Breast Cancer (cont.)

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I have a ductal carcinoma in situ (DCIS), a type of localized cancer. Why have I been advised to have a mastectomy when other women with invasive cancer have lumpectomies?

Ductal carcinoma in situ (DCIS) presents a difficult dilemma. The DCIS cells originate from the inside of the breast gland ducts (microscopic tubes). As they multiply, the cells fill and spread through the normal ducts of the breast glandular tissue.

Most patients with DCIS can undergo successful breast-conservation therapy but not all. The diagnosis implies that this is an "early" form of cancer in the sense that the cancer cells have not acquired the ability to penetrate normal tissue barriers or spread through the vascular or lymphatic channels to other sites of the body. It is important to realize that breast cancer is a wide spectrum of diseases and no comparisons should be made just on the basis that someone you know has "breast cancer" and shares a different treatment approach with you.

DCIS is currently an area of controversy in the field of breast cancer. Doctors know that many cases of DCIS are not likely to spread beyond the ducts, and aggressive treatment for all cases of DCIS means that many women are being overtreated.

The risk of DCIS is that a few of the abnormal cells may ultimately become invasive. This invasive change is the real risk of DCIS. Currently studies are underway in an attempt to identify which cases of DCIS are most likely to become invasive and which cases will follow a more indolent course.

After excision of the abnormal areas, most cases of DCIS do not recur. However, in some cases there is recurrence of DCIS or even the development of invasive cancer. The management of DCIS is difficult because it is difficult to predict which cases of DCIS will be aggressive and have the potential to recur or progress to invasive cancer.

Your treatment team should be able to discuss the pros and cons of the different approaches and actively include you in the decision process.

Medically Reviewed by a Doctor on 9/25/2013

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