The DCIS Dilemma: November 18, 2013

Cancer experts are increasingly being forced to draw the line. Distinguishing what is and isn’t cancer. When it comes to breast cancer, more women are getting the diagnosis of DCIS, or non-invasive breast cancer.

“Basically ductal carcinoma in situ means that it’s cancerous cells that are still within the milk ducts. Once they go beyond the milk ducts into surrounding tissue then its called invasive cancer,” says Dr. Gail Santucci, diagnostic radiologist with Lee Memorial Health System.

Many women find it difficult to distinguish between pre-invasive and invasive and often overestimate the implications. In fact it involves a spectrum, ranging from low grade to high grade - each carry a different risk. Currently most experts believe DCIS merits intervention.

“The approach right now is try to do a minimally invasive type treatment of the cancer where you have a lumpectomy which is local excision rather then the whole breast being removed and then radiation therapy to prevent the spread of more cancer into the remaining breast tissue,” says Dr. Santucci.

New research is raising concern about labeling. When women get a DCIS diagnosis they often focus on the term ‘carcinoma’ or only hear ‘cancer’ which affects their views on treatment. Some believe surveillance is a feasible option, as many men do with early stage prostate cancer. The challenge is in making sure people who need treatment get it.

“When you hear in the news occasionally ‘well, breast cancer is over-treated’ a lot of these pre-cancers turn into a problematic cancer that would kill the patient. And it might; you don’t know for sure,” says Dr. Santucci.

More than 50,000 women a year in the U.S. are diagnosed with DCIS. It’s rising rate coinciding with more widespread use of mammography. A difficult dilemma with many unknowns and so much at stake.

“It’s not fully sorted out, yet I think everyone agrees that high grade ductal carcinoma in situ definitely needs to be treated,” says Dr. Santucci.