DCIS: Treatment Options and Controversies for Early-Stage Breast Cancer

Q: DCIS: Treatment Options and Controversies for Early-Stage Breast Cancer

Dear Hommie： 1. Ductal Carcinoma In Situ (DCIS) is classified as a non-invasive breast cancer, with statistics indicating that approximately 30% may progress to invasive breast cancer within 5 to 10 years. 2. Knowing that one has DCIS and the associated risk o

Stage 0 breast cancer

Hello, this year during a mammogram, some calcifications were found in the right breast.
After undergoing breast ultrasound and biopsy, it was determined to be DCIS (Ductal Carcinoma In Situ).
Since the lesion is smaller than 1 cm and has not invaded beyond the ducts, and I don't have any noticeable symptoms, I am considering whether to undergo surgery and what subsequent treatments to pursue.
Recently, I have read some reports regarding the controversies surrounding the treatment of DCIS, so I have not yet arranged a treatment plan.
I would like to ask for any recommendations.
Thank you!

Hommie, 30~39 year old female. Ask Date: 2015/10/23

Dr. Zhou Jiazhen reply Breast and Thyroid

Dear Hommie:
1.
Ductal Carcinoma In Situ (DCIS) is classified as a non-invasive breast cancer, with statistics indicating that approximately 30% may progress to invasive breast cancer within 5 to 10 years.

2.
Knowing that one has DCIS and the associated risk of malignant progression can create psychological stress for patients.
If left untreated and only monitored closely, it raises concerns about whether patients can psychologically cope and whether it will affect their daily lives and work.
Therefore, surgical intervention is often recommended, followed by regular monitoring.

Reply Date: 2015/10/23

More Info

Ductal Carcinoma In Situ (DCIS) is a non-invasive form of breast cancer that is characterized by the presence of abnormal cells in the lining of the breast ducts. It is often detected through mammograms as microcalcifications and is considered an early stage of breast cancer. The management of DCIS can be a complex decision-making process, particularly when considering treatment options and the associated controversies.

Treatment Options for DCIS
1. Surgery: The primary treatment for DCIS is surgical intervention, which can involve either a lumpectomy (removal of the tumor and a small margin of surrounding tissue) or a mastectomy (removal of one or both breasts). The choice between these options often depends on the size and location of the DCIS, as well as patient preference. In your case, since the lesion is less than 1 cm and has not invaded beyond the ducts, a lumpectomy may be a reasonable option, followed by radiation therapy.

2. Radiation Therapy: After a lumpectomy, radiation therapy is typically recommended to reduce the risk of recurrence. This is particularly important in cases of high-grade DCIS or when the margins are not clear.

3. Hormonal Therapy: If the DCIS is hormone receptor-positive, hormonal therapy (such as tamoxifen) may be recommended to lower the risk of developing invasive breast cancer in the future. However, this is not applicable if the DCIS is hormone receptor-negative.

4. Active Surveillance: Some patients may opt for active surveillance, which involves close monitoring without immediate treatment. This approach is more common for low-grade DCIS and in patients who are older or have significant comorbidities. However, this option requires careful consideration of the psychological impact and the potential for progression to invasive cancer.

Controversies Surrounding DCIS Treatment
The management of DCIS is often debated among healthcare professionals due to the varying opinions on the necessity and aggressiveness of treatment. Some key points of contention include:
- Overdiagnosis and Overtreatment: Critics argue that many cases of DCIS may never progress to invasive cancer, leading to unnecessary treatments that can have significant physical and emotional side effects. This has led to discussions about the need for more personalized treatment approaches based on individual risk factors.

- Psychological Impact: The diagnosis of DCIS can cause significant anxiety and stress for patients. The fear of cancer recurrence or progression can affect quality of life, and this psychological aspect should be considered when discussing treatment options.

- Risk of Progression: Studies suggest that approximately 30% of untreated DCIS may progress to invasive breast cancer within 5 to 10 years. This statistic often weighs heavily in the decision-making process for patients and their healthcare providers.

Recommendations
Given your situation, where the DCIS is small and non-invasive, it is crucial to have a thorough discussion with your healthcare team about the potential benefits and risks of each treatment option. Here are some recommendations:
1. Consult with a Breast Specialist: A breast surgeon or oncologist can provide insights tailored to your specific case, including the characteristics of your DCIS and your overall health.

2. Consider a Multidisciplinary Approach: Engaging with a team that includes a surgeon, medical oncologist, radiation oncologist, and possibly a psychologist can help you make a well-rounded decision.

3. Evaluate Your Comfort with Surveillance: If you are leaning towards active surveillance, consider how comfortable you are with the idea of monitoring your condition closely and the potential for anxiety that may arise from this approach.

4. Stay Informed: Continue to educate yourself about DCIS and treatment options. Understanding the latest research and guidelines can empower you to make informed decisions.

In conclusion, the management of DCIS involves a careful balance of treatment benefits, risks, and personal preferences. Engaging in open discussions with your healthcare providers and considering your psychological well-being will be key in navigating this decision.

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