Ductal Carcinoma in Situ (DCIS) - Johns Hopkins Medicine

Ductal carcinoma in situ (DCIS) is a condition that affects the cells of the milk ducts in the breast. The cells lining the milk ducts turn malignant ... SkipNavigation COVID-19Updates Masksarerequiredinsideallofourcarefacilities.Wearevaccinatingalleligiblepatients.Learnmore: Vaccines,Boosters&AdditionalDoses|Testing|PatientCare|VisitorGuidelines|Coronavirus|EmailAlerts FindmoreCOVID-19testinglocationsonMaryland.gov. HealthHome ConditionsandDiseases BreastCancer DuctalCarcinomainSitu(DCIS) ShareonFacebook ShareonTwitter ShareonLinkedin ShareonPinterest ShareviaEmail PrintthisPage Breast FeaturedExperts: BonnieSun,M.D. Ductalcarcinomainsitu(DCIS)isaconditionthataffectsthecellsofthemilkductsinthebreast.Thecellsliningthemilkductsturnmalignant(cancerous)butstayinplace(insitu).DCISisanearlyformofbreastcancer.Itisnotinvasive—themalignantcellsdonotgrowthroughthewalloftheductorspreadtolymphnodesorthebloodstream. BonnieSun,M.D.,ofJohnsHopkins’breastcenter,providesperspective: DuctalCarcinomaInSitu(DCIS)—WhatYouNeedtoKnow DCISaccountsforabout20%ofbreastcancers. Theconditiondoesnotusuallycausesymptomsbutcanshowuponamammogram,typicallyasmicrocalcificationclusters. DCIScanbetreatedwithsurgery,sometimeswithradiationandmedicine.Chemotherapyisnotneeded. Withtimelydiagnosisandtreatment,patientscanexpectagoodoutcome. WhatareDCISsymptoms? Ductalcarcinomainsitudoesnothavespecificsymptomssuchalumporbreastpain.“Mostcasesarediagnosedinamammogrambeforecausinganysymptoms,”Sunsays.DCISmostcommonlyshowsuponamammogramasnewcalciumdeposits,butnotalways—sometimes,adistortionofthebreasttissueonthescancanbeasignofDCIS. Oncethecancerouscellsstarttoinvadethemilkduct,youmightnoticeitchingorulceration(formationofasore). SunnotesthatDCIScanoccurinmen,andsincetheydonotgetregularscreeningmammogramsasarule,theproblemcanshowupasabloodynippledischargeorlump. Alumpinthebreastofawomanoramancanbeinvasivecancerandshouldbecheckedbyadoctorrightaway. HowisDCISdiagnosed? Ifadoctorseesthecalcificationsonyourmammogram,heorshewillrecommendmoretests,whichcouldincludeabreastbiopsy.Duringthebiopsy,adoctororotherhealthcareprovidertakessamplesofcellsortissuesfromyourbody.Thecellsareexaminedbyapathologist—adoctorwhochecksforsignsofdiseaseinbodytissues.Thepathologistlooksatthecellsunderamicroscopetoseeifcancerispresent. AparticularkindofbiopsycalledastereotacticcoreneedlebiopsycandiagnoseDCIS.Thisisanonsurgical,outpatientprocedure.Aftergivingyoumedicinetonumbthebreastarea,thedoctorortechnologistcollectscellsfromtheareaofconcernusinganeedleguidedbymammography. Lesseningthewaittimecanreducestress Waitingforresultscanbestressful,andadvancedbreastcenterskeepthatinmindandtrytominimizethetimebetweentestingandresults. “AtJohnsHopkins,wearesensitivetotheanxietyapossiblediagnosisofDCIScreatesforourpatients,”Sunsays.“IftheradiologistwhoreadyourmammogramsuspectsyouhaveDCIS,heorshewillarrangeforyoutohaveastereotacticbiopsyassoonaspossible.”Biopsyresultsareusuallyreturnedinaboutaweek. WhatisthetreatmentforDCIS? Lumpectomywithradiation.Thestandardtreatmentisbreast-preservingsurgery(alumpectomy)withradiationtherapy,whichresultsinsuccessfuloutcomesformostpatients.Cancerscanbelargerthanexpected,soabout20%ofthetime,patientsneedare-excisionlumpectomy—anothersurgery—toremoveallofthecancer.Typically,theremainingbreastwillthenhaveradiationtherapytoreducetheriskoflocalrecurrence.LumpectomyplusradiationisagoodalternativetomastectomyfortreatmentofDCIS. Mastectomy.Somepatientshaveductalcarcinomainsituinmorethanonequadrantofthesamebreast(multicentricbreastdisease).Sometimes,theDCISisverylargerelativetothepatient’sbreastsize.Inthesesituations,amastectomy(withorwithoutimmediatereconstruction)isrequiredtoaddressmalignantcellsthataremorewidespread.RadiationtherapyisnotneededforDCIStreatedwithmastectomy. Chemotherapy.ChemotherapyisnotneededforDCISsincethediseaseisnoninvasive. Hormonal(endocrine)therapy.Hormonal(endocrine)therapymaybeappropriateforthosewhoseductalcarcinomainsituishormonereceptorpositive. WhatshouldIexpectafteraDCISdiagnosis? TheoutlookafterDCISdiagnosis,Sunsays,isencouraging.“Withcontinued,rigorousmonitoring,theprognosisforDCISisexcellent,”sheexplains.“Yourdoctorwillrecommendaregularscreeningscheduletoguardagainstrecurrenceintheoriginalbreast,andtomonitortheotherbreastforanysignsofmalignancy. “Ourexpectationisforacompleteresolutionoftheproblemwithpropertreatment.Thisisalocaldiseaseandtreatmentbysurgerycanbesufficient.Chemotherapyisn’tnecessary,andinsomecases,hormonemedicationandradiationaren’teither.” WillDCISreturnorspread? SinceDCISisanoninvasiveformofcancer,itdoesnotspreadthroughoutthebody(metastasize). Forpatientshavingalumpectomywithradiation,theriskoflocalrecurrencerangesfrom5%to15%. Forthosehavingmastectomy,theriskoflocalrecurrenceislessthan2%.Patientswhoreceivehormonaltherapyaftersurgeryfurtherreducetheirriskofrecurrencebyhalf. Breastcancermaydevelopinthepatient’sotherbreast,butonlyinabout5%ofcases.Ifthishappens,thecancerinthesecondbreastisnotconsideredarecurrence,butanewprimarybreastcancer.Itcanalsobeadifferenttypeofbreastcancer. Surgerycanrevealadditionalcancer ThereisasmallpossibilitythatinvasivecancerwillbefoundduringthefinalpathologyexaminationaftersurgicalremovalofDCIS.Whenthathappens,”Sunsays,“thediagnosiswouldbeupgradedandadditionalsurgeryandothertreatmentsmaybeneeded.Wetakeeachsituationindividuallyandthemostoptimaltreatmentwillbetailored.Thisisimportantbecauseeachtumorandeachpatientisdifferent.” ShenotesthatatJohnsHopkinsMedicine,thepathologistswithwhomsheworksareespeciallyskilledinidentifyinganyinvasivecancerthatmightbepresent.“HavingDCIStreatedatacomprehensivebreastcenterensuresyouareinthebestpossiblehands,”Sunsays. MovingOnAfterDCIS Sunemphasizesthatqualityoflifeisaveryimportantaspectofbreastcancertreatment.“Sincemanyofourpatientsaresuccessfullytreated,wehavemanyyearsoflifetoconsider,”shesays.“Byempoweringandeducatingourpatientsandmakingtreatmentplanstogether,ouraimistominimizeanyregretsabouttreatmentdecisions.Wewantourpatientstofeelhealthyandhappyafterbreastcancertreatmentisfinished.” HowdoIpreventDCIS? “Getyourmammogramsontime,”saysSun.“MammogramsthemselvesdonotpreventDCIS,butcancatchitearly.Earlydetectioncanmeanabetteroutcomewithlesstreatment.” FindaDoctor SpecializingIn: BreastCancer Mammography AtAnotherJohnsHopkinsMemberHospital: HowardCountyGeneralHospital SibleyMemorialHospital SuburbanHospital FindaTreatmentCenter BreastCancerProgram FindAdditionalTreatmentCentersat: HowardCountyGeneralHospital SibleyMemorialHospital SuburbanHospital Related BreastCancer:AnswersfromExpertDr.DavidEuhus AboutBreastCancerinMen 6MammogramMyths InflammatoryBreastCancer RequestanAppointment FindaDoctor 410-955-5000 Maryland 855-695-4872 OutsideofMaryland +1-410-502-7683 International FindaDoctor SeeMore Related Breastcancer BreastCancer:AnswersfromExpertDr.DavidEuhus Breastcancer AboutBreastCancerinMen Breastcancer 6MammogramMyths RelatedTopics Breast