Ductal Carcinoma In Situ

• When the cells lining the ducts have features of carcinoma, but haven’t crossed the basement membrane of the duct and is confined to the duct, it is called as ductal carcinoma in situ.

• There are many stages in which the ductal carcinoma in situ develops. They are
• Ductal Hyperplasia - There is overgrowth in the number of cells lining the ducts
• Atypical Ductal Hyperplasia - In addition to an increased number of cells lining the ducts, the cells get converted to an abnormal appearance
• Ductal Carcinoma in situ - Here the cells lining the ducts show features of carcinoma, but they are confined to the ducts.
• Invasive Ductal Carcinoma - Cancer arising from the ducts have breached the basement membrane and spread to the other areas of the breast and beyond.

• Most of the ductal carcinoma in situ present asymptomatically and are detected while screening with mammograms. A small percentage of patients may present with a small palpable mass or bloody nipple discharge.

• Ductal Carcinoma accounts for about 17 to 34 % of mammographically detected tumours.

• Ductal Carcinoma in situ are precursors for breast cancers. They are not life-threatening. But they need to be treated so that they don’t get converted to invasive breast cancers.

• DCIS is diagnosed with mammogram where they present as microcalcifications that are arranged in clusters and are of different shapes and sizes. With ultrasound guidance biopsy is usually done by a core needle biopsy. If the biopsy is inconclusive, excision biopsy where in the tissue removed in toto is removed.

• If lumpectomy had been done, there is a 30% chance of recurrence. With radiotherapy, the chance of recurrence reduces by 15%. Most of the recurrences are within the first five years. A patient who had a DCIS before has a higher chance of getting breast cancer back compared to the normal population in the same side breast if lumpectomy had been performed and also in the opposite breast. Hence patients need to be followed up regularly by
• Monthly self-examination of the breast
• Examination by the doctor every six months
• Mammography screening once every year