DCIS: What You Should Know About Breast Cancer Treatment Options

New study supports active treatment
DCIS: What You Should Know About Breast Cancer Treatment Options

To treat or not to treat – that’s the question women and doctors alike must explore when it comes to a form of breast cancer known as ductal carcinoma in situ, or DCIS. A review published Thursday in the journal JAMA Oncology supports those who believe it’s best to actively treat DCIS.

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DCIS is the very earliest form of breast cancer. DCIS is noninvasive, meaning it hasn’t spread out of the duct and invaded other parts of the breast.

DCIS is almost always curable. If untreated, however, ductal carcinoma in situ may become invasive cancer. But not everyone with DCIS will develop invasive disease or are at risk for the cancer to spread to other parts of the body.

Some believe this pre-cancer, or stage zero cancer, should be treated conservatively — in other words, with close monitoring — while others believe that standard cancer treatment, including breast-conserving surgery, is best.

In treating DCIS, doctors are trying to prevent invasive breast cancer reccurences which can lead to distant metastases.  But there is no way to identify for certain which patients will go on to develop invasive reccurences.

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Active treatment

Cleveland Clinic radiation oncologist Chirag Shah, MD, led a team of researchers who reviewed 50 studies to see whether conservatively treating DCIS was a reasonable option or whether it was best to continue using a standard regimen of surgery, radiation and endocrine therapy.

After summarizing the data, results show that actively treating DCIS with the standard regimen is still the best option for most. The data showed that radiation after surgery reduces the risk of cancer recurring in the breast.

“The results of our review demonstrated that at this time DCIS is best managed using traditional treatments. So the recommended treatment for DCIS would be surgery followed by radiation in appropriately selected women,” Dr. Shah says.

More mammography, more DCIS

The rate at which DCIS is diagnosed has increased dramatically in recent years because more women are seeking mammography screening.

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Because DCIS usually has no symptoms, it’s usually found on a mammogram. DCIS often appears as small clusters of calcifications that have irregular shapes and sizes.

“Without standard treatment following surgery, we know that about 50 percent of the time, recurrences are invasive cancers,” Dr. Shah says. “So that’s the reason that we do treat them aggressively and don’t simply monitor them.” 

Dr. Shah says the area of DCIS continues to evolve and research is ongoing. For now, it’s important for women diagnosed with DCIS to talk to their doctor about the benefits and risks of each treatment option.

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