The most common type of breast cancer in women that is noninvasive is referred to as DCIS, which stands for Ductal Carcinoma In Situ. The term "in situ" refers to cancer cells that have not moved out of the system in which they began to grow. With DCIS the cancer cells develop in a milk duct in the breast and are found before they have a chance outside of the duct. DCIS is the noninvasive version of Ductal Carcinoma and is usually discovered during the course of a regular mammography because it can show up as specks of calcifications. If these specks appear, then the next step is a biopsy.
Ductal Carcinoma In Situ is referred to as a Stage 0 cancer, but it is taken very seriously by doctors. Treatment for DCIS is usually much more aggressive than it's in situ cousin, LCIS (or lobular neoplasia). Even though it is a serious condition, there is plenty of time to educate yourself and weigh all your options concerning treatment and possible reconstruction. There is close to a 100% rate of success in treating DCIS with the standard medical treatment.
DCIS usually appears in two different forms, which describe how the cancer looks on pathological examination under a microscope. The comedo type will express dead cells out of it, much like a pimple or zit on the skin, hence the name comedo.
The non-comedo DCIS types are 1) solid where the DCIS cells fill in the milk duct all the way, 2) cribiform DCIS where the cells do NOT completely fill in the duct, in fact there will be some areas of empty space between the cancer cells and 3) papillary and micropapillary DCIS in which the cells are sparse, like cribiform, but have a pattern to them.
The comedo type is considered to be more aggressive than that of the non-comedo types. By looking under a microscope, a pathologist can tell the difference between the two based on the number of dead, or necrotic, cells in the middle of the milk duct. Have large amounts of dead cells in a cancerous area means that the cancer can be faster growing.
Even though DCIS is considered to be a pre-cancer or Stage 0, the treatment options are very similar to invasive ductal carcinoma. Depending on where the area of DCIS is located and how many areas there are, a patient will have a choice between a lumpectomy and mastectomy. As with Stage 1 and higher cancers, further treatment will be decided based on the size of the area or tumor, the pathologic grade, HER2 status, lymph node involvement and the hormonal status. Family history and other related risk factors should also be taken into consideration when deciding on treatment options.
While a diagnosis of DCIS can be frightening, it is certainly a very treatable condition. Fortunately by catching the cancer before it has broken out of the ductal system and made its way into the fatty breast tissue or lymph system, the chance that the disease has spread is very very small.
The majority of all breast cancers start in the ducts of the breast. However, the ductal system is not the only area of the breast where cancer can grow. At the inside end of the duct is a lobe. This is referred to as the lobular system, where the milk is produced. 10% to 15% of breast cancers get their start in the lobes of the breast. Before lobular carcinoma develops, it begins as lobular carcinoma in situ or LCIS.
By "in situ" we are referring to cancer cells that are present in a system, but have not yet spread outside of it. The term LCIS refers to an increase of abnormal cells in the lobes of the breast that produce milk.
Although the abnormal cells classified as LCIS could develop into cancer and are called Stage 0 cancer, it is not considered to be an actual cancer. Having it present in the breast means that cancer could develop over time. Because of this new way of thinking about LCIS, doctors have started to rename it "lobular neoplasia" which is in reference to the abnormal growth of the cells.
Since women with LCIS have a much higher risk of ending up with breast cancer they must be followed up closely. A lot of times a woman will find out she has LCIS because of a biopsy that was done for something unrelated to the LCIS. While LCIS has been reclassified as a "non-cancer" that is treated differently than Ductal Carcinoma in situ, it is still a worrisome condition. Women who have been diagnosed with this should talk over all their options with their breast specialist to make a well informed decision on what, if any treatment options to follow.
Women with LCIS will be followed up closely. The standard followup will be a regular mammogram and screening. It will also consist of monthly self exams and regular visits to a breast specialist. Most women receive no other treatment for LCIS. If they do notice changes in their breasts or any thing that appears to be abnormal, they should contact their doctor immediately.
Some women may choose to take tamoxifen and may possibly participate in the STAR clinical trial. The STAR trial compares the effects and preventative effectiveness of tamoxifen and raloxifene. Both drugs reduce the amounts of hormones in the breast tissue. These drugs are usually taken for a period of five years. Tamoxifen has shown in studies to reduce the occurrence of more advanced breast cancer by up to 49% in women that have had LCIS or that have additional risk factors for developing breast cancer. Those addition risks are having atypical hyperplasia, or a family member with the disease. Recent studies have shown raloxifene to be very effective in preventing breast cancer in post menopausal women.
Some women who have a high risk of developing breast cancer may choose to have a preventive mastectomy of both sides with reconstruction to prevent breast cancer from occurring. Women who have this procedure will have a much lower risk of developing the disease.
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