is no one approach that is suitable for all women and the treatment offered to you will depend on factors such as the extent of DCIS and the grade.

Surgery

As for most types of breast cancer you will be offered surgery as your first treatment. For many years the treatment for most cases of DCIS was mastectomy removing the whole breast , which meant there was a very low risk of the cancer coming back. However, more recently trials have shown that removing the part of the breast containing the DCIS is enough in most cases.

The type of surgery offered could range from wide local excision, which involves removing the area of DCIS and an area of normal tissue around it, to mastectomy with or without breast reconstruction.

Mastectomy is usually recommended if the DCIS affects a large area of the breast; or it has not been possible to get a clear area of normal tissue around the DCIS by wide local excision; or there is more than one area of DCIS.

Generally speaking, the lymph nodes in the axilla glands in the armpit don’t need to be removed for DCIS.

Adjuvant treatments

Adjuvant treatments are treatments given in addition to surgery to reduce the risk of DCIS coming back or an invasive cancer developing. These include radiotherapy and hormone therapy.

Coping with breast cancer

Finding out that you have breast cancer can leave you feeling a number of different emotions. Fear, shock, sadness and anger are all common feelings at this time.
Although DCIS is a very early and treatable form of breast cancer, many women still experience times when they feel anxious and rather negative. Remember that there are people who can support you so don’t be afraid to ask for help. You can let other people know how you are feeling, particularly your family and friends, so that they can be more supportive. It can also help to discuss your feelings or worries with your breast care nurse or specialist.
Alternatively a professional counsellor might be more appropriate if you want to talk through your feelings in more depth over a period of time. Your breast care nurse, specialist or GP can usually arrange this.
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Further Support

You might find it easier to share your feelings with someone who has had a similar experience to you. Reach to Recovery is a programme set up to help and support women who have recently had a breast cancer diagnosis. The programme works on the principle of personal contact between the patient and a Reach to Recovery volunteer – a woman who has had treatment for breast cancer. Carefully selected and fully trained volunteers are available to provide advice and reassurance at a time when a woman is most in need of both. For more information on individual support or support groups in your area, call the National Cancer Freefone Helpline on 1800 200 700.

Help from Action Breast Cancer

Action Breast Cancer is a national project established by the Irish Cancer Society to provide breast cancer information and support and to fund breast cancer research. Its services are free, confidential and accessible.
For more information call the National Cancer Freefone Helpline on 1800 200 700 or visit www.irishcancer.ie
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ABC would like to thank Breast Cancer Care in the UK for their permission to adapt the text in this factsheet from their series of factsheets