Hello spook2,
Ductal carcinoma in situ, or DCIS, is the most common type of
non-invasive breast cancer in women, affecting the milk duct portion
of the breast. ?An estimated 185,000 cases of invasive breast cancer
are diagnosed each year, and approximately 20% to 30% of breast
cancers detected by mammography are carcinoma in situ.? The numbers of
cases has increased greatly in the last two decades, due to
mammography and early detection. According to the Imaginis site, cited
below, the outlook for this type of cancer is greater than invasive
forms of the disease, as it generally is contained within the ducts,
and does not affect the fatty tissue. However, left untreated, DCIS
becomes invasive, spreading to nearby breast tissue, and even
metastasizing (spreading) to other areas of the body. DCIS is a slow
growing cancer, giving you a bit of time to decide on treatment
options. Lumpectomy, followed by radiation, lumpectomy followed by
five years of Tamoxifen, and mastectomy are the most common
treatments, and survival rates are very good; between 95% and 100% for
women, 10 years after surgery! However, there doesn?t seem to be many
helpful recent studies. As you will see, selecting the best treatment
for a woman is a decision to be made after reviewing all the
?evidence?, along with a dialogue between the patient and the
physician. No one treatment is right for everyone. I am presenting you
with information from several reputable sites, to help you determine
at the best choice for your case.
One of the studies I found, published on the Breast Cancer Center site
quotes these statistics: ?In this study, 1,804 women with DCIS were
treated with either lumpectomy, radiation therapy and placebo or
lumpectomy, radiation and tamoxifen for 5 years. The average follow-up
was 74 months. Only 8.2% of patients treated with tamoxifen
experienced cancer recurrence, compared to 13.4% of patients treated
with placebo. The incidence of invasive breast cancer in women treated
with tamoxifen was 4.1% at 5 years, 2.1% in the same breast and 1.8%
in the opposite breast and 0.2% at regional or distant sites.
The researchers concluded that surgery, radiation therapy and
tamoxifen was more effective for prevention of breast cancer
recurrence in patients with DCIS than surgery and radiotherapy?
http://health.yahoo.com/health/centers/breast_cancer/6267
Imaginis
http://imaginis.com/breasthealth/dcis.asp
American Society of Clinical Oncology
http://www.asco.org/ac/1,1003,_12-002489-00_18-002003-00_19-00101423,00.asp
Canadian Medical Association Journal
http://collection.nlc-bnc.ca/100/201/300/cdn_medical_association/cmaj/vol-158/issue-3/breastqa/guide5.htm
According to this article, by Dr. Melvin Silverstein, ??no single
approach to treatment is suitable for all patients?
http://www.findarticles.com/cf_dls/m0999/n7160_v317/21175419/p10/article.jhtml?term=
Lumpectomy and Lumpectomy followed by radiation therapy and or Tamoxifen:
Lumpectomy (also called Breast-conserving surgery or BCS)
Lumpectomy refers to the surgical removal of a cancerous lump (or
tumor) in the breast along with a small margin of the surrounding
normal breast tissue. Lumpectomy is preferred by many women, as it
leaves the breast intact. The cure rate is almost 100%, if there are
no cancer cells left in the margin around the tumor.
Lumpectomy is not for all women. The American Cancer Society
recommends ?that women who have already undergone radiation treatment
in the breast/chest area, women with two or more areas of cancer in
the same breast (requiring an additional incision to remove each),
women whose previous lumpectomy did not completely remove the cancer,
women with connective tissue diseases such as scleroderma (which make
tissue sensitive to radiation), or women who would be pregnant at the
time of radiation treatment (possibly harming the fetus) should not
consider a lumpectomy as advisable treatment.
Lumpectomy is recommended when only one area of the breast is
affected, if the patient is elderly or not in good health.
Reasons for NOT having a lumpectomy:
Having had a previous lumpectomy that did not remove all the cancer
Having more than one cancerous area in the same breast
Patient has a connective tissue disease
Pregnant
http://imaginis.com/breasthealth/dcis.asp#lump
?The other main option is lumpectomy (also known as breast-conserving
surgery) followed by radiation treatment. Lumpectomy followed by
radiotherapy is now the generally recommended treatment for early
invasive breast cancer, and is also used for DCIS.? After a
lumpectomy, most patients require six to seven weeks of radiation
therapy to destroy any remaining cancer cells.
http://collection.nlc-bnc.ca/100/201/300/cdn_medical_association/cmaj/vol-158/issue-3/breastqa/guide5.htm
Dana Farber Cancer Institute
http://www.dfci.harvard.edu/res/research/dcis_QandA.asp
According to Dr. Melvin Silverstein, a surgical oncologist, ??found
that radiation therapy does not appear to benefit patients when the
margin width ? the distance between the boundary of the lesion and the
edge of the excised specimen ? is 10 millimeters or more.? Radiation
therapy is expensive, and has its share of side effects, one of which
is a change in the texture of the breast, making mammograms more
difficult, after surgery.
http://ccnt.hsc.usc.edu/services/breast_cancer/carcinoma.htm
About Dr. Silversein:
http://ccnt.hsc.usc.edu/services/breast_cancer/bios.htm#silverstein
Women with ductal carcinoma in situ (DCIS) who are treated with
breast-conserving therapy (lumpectomy) are at a slightly higher risk
of experiencing a recurrence than those women who are treated with
mastectomy (removal of the affected breast).
However, several studies have shown that women treated with breast
conserving therapy who have local recurrence of DCIS are not at any
significantly greater risk of dying from the disease than women
treated with mastectomy. DCIS is a common type of cancer that is
confined to the milk ducts of the breast.
http://imaginis.com/breasthealth/lumpectomy.asp
Tamoxifen (Nolvadex)
Tamoxifen has been used for 20 years as a breast cancer treatment
option, and is currently being used as a five year regimen following a
lumpectomy. Some side effects of Tamoxifen are hot flashes and weight
gain and, rarely, the development of blood clots or endometrial
cancer.
?To grow and reproduce, breast cancer cells require the female hormone
estrogen. Tamoxifen is an "anti-estrogen" and works by competing with
estrogen to bind to estrogen receptors in breast cancer cells.
Tamoxifen is formally known as a selective estrogen receptor modulator
(SERM). By blocking estrogen in the breast, tamoxifen helps slow the
growth and reproduction of breast cancer cells?
http://imaginis.com/breasthealth/dcis.asp#lump
Radiation Therapy After Surgery
From Imaginis : Lumpectomy usually requires six to seven weeks of
radiation therapy immediately following surgery. Radiation sessions
last approximately fifteen to thirty minutes. Side effects of
radiation therapy may include:
· swelling of the infected area
· a feeling of heaviness in the breast
· a sunburn-type appearance of skin in the affected area
· fatigue
· loss of appetite
http://imaginis.com/breasthealth/dcis.asp#lump
Mastectomy
Today, many surgeons perform simple mastectomy or recommend lumpectomy
to treat DCIS.
A simple mastectomy removes the breast tissue only. However, if during
surgery or biopsy, the lymph nodes are found to contain cancer cells,
the lymph nodes will be removed also.
?Most of the time, the nipple is not removed during simple mastectomy,
although milk ducts leading to the nipple are cut. The underlying
tissue is gently cut free, removed, and often a drainage tube is
inserted in the affected area. The skin is carefully closed with
stitches or clips, which are usually removed within a week?
Possible effects of mastectomy include:
· wound infection
· hematoma (blood trapped in the wound)
· seroma (clear fluid trapped in the wound)
· temporary to permanent limitations of arm/shoulder movement
(lymphedema) if lymph nodes are removed during the operation
· numbness in the upper-arm skin
Today, many women and their physicians are choosing lumpectomy over
mastectomy to treat DCIS. Though both procedures have equal survival
rates, mastectomy does carry the psychological burden of waking up
without a breast (if breast reconstruction is not immediate).
http://imaginis.com/breasthealth/news/news1.13.00.asp
http://imaginis.com/breasthealth/dcis.asp#lump
?In the past, a diagnosis of DCIS always meant mastectomy (removal of
the whole breast), and this may still be the best option for some
women?
http://collection.nlc-bnc.ca/100/201/300/cdn_medical_association/cmaj/vol-158/issue-3/breastqa/guide5.htm
Deciding on a treatment:
The best treatment for any one individual depends on the cancer
staging and how much of the breast is involved.(DCIS is Stage 0)
Simple Mastectomy is the treatment of choice if the cancer is
affecting more than one area of the breast. Most of the research I
found supported a mastectomy as being the treatment of choice.
?Women with ductal carcinoma in situ (DCIS) who are treated with
breast-conserving therapy (lumpectomy) are at a slightly higher risk
of experiencing a recurrence than those women who are treated with
mastectomy (removal of the affected breast). ?
http://imaginis.com/breasthealth/lumpectomy.asp
?A simple mastectomy involves removing the affected breast and
sometimes a small part of the underarm lymph nodes. Whenever possible,
surgeons attempt to leave the overlying skin intact; or alternatively,
they leave a large amount of surrounding tissue to ensure breast
reconstruction.? If there is any sign that the cancer has spread to
your lymph nodes, the surgeon will remove them as well, during a
mastectomy.
CancerBackUp
http://www.cancerbacup.org.uk/Cancertype/Breast/DCISLCIS/DCIS
Breast Cancer Action web site
http://www.bcaction.org/Pages/SearchablePages/2000Newsletters/Newsletter059I.html
Further Information:
=====================================================
Some guidelines for treatment:
From Breast Cancer.org, this article on making treatment decisions:
http://www.breastcancer.org/tre_surg_answer.html
and Lumpectomy vs. mastectomy:
http://www.breastcancer.org/tre_surg_masvslump.html
"I have some people who say, ?With a 12% chance that the cancer is
going to come back, I'd rather just get my breast removed.' I have
other people who say, 'Hey, I've got an 88% chance the cancer is never
going to come back! Why would I have my breast removed now? If it
comes back, we'll remove it then. The survival is the same. Let's go
with the breast-conserving surgery.? It's all a matter of what you're
comfortable with." ?Thomas G. Frazier, M.D
http://www.breastcancer.org/tre_surg_masvslump.html
National Guideline Clearinghouse
http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=3701
About radiation therapy:
http://imaginis.com/breasthealth/radio_bctreatment.asp
DCIS is a Stage 0 cancer. Staging is described on this OncoLink site.
(Scroll down to just below the middle of the page):
http://www.oncolink.com/types/article.cfm?c=3&s=5&ss=33&id=8320
Types of Ductal Carcinoma in Situ
From Imaginis:
· The term, ductal carcinoma in situ (DCIS), refers to a family of
cancers that occur in the breast ducts. There are two categories of
DCIS: non-comedo and comedo. The term, comedo, describes the
appearance of the cancer. When comedo type breast tumors are cut, the
dead cells inside of them (necrosis) can be expressed out just like a
comedo or blackhead on the skin.The most common non-comedo types of
DCIS are: Solid DCIS: cancer cells completely fill the affected breast
ducts.
· Cribiform DCIS: cancer cells do not completely fill the affected
breast ducts; there are gaps between the cells.
· Papillary and micropapillary DCIS: the cancer cells arrange
themselves in a fern-like pattern within the affected breast ducts;
micropapillary DCIS cells are smaller than papillary DCIS cells.
Comedo type DCIS (also referred to as Comedocarcinoma) tends to be
more aggressive than the non-comedo types of DCIS. When necrosis is
associated with cancer, it often means that the cancer is able to grow
quickly. Necrosis is often seen with microcalcifications (tiny
calcium deposits that can indicate cancer).
http://imaginis.com/breasthealth/dcis.asp
There is a well done illustration on this Cancer BackUp site, showing
the milk ducts and fatty breast tissue:
http://www.cancerbacup.org.uk/Cancertype/Breast/DCISLCIS/DCIS
?In situ? refers to the fact that the cancer is contained in one
place, and described by the HyperDictionary as ?Early cancer that has
not spread to neighboring tissue?
http://www.hyperdictionary.com/dictionary/In+Situ+Cancer
You may find this Breast Cancer Care forum of interest:
http://www.breastcancercare.org.uk/Chat/Forums/DuctalcarcinomainsituDCIS/877594
A study of a new DCIS drug, Arimidex
http://www.nsabp.pitt.edu/B35_National_Press_Release.pdf
A 1997 case study of a woman with DCIS
http://www.bci.org.au/cases/97-01/97-01p1.htm
All about Breast Cancer, from one of my favorite websites, eMedicine.com
http://www.emedicinehealth.com/articles/13615-1.asp
Survival rates, by stages, from Imaginis. Scroll down to just below
the middle of the page.
http://imaginis.com/breasthealth/staging.asp#survival
To sum it up, it appears that lumpectomy with radiation therapy,
followed by a five year regimen of Tamoxifen is the course of action
yielding the highest survival rate. Canadian doctors prefer the option
of lumpectomy with radiation, and weren?t sure the side effects of
Tamoxifen warranted its use, according to this study, from The
American Cancer Society
http://www.cancer.org/docroot/NWS/content/NWS_3_1x_Canadian_Guidelines_on_Treating_Ductal_Breast_Cancer_IIn_SituI_Updated.asp
I hope this has assisted you in making an informed decision, spook2,
and I hope you are not spooked by DCIS.(I read once, a while back,
that 15% of all women who died of natural or non-cancer causes were
found to have DCIS, unbeknownst to them. Remember, the survival rate
for DCIS is the highest of all the breast cancers! Read all you can,
and discuss the treatment options thoroughly with your doctor. Don?t
forget to schedule a mammogram, 6 months after a lumpectomy (or
biopsy).
If any part of my answer is unclear, or if I have duplicated
information you already have, please request an Answer Clarification,
before rating. This will allow me to assist you further, is possible.
Best of luck,
crabcakes-ga
Search Terms
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