Ductal Carcinoma in Situ (DCIS) Program

What is Ductal Carcinoma in Situ (DCIS)?

Ductal carcinoma in situ (DCIS) is the earliest form of breast cancer where the abnormal cells are confined within the milk duct of the breast. DCIS is sometimes referred to as stage 0 cancer, non-invasive breast cancer, or pre-cancer; these terms all mean the same thing. DCIS is not life-threatening and prognosis is excellent, but having DCIS can increase the risk of developing an invasive breast cancer in the future.

Our Unique Approach to Treating DCIS

The Ductal Carcinoma in Situ (DCIS) Program at Dana-Farber Brigham Cancer Center is the only program in the Northeast dedicated to DCIS. Our program combines clinical care with in-depth research and educational resources to provide individualized care for each patient's unique situation. Our specialized team includes distinguished breast cancer surgeons, medical oncologists, and radiation oncologists with specific expertise in DCIS, as well as dedicated physician assistants and nurse practitioners.

Educational Resources

There are many treatment options for patients with DCIS, and all options have excellent long-term outcomes. With so many options, deciding what is right for you can be overwhelming. Our team of experts is focused on taking the time to make sure that you have all the information you need to make an informed decision about your care, while supporting you every step of the way.

Supportive Resources

To address all your physical and emotional needs, we provide a comprehensive range of support services, including a variety of integrative therapies through the Leonard P. Zakim Center for Integrative Therapies and Healthy Living. Among our many services, we offer individual and family counseling, genetic counseling, physical therapy, social work, nutrition services, acupuncture, and massage.

Diagnosis and Treatment for DCIS

What are the signs and symptoms of DCIS?

Most people with DCIS experience no outward symptoms. A small number of people may have a lump in the breast or discharge (fluid) coming out of the nipple.

How Is DCIS found?

About 80% of DCIS cases are found by screening mammography.

Is all DCIS the same?

Not all DCIS is the same. DCIS is a spectrum of disease, and the biopsy report that your doctor receives will describe features that help determine whether you have low-risk DCIS or high-risk DCIS. This will influence the treatment options available to you.

Does DCIS need to be treated immediately?

DCIS does not need to be treated immediately, since the abnormal cells are contained within the duct. However, in some cases, if left untreated long enough, the DCIS cells can break through the wall of the milk duct and become invasive breast cancer.

Most DCIS likely takes a long time — possibly years — to develop into invasive cancer, and some DCIS will never develop into invasive cancer. Understanding which patients with DCIS are at low risk for developing invasive breast cancer and which patients are at high risk is an important goal of the DCIS program. It is generally safe for patients to take the time they need to evaluate all of their options and decide if and when surgery or other treatment is right for them.

What are the treatment options for DCIS?

There are several treatment options to consider. You and your physician can discuss what's appropriate for you based on your specific biopsy results and disease characteristics. We encourage everyone diagnosed with DCIS to get a second opinion with us to help understand your options for treatment. All of the treatment options for DCIS are associated with excellent survival rates, including:

• Lumpectomy: A lumpectomy, also known as breast-conserving surgery, removes only the area of the breast tissue with DCIS and a small amount of healthy tissue around the DCIS to ensure complete removal (this is referred to as achieving a negative margin).
• Lumpectomy with radiation: After lumpectomy, radiation therapy to the remaining breast tissue may be recommended to reduce the risk of local recurrence (the chance that cancer will develop again in the same breast).
• Mastectomy: A mastectomy is the removal of all breast tissue. A mastectomy may be recommended if there is more than one area of DCIS in the breast, or if your surgeon is concerned about your cosmetic outcome with a lumpectomy. Radiation therapy is generally not recommended after a mastectomy for DCIS. If you undergo mastectomy, your surgeon will also talk with you about your options for breast reconstruction.
• Endocrine (hormonal) therapy: Some DCIS cells are sensitive to estrogen, meaning they use estrogen to grow. This is called estrogen receptor (ER)-positive DCIS. If you have ER-positive DCIS, medication (in pill form) to block estrogen may be recommended to reduce the risk of recurrence in that breast after surgery and to decrease the risk of developing a breast cancer in the other breast. Endocrine therapy is typically taken for five years and may be recommended with or without radiation.

Learn more about our approach to caring for patients with breast cancer.