| Ductal Carcinoma-in situ (DCIS)
Ductal Carcinoma-in situ is the name given to pre-cancerous changes in the breast. This is the stage before breast cancer and very different from breast cancer. Under the microscope abnormal cells similar to cancer cells can be seen within the breast ducts, but these cells do not have the ability to invade the surrounding tissue or to live outside the breast duct. As a consequence DCIS can never spread to the lymph glands or away from the breast and for this reason is not life threatening in itself. If left untreated however, DCIS will often, though not always, turn into breast cancer with potentially more serious consequences.
Ductal Carcinoma-in situ is most often discovered when you have a mammogram. In particular it produces fine specks of calcium which show up on a mammogram. A needle biopsy is usually required to make the diagnosis for certain. It is unusual to have any symptoms as DCIS does not cause any pain and only rarely leads to lump or to nipple discharge.
Ductal Carcinoma-in situ is nearly always treated by surgery. It is essential to remove all of the affected tissue in a way that leaves none of the problem behind. Often this can involve the removal of only a small area of breast tissue but if the changes are very extensive a mastectomy can sometimes be required. In these cases breast reconstructive surgery can be safely carried out at the same time as the mastectomy.
Ductal Carcinoma-in situ is classified under the microscope according to its aggressive potential. High grade DCIS turns into breast cancer much more quickly and when it does turn into cancer it is of the more aggressive type. Low grade DCIS is the opposite taking many years to become cancerous and sometimes never going cancerous at all. If it does become cancerous the type of cancer that evolves is of equally low grade, growing very slowly and often not spreading. In cases of high grade DCIS we usually recommend the addition of radiotherapy to the breast to minimise the chances of further problems. Radiotherapy is occasionally also recommended in cases of intermediate grade DCIS, not of great benefit in low grade DCIS.
The success of the treatment for DCIS depends on the grade. There is very little chance that low grade DCIS will recur but approximately 1/4 of all cases of high grade DCIS develop further DCIS (50%) or invasive breast cancer (50% of recurrences are invasive breast cancer). The addition of radiotherapy reduces the chance of recurrence by a half, giving a recurrence rate of approximately 12-13% in cases of high grade DCIS. Women who have a mastectomy have only a very small chance of recurrence (1%) even if they have high grade DCIS.
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