DCIS: What is “Stage Zero” Breast Cancer?

???????????????This year nearly 227,000 women in the United States will be newly diagnosed with breast cancer, according to estimates by the National Cancer Institute. But thanks to breast cancer awareness campaigns and early detection, more women than ever are getting mammograms and more cancers are being spotted early.

Many women are told they have something called ductal carcinoma in situ (DCIS), or “Stage Zero” cancer, in which abnormal cells are found in the center of the milk-producing ducts. Before universal screening, DCIS was rare. Now DCIS and the less common lobular carcinoma in situ account for almost a quarter of new breast cancer cases — some 60,000 a year.

A diagnosis of DCIS raises all sorts of questions. Is it cancer? Is it life threatening? What is the treatment?

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Lisa Bailey, M.D., breast surgeon and co-director of the breast cancer program at Alta Bates Summit Medical Center.

“DCIS is non-invasive, and is technically a pre-cancer and is not life threatening,” says Lisa Bailey, M.D., breast surgeon and co-director of the breast cancer program at Alta Bates Summit Medical Center. “If you have DCIS, it means that you have abnormal cells in the milk duct. While most invasive cancer begins as DCIS, not all DCIS will go on to become an invasive cancer.”

Diagnosing DCIS

Like other types of cancer, DCIS is usually diagnosed by a team of medical professionals (including radiologists, surgeons, and pathologists), using these techniques:

  • Mammography. In a sense, increased use of mammography is responsible for the increase in DCIS, because it has increased early detection. A finding of DCIS may indicate a diagnosis before the lesion becomes an invasive cancer, a significant benefit to the woman. Confined to the ducts, DCIS tumors are often too small to cause symptoms or to be felt on a breast exam. DCIS is likely to be identified during an annual mammogram that reveals tiny calcium deposits — microcalcifications — which appear as lines or clusters on an X-ray image and are sometimes associated with cancer.
  • Magnetic resonance imaging. MRI is increasingly used in breast imaging, but it hasn’t yet been found significantly better than mammography in screening for DCIS.
  • Biopsy. Once DCIS is suspected, a biopsy is needed to determine whether cancer is present and, if so, the extent of the disease.
  • Pathology. Pathologists examine the biopsy sample to determine how far the tissue has strayed from normal breast tissue. They look at the structure and arrangement of the cells under a microscope and may test the sample to determine the presence of receptors for estrogen and progesterone or abnormalities in genes associated with cancer.

“The pathology report includes information about the size and grade of the DCIS,” says Dr. Bailey. “The pathology report is very important because it can help determine what course of action is needed, including treatment and surgery planning.”

Right now, the treatment consists of surgery—either a lumpectomy or mastectomy depending on how widely the cells appear in the ducts. If the cells are concentrated in one place, the usual treatment is a breast-conserving surgery (lumpectomy) followed by radiation. Some women may have a mastectomy if the abnormal cells are found in many places.

“Because the risk of metastasis is so low with DCIS, we don’t need to remove the lymph nodes and chemotherapy is not necessary in treating DCIS,” says Dr. Bailey. “An important statistic to remember is that the survival rate for women with DCIS is very good, nearly 100 percent.”

According to Dr. Bailey, researchers are now studying how hormonal therapy before surgery may one day predict which cases of DCIS will progress to invasive breast cancer and which women may not need radiation therapy after undergoing a lumpectomy for DCIS, or which patients even need surgery.

“The ultimate goal is to be able to identify some women who do not need surgery at all for DCIS and treat them with hormonal medicine,” she says. “The research is getting us closer to being able to do just that.”

Alta Bates Summit Medical Center recognizes the importance of preventive breast health and is committed to providing the most comprehensive breast care. Visit us online to learn more about our breast cancer services and support programs.

Don’t miss Alta Bates Summit Medical Center’s 5th Annual Breast Cancer Symposium on Wednesday, Oct. 22. Expert scientists from the Breast Cancer Fund will discuss environmental factors that may be linked to breast cancer and share tips for reducing your risk. The free event will take place from 6 to 8 p.m. at Samuel Merritt University Bechtel Hall, 400 Hawthorne Ave., Oakland. Call (510) 869-6737 to reserve your seat.

 

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