The aim of treatment is to remove all the DCIS from within the breast, as some cases of DCIS will recur (come back) if they are not completely removed or become invasive if left untreated.
However, some cases of DCIS may never develop further or may grow so slowly that they would never cause any harm during a person’s lifetime.
The type, size and grade of the DCIS can help predict if it will become invasive but currently there is no way of knowing for certain in each individual case. For this reason, treatment is usually recommended, but for some people this may not be necessary and might be seen as over-treatment of their condition. You may wish to discuss this possibility with your specialist team.
Research is ongoing into DCIS and there may be clearer guidance available in the future on how best to manage it.
Surgery is usually the first treatment for DCIS. This may be breast-conserving surgery, usually referred to as a wide local excision or lumpectomy. This is the removal of the DCIS with a margin (border) of normal breast tissue around it. Alternatively this may be a mastectomy (the removal of all of the breast tissue).
You may be offered a choice between these two types of surgery, depending on the size and location of the area affected. Your breast surgeon will discuss this with you. However, a mastectomy is usually recommended if the DCIS affects a large area of the breast; or if there is more than one area of DCIS; or if it hasn’t been possible to get a clear margin of normal tissue around the DCIS using breast-conserving surgery.
As most cases of DCIS can’t be felt, a procedure called localisation is often used before breast-conserving surgery. This helps mark the exact area to be removed during surgery and may involve using a mammogram as a guide to insert a very fine wire into the area of concern. This procedure usually takes about 30 minutes. You will be given a local anaesthetic to numb the area but may feel a little uncomfortable as the breast is compressed throughout the procedure. Once the wire is in the correct place, it’s covered with a padded dressing and left there until surgery when the wire is removed. Surgery usually takes place on the same day as the localisation but may be the day after. The wire won’t move during this time as it’s carefully secured.
If you are going to have a mastectomy you will usually be able to consider breast reconstruction. This can be done at the same time as your mastectomy (immediate reconstruction) or months or years later (delayed reconstruction).
Generally the lymph nodes (glands) under the arm (the axilla) don’t need to be sampled (tested) for DCIS – as they are for invasive breast cancer. This is because the cancer cells haven’t developed the ability to spread outside the ducts into the surrounding breast tissue. However, if you are having a mastectomy and immediate reconstruction your specialist may discuss sampling the lymph nodes at the same time.
The breast tissue removed is examined following surgery by a pathologist (a specialist in analysing tissue and cells). Sometimes an area of invasive breast cancer is found as well as DCIS. Your consultant will let you know if any invasive breast cancer was found as well as the DCIS. If invasive cancer is found, this will affect the treatment you are offered and you may need surgery to remove lymph nodes from the axilla to check for possible spread of the cancer to this area.
Additional (adjuvant) treatments
After surgery you may need further treatment. This is called adjuvant (additional) treatment and may include radiotherapy and in some cases hormone therapy. Chemotherapy is not used as a treatment for DCIS.
Radiotherapy is usually recommended after breast-conserving surgery to reduce the chance of the DCIS recurring (coming back) in that breast. Your specialist will explain the likely benefits of radiotherapy for you and also tell you about any possible side effects.
Hormone (endocrine) therapy
Tamoxifen is a hormone therapy drug used to treat oestrogen receptor positive invasive breast cancer, however its benefits in DCIS are much less clear and may not outweigh the possible side effects. There are ongoing trials evaluating the use of hormone therapy in DCIS. Your specialist will discuss whether taking Tamoxifen is appropriate for you.
Being told you have DCIS can leave you feeling different emotions. Fear, shock, sadness and anger are all common feelings at this time. Although DCIS is an early form of breast cancer with a very good prognosis (outlook), some people understandably still feel very anxious and frightened. People can often struggle to come to terms with being offered treatments such as mastectomy, at the same time as being told their DCIS may never do them any harm.
Sometimes people feel less able to express their anxiety and concerns about their diagnosis of DCIS because they have not needed treatment such as chemotherapy and may not face a high risk of problems in the future. Because of this they do not feel able to ask for support. Remember that there are people who can support you so don’t be afraid to ask for help.