Illustrated by Mary Galloway.Earlier this week, Janice Dickinson told the Daily Mail that she's been diagnosed with early-stage breast cancer: ductal carcinoma in situ (DCIS). The good news is this is the earliest stage of breast cancer, meaning it's treatable. But in recent years, there has been a debate among experts about what treatment for DCIS should be.
"To some extent, the name is a misnomer," explains Alastair Thompson, MD, a professor of breast surgical oncology at The University of Texas MD Anderson Cancer Center. "People emphasize the 'carcinoma' and equate that to cancer. But the most important words are 'in situ,' meaning 'inside the duct.' What makes it differ hugely from what we conventionally think of as cancer is that it's confined within the ducts...rather than being something that spreads and puts tentacles into surrounding tissues."
Here's what you need to know about the (sometimes confusing) condition:
How exactly is DCIS different from other breast cancers?
"DCIS is a spectrum of changes going on within the tubes of the breast," explains Dr. Thompson. "The cells that line these ducts become a little larger." If left alone for many years, these cells can develop into a more invasive form, spreading in the body. But most of the time, the cells do not leave these ducts, unlike other, more invasive forms of breast cancer. What this means is that your chances of dying from DCIS itself are very low, but sometimes DCIS turns into a more aggressive cancer. Research suggests that having DCIS does slightly raise your risk for dying of a different breast cancer later on.
How common is it?
Until relatively recently, DCIS was a pretty rare thing. But now that screenings and imaging techniques have become both more frequent and more accurate, DCIS diagnoses have become much more common. "It’s really become a feature of the modern world," says Dr. Thompson. And now about 60,000 women per year in the U.S. are diagnosed with DCIS.
Not all of these instances will become more serious cancers, and increasingly, doctors are learning that not all of those diagnoses require the same aggressive treatment.
What are the first signs you have DCIS?
"Usually with DCIS there’s nothing to feel, nothing to see on the outside," says Dr. Thompson. On the other hand, unusually, you may find an odd lump or discharge or blood coming from your nipple.
What makes it differ hugely from what we conventionally think of as cancer is that it's confined within the ducts.
What do you do once you're diagnosed?
The first thing will be to make sure that your imaging is accurate. That may include getting a magnified version of your mammogram or extra tests, such as an ultrasound, X-ray, or MRI. From there, your doctors will want a sample of whatever it is they've identified in your mammogram. "That is best done by freezing [the area] with local anesthetic and putting a needle through the skin into the area designated by the imaging," Dr. Thompson explains. "The key thing is to take sufficient samples to make sure there isn’t anything invasive going on."
Once your doctor has a better idea of what's going on, you may need surgery. That could be a lumpectomy or a more major mastectomy. Dr. Thompson says there's a growing movement among doctors to make sure only those who really need surgery are going through it. Some women may be able to leave their DCIS alone, but should still go in for regular surveillance check-ups.
Then, if you decide to do surgery, you may also have radiation therapy. And finally, to prevent the cancer from recurring or another cancer from developing, Dr. Thompson says you may be prescribed drugs that block estrogen.
How do you decide what to do?
"We used to think of DCIS as a single condition, but it’s a spectrum," says Dr. Thompson. "There are some that can sit in the breast for decades and not do anything, but others can progress into an invading breast cancer."
At this point we're still learning how, exactly, to decipher which is which. But Dr. Thompson says there are trials happening in Europe that will shed some light. For now, ultimately, the decision to move forward with surgery should be up to you and your doctor, and it will depend on your unique situation.
What are the risk factors for DCIS?
Risk factors, aside from simply being a woman, are pretty limited. But we do know that drinking alcohol, not exercising, and eating a poor diet put you at a higher risk for breast cancer in general. Also, as we age and our breast tissue changes, DCIS becomes more common, Dr. Thompson explains. He also says there are some inherited genetic traits that might make it more likely for us to develop DCIS. But, overall, no one's really sure why some get it and some don't.
The bottom line is: You're unlikely to detect breast cancer on your own. So make sure you're getting the regular screening that's right for your age and your personal set of breast cancer risk factors (e.g. family history). And, of course, if you're concerned about any breast changes, check with your doctor ASAP.
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