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  DCIS – The Controversial Breast Cancer

Everyone has heard of Breast Cancer. Those 2 words are enough to scare any of us, men or women, as we all know someone who has had a fight with this disease. With this disease everyone always thinks about lumps being detected, and then being removed followed by further treatment.

How many of you have heard about Ductal Carcinoma in Situ (DCIS)? If you have heard about it, how much do you really know?

DCIS is a much debated subject amongst the specialists, and the definition and treatment varies from consultant to consultant as well from country to country. There is a considerable lot of data on the web, however again a great deal of this fluctuates.

Definition of DCIS

DCIS is described in the UK as a non-invasive breast cancer. In other words, there are cancer cells present, but they are enclosed within the milk ducts and haven’t become invasive (i.e. a tumour), therefore are ‘in situ’.
In the USA many of the doctors refer to this as a “pre-cancer”, however this can be highly misleading making many people believe it’s something that isn’t yet cancerous so shouldn’t be taken as seriously. There are cancer cells present, they’re just not invasive yet but have the potential to do so.

Diagnosis of DCIS

DCIS cannot usually be detected by palpation on the skin, as there isn’t often a lump, and most people don’t notice any symptoms what so ever. It is usually only detectable using imaging such as mammograms, MRI, ultrasound or thermographs. Therefore, it’s often found when women go for their routine breast screening. For those women who miss their screening, or are too young for routine screening, it may not be detected until after it’s become invasive. Usually the area of DCIS is found surrounding small crystals called micro calcifications in the breast area. These areas are viewed under ultrasound and biopsies taken to examine them. It is from this that the final diagnosis is made. In the UK it makes up 20% of breast cancers that are diagnosed by screening mammogram.

Types of DCIS

Invasive breast cancer is graded from 1 to 3, with 1 being the least advanced. An invasive cancer can change from grade 1 to 3, so can change and get progressively worse. DCIS is graded as low, intermediate or high.

Low is as it sounds, it is the least likely to become invasive, whereas high means that there is a greater chance of the DCIS becoming invasive. Unlike with invasive cancer the DCIS cannot change or progress from low to intermediate to high – it is either low or medium or high and remains as such.

If left untreated then it is thought that many of the DCIS cases could become invasive, this is especially true for high grade DCIS. The grading is given after the tissue is examined in a lab following the biopsy.

Treatments for DCIS

The first thing that the medical team usually do is work out how large an area is affected and what grade the DCIS is, and then they make their decision about further treatment.

The main idea of the treatment is to clear the breast area of all DCIS. If this is not done then there may be a chance that the DCIS could become invasive. For some people the DCIS may never progress and may go away on its own. Much of this depends on the type, size and area it covers, but there is no real way to know for sure.

It is due to these reasons that the decision about whether to treat, and what sort of treatment to have can be very difficult. Some women may feel that they are being “over treated” if there is a chance that the DCIS will not get worse.

Debate about Screening and DCIS treatment

There is a great debate among the experts about whether breast screening is more helpful or more harmful. The diagnosis of DCIS has expanded after the presentation of routine mammograms, as more often than not this couldn't have been seen or felt without the imaging. Once diagnosed it will be dealt with using medical intervention. Some experts feel that this puts many patients through a lot of unnecessary stress and treatments, especially if it proves that there wasn’t a high incidence of DCIS and its low grade. There is always the chance that if left alone the DCIS could just be dealt with by the body or may not get worse so no treatment would have been needed. So the debate is whether routine mammograms are useful in detecting early breast cancer or more harmful by putting some women through unnecessary treatments and stress.
Also, the actual DCIS definition and treatment is in great debate. Does a woman with non-invasive breast cancer really need a mastectomy, a surgery which could lead to a lot of mental anguish and body dysmorphia?

So the debate will continue about DCIS, but one thing to remember is that so the level headed discussion will proceed about DCIS, yet one thing to recall is that this is a form of cancer as cancer cells are present. However, the options about whether to treat or how to treat are based on very individual circumstances and there is no one size fits all.

Pamela Acker | BreCeCan 2018 | Abu Dhabi | Big Oncology Event

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