Treatments and drugs
Treatment of DCIS has a high likelihood of success, in most instances removing the tumor and preventing any recurrence.
In most cases, treatment options for DCIS include:
- Lumpectomy and radiation therapy
- Simple mastectomy
In some cases, treatment options may include:
- Lumpectomy only
- Lumpectomy and the drug tamoxifen
If you're diagnosed with DCIS, one of the first decisions you'll have to make is whether to treat the condition with breast-conserving surgery (lumpectomy) or breast-removing surgery (mastectomy).
Lumpectomy. Lumpectomy is surgery to remove the area of DCIS and a margin of healthy tissue that surrounds it.
The procedure allows you to keep as much of your breast as possible, and depending on the amount of tissue removed, usually eliminates the need for breast reconstruction.
Lumpectomy followed by radiation therapy is the most common treatment for DCIS.
Research suggests that women treated with lumpectomy have a slightly higher risk of recurrence than women who undergo mastectomy; survival rates between the two groups are very similar.
For older women with multiple medical conditions, lumpectomy plus tamoxifen therapy, lumpectomy alone or no treatment may be an option.
Mastectomy. For treating DCIS, a simple mastectomy — removing the breast tissue, skin, areola and nipple, and possibly the underarm lymph nodes (sentinel node biopsy) — is one option.
Breast reconstruction after mastectomy, if desired, can be performed in most cases.
Because lumpectomy combined with radiation is equally effective, simple mastectomy is less common than it once was for treating DCIS.
Most women with DCIS are candidates for lumpectomy. However, mastectomy may be recommended if:
- You have a large area of DCIS. If the area is large compared with the size of your breast, a lumpectomy may not produce acceptable cosmetic results.
- There's more than one area of DCIS (multifocal or multicentric disease). It's difficult to remove multiple areas of DCIS with a lumpectomy. This is especially true if DCIS is found in different sections — or quadrants — of the breast.
Tissue samples taken for biopsy show abnormal cells at or near the edge (margin) of the tissue specimen. There may be more DCIS than originally thought, meaning that a lumpectomy might not be adequate to remove all areas of DCIS. Additional tissue may need to be excised, which could require removing the breast (mastectomy) if the area of DCIS involvement is larger relative to the size of the breast.
If the area of DCIS is large, relative to the size of your breast, lumpectomy also may produce unacceptable cosmetic results.
You're not a candidate for radiation therapy. Radiation is usually given after a lumpectomy.
You may not be a candidate if you're diagnosed in the first trimester of pregnancy, you've received prior radiation to your chest or breast, or you have a condition that makes you more sensitive to the side effects of radiation therapy, such as systemic lupus erythematosus.
- You prefer to have a mastectomy rather than a lumpectomy. For instance, you might not want a lumpectomy if you don't want to have radiation therapy.
Surgery for DCIS typically doesn't involve removal of lymph nodes from under your arm because it's noninvasive. The chance of finding cancer in the lymph nodes is extremely small.
If tissue obtained during surgery leads your doctor to think abnormal cells may have spread outside the breast duct or you are having a mastectomy, then a sentinel node biopsy or removal of some lymph nodes may be done as part of the surgery.
Radiation therapy uses high-energy beams, such as X-rays, to kill abnormal cells. Radiation therapy after lumpectomy reduces the chance that DCIS will come back (recur) or that it will progress to invasive cancer.
A type of radiation therapy called external beam radiation is most commonly used to treat DCIS.
Radiation is typically used after lumpectomy. But for some women, radiation may not be necessary. This might include those with only a small area of DCIS that is considered low grade and was completely removed during surgery.
The drug tamoxifen blocks the action of estrogen — a hormone that fuels some breast cancer cells and promotes tumor growth — to reduce your risk of developing invasive breast cancer.
Tamoxifen is effective only against cancers that grow in response to hormones (hormone receptor positive cancers).
Tamoxifen isn't a treatment for DCIS in and of itself, but it can be considered as additional (adjuvant) therapy after surgery or radiation in an attempt to decrease your chance of developing a recurrence of DCIS or invasive breast cancer in either breast in the future.
If you choose to have a mastectomy, there's less reason to use tamoxifen.
With a mastectomy, the risk of invasive breast cancer or recurrent DCIS in the small amount of remaining breast tissue is very small. Any potential benefit from tamoxifen would apply only to the opposite breast.
Discuss the pros and cons of tamoxifen with your doctor.