Ductal carcinoma in situ (DCIS) is a non-invasive breast condition where abnormal cells are found in the lining of a breast duct but have not spread outside the duct to other tissues. Because it is confined and non-invasive, treatment aims to remove or destroy these abnormal cells to prevent progression to invasive breast cancer. The treatments for DCIS are varied and tailored to individual cases, balancing effectiveness with quality of life considerations.
The primary treatment for DCIS is **surgery**, which involves removing the abnormal cells. There are two main surgical options:
– **Lumpectomy (breast-conserving surgery):** This procedure removes the DCIS and a small margin of surrounding healthy tissue while preserving most of the breast. Lumpectomy is often preferred when the DCIS is localized and small. It allows women to keep their breast and is usually followed by radiation therapy to reduce the risk of recurrence.
– **Mastectomy:** This surgery removes the entire breast and is considered when DCIS is widespread, involves multiple areas of the breast, or if there are other risk factors such as genetic predispositions. Mastectomy eliminates the risk of recurrence in the affected breast but is a more extensive surgery. Some women opt for preventive mastectomy of the other breast if they have a high risk of developing cancer there.
After surgery, **radiation therapy** is commonly recommended, especially after lumpectomy. Radiation targets any remaining abnormal cells in the breast to lower the chance that DCIS or invasive cancer will return. Radiation is typically given daily over several weeks. However, some women with very low-risk DCIS may choose to skip radiation after lumpectomy, depending on their doctor’s advice and personal preferences.
In addition to surgery and radiation, **hormonal therapy** may be offered if the DCIS cells have hormone receptors (estrogen or progesterone receptors). Medications like tamoxifen or aromatase inhibitors can help reduce the risk of recurrence by blocking hormones that might promote cancer growth. Hormonal therapy is taken as a pill for several years and is more common in hormone receptor-positive DCIS.
For some patients, especially those with very low-risk DCIS, **active surveillance or monitoring** is being studied as an alternative to immediate surgery. This approach involves close follow-up with regular imaging and exams to watch for any changes, delaying or avoiding surgery unless progression occurs. Clinical trials are ongoing to determine when this might be a safe option.
Other treatments such as chemotherapy or targeted therapy are generally not used for DCIS because it is non-invasive and has not spread beyond the ducts.
Deciding on the best treatment involves considering several factors:
– The size and grade of the DCIS lesion
– Whether the DCIS is hormone receptor-positive
– The patient’s age, overall health, and personal preferences
– Genetic risk factors or family history of breast cancer
– The ability to attend radiation therapy sessions if lumpectomy is chosen
– Emotional and psychological impact of surgery choices, including body image and anxiety about recurrence
Some women may also consider **breast reconstruction** after mastectomy, which can be done immediately or later, depending on their situation.
In summary, treatment for ductal carcinoma in situ typically centers on surgery—either lumpectomy or mastectomy—often followed by radiation therapy and sometimes hormonal therapy. Emerging options like active surveillance are under investigation for select cases. The choice of treatment is highly individualized, aiming to effectively manage the condition while respecting the patient’s values and lifestyle.
