Have you ever heard of something like this in your breasts? (Ductal Carcinoma in Situ - DCIS) Let's talk about this!

Have you ever heard of the name `DCIS`? Perhaps a doctor mentioned it during your breast exam `(Mammogram).` This is actually a cancer condition that occurs inside the milk ducts of the breast, and can be detected at a very early stage. Don't worry, knowing this will give you a lot of relief.

What is DCIS (Ductal Carcinoma in Situ)?

Simply put, DCIS is cancer that develops in the milk ducts in your breasts. These ducts are the ones that carry milk from your breasts to your nipples when you breastfeed. The word "in situ" means "in place." This means that the cancer cells have grown out of the ducts and have not yet spread to other parts of the breast.

Doctors sometimes call this noninvasive or pre-invasive breast cancer. This means that the cancer cells have not grown beyond the walls of the milk ducts. DCIS does not usually spread (metastasize) to other parts of the body, like more aggressive, invasive cancers.

However, even though DCIS does not spread outside the breast, in some cases it can develop into invasive ductal carcinoma . That is, it can spread outside the breast. That is why it is so important to talk to a doctor about this. Then you can talk about treatment options that can reduce this risk.

How common is DCIS?

DCIS is actually the most common type of breast cancer in women. It accounts for 20% to 25% of newly diagnosed breast cancers. Men can also develop DCIS, but it is very rare (less than 0.1% of cancer diagnoses).

Currently, the number of reported cases of DCIS has increased slightly. But experts say that this is not because the number of cases of DCIS has increased, but because more people are being diagnosed and treated . That is, tests like mammograms have made it possible to detect the condition earlier.

What are the symptoms of DCIS?

Most of the time, DCIS doesn't show any specific symptoms . You might not even notice anything. However, a very small number of people may notice things like this:

• Feeling like a lump in the breast.
• Itching on the breast skin.
• A discharge (e.g., blood) coming from the nipple.

If you see something like this, you should see a doctor without delay, right?

What causes DCIS?

DCIS occurs when healthy cells in your milk ducts mutate , meaning they change their nature and start to grow rapidly and uncontrollably. It's like a small plant growing out of control, like a weed. But experts aren't sure why these cells change so suddenly, or why some people's DCIS turns into aggressive cancer while others don't.

What are the risk factors for developing DCIS?

There are some factors that can increase your risk, or likelihood, of developing DCIS. Let's take a look at what they are:

• If your blood relatives (mother, sister, daughter) have had breast cancer.
• If you have previously had breast cancer , or if you have a condition in which cells in the breast grow abnormally, such as atypical hyperplasia .
• You are a woman (this is most common among women).
• Being over 30 years of age . This risk increases slightly with age.
• If you started menstruating before the age of 12 .
• If you had your first baby after the age of 30 .
• If your breast tissue is too dense, you may have ``dense breast tissue'' . This can only be detected by a mammogram.
• If you have certain gene mutations (e.g., BRCA1 and BRCA2 genes) that increase your risk of cancer.
• If you have previously received radiation therapy to the breast or chest (for another condition).
• If you have never been pregnant or breastfed a baby.
• If menopause has begun after the age of 55 .

However, having one or more of these risk factors does not mean you will develop DCIS, right? For example, having a family history of breast cancer is a risk factor for DCIS, but most people with DCIS have no family history of breast cancer. Risk factors only increase the chance of developing a condition. So it's important to be aware of them.

What are the possible complications of DCIS?

The important thing is that if you don't treat DCIS, it can turn into invasive ductal carcinoma . This means that the cancer can grow out of the milk ducts and spread to other tissues in the breast. So, if you're diagnosed with DCIS, it's very important to get treatment as soon as possible.

Additionally, after you've been treated for DCIS, you're at risk of developing other health conditions as you age. For example:

• Osteoporosis (thinning of the bones)
• High blood pressure
• Heart disease

To reduce the risk of these complications, it is wise to ask your doctor how often you should go for screenings and follow-ups.

How is DCIS diagnosed?

Doctors detect more than 90% of DCIS cases through mammograms . That is, an X-ray of your breasts. If your mammogram results show anything suspicious, such as small calcium deposits (microcalcifications), they will do a biopsy to confirm.

• Mammogram: In addition to a regular breast exam (screening mammogram), your doctor may order a special mammogram (diagnostic mammogram). This can take more detailed pictures of your breast tissue from different angles. This takes a little longer than a regular mammogram.
• Breast Biopsy: Doctors do this test to make sure there are no cancer cells in your breast. In this test, a small piece of tissue is taken and examined under a microscope.

Are there grades of DCIS?

Yes, doctors classify DCIS into three grades. These grades are determined by how abnormal the cancer cells look under a microscope and how fast they are likely to grow.

• Low grade (slow-growing): The cancer cells look very much like healthy breast cells. They grow slowly.
• Intermediate grade (fast-growing): The abnormal cells look somewhat like healthy breast cells, but are slightly different than low grade.
• High grade (growing rapidly and uncontrollably): The cancer cells look completely different from healthy breast cells. These are the fastest growing and most likely to become an aggressive cancer.

What are the stages of DCIS?

DCIS is a stage 0 breast cancer. It is largely treatable and curable. Doctors classify cancers from stage 0 to IV (4). Stage 0 means the cancer is in the same place where it started and has not spread. Although DCIS is always stage 0, the tumor can be any size and can involve multiple milk ducts within the breast.

What are the treatments for DCIS?

Although DCIS is not a serious cancer, it is important to get treatment . Or have your condition monitored regularly by a doctor. This is because some types of DCIS, especially high-grade ones, can become invasive if left untreated. This means that the cancer can spread beyond your milk ducts and into surrounding breast tissue.

The most commonly used treatments for DCIS are:

• Breast-Conserving Surgery (BCS) or Lumpectomy: This involves removing only the area of ​​cancer cells, along with a small amount of healthy breast tissue around the cancer. This removes a small amount of healthy tissue (margin) to make sure that no abnormal cells are left. Your doctor will leave most of your breast intact.
• Radiation therapy: This treatment is usually given after BCS surgery. It is used to kill any remaining cancer cells and reduce the risk of the cancer coming back. Some people need this treatment for a few days, others for a few weeks. Your doctor will talk to you about your individual treatment plan.
• Mastectomy: This involves removing the entire affected breast, or sometimes both breasts (double mastectomy). If you are not eligible for BCS (for example, if DCIS has spread to the entire breast, the tumor is very large, or you do not want radiation therapy), you may need to have a mastectomy.

If you have had a mastectomy, you may want to consider breast reconstruction . This is surgery to reshape your breasts. This can be done at the same time as or after your mastectomy. If you have a BCS, breast reconstruction is often not necessary. Talk to your doctor about how you want your breasts to look after treatment.

What happens after DCIS surgery?

After surgery, your doctor may prescribe medication to prevent DCIS from recurring, especially if your DCIS is hormone-sensitive (ER-positive). The most common medications are:

• Tamoxifen (Tamoxifen - Nolvadex®)
• Aromatase inhibitors ( e.g. anastrozole, letrozole)

This treatment is called hormone therapy . These medications work by stopping the hormone estrogen from helping cancer cells grow. The total treatment period usually takes about five years.

Can DCIS be prevented?

Many risk factors for DCIS (e.g., family history, genetics) are not really something we can control or prevent. However, if detected early , DCIS is much more likely to be curable. That's why mammograms are so important.

• Most women should start getting mammograms every year (or every two years, depending on their doctor's advice) after they turn 40 .
• If you are at higher risk for breast cancer (for example, if someone in your family has it), your doctor may recommend that you start screening even earlier.

It's best to talk to your doctor about how often you should have a mammogram based on your risk factors.

What is the life expectancy with DCIS?

This is the best news! The survival rates for people with DCIS are very high . According to the American Cancer Society, almost everyone with DCIS (and who gets treatment) can be cured . That means the 10-year survival rate is around 98-99%.

The results after treatment are usually very good. DCIS rarely recurs. Even if it does (in the same breast or the other breast, perhaps as an aggressive cancer), it can often be treated and cured. Therefore, DCIS is not life-threatening, if treated properly.

How should I take care of myself?

With DCIS, you will need to continue to be under the supervision of a doctor after treatment.

• You will usually need to see a doctor for a physical examination every 6 to 12 months , for at least five years, and then once a year.
• Also, you will likely need to have a mammogram every year.
• If you are taking hormone therapy, you should take it exactly as your doctor tells you.

However, everyone's situation is different. Work with your doctor to determine your post-treatment care plan. It's important to follow your doctor's instructions carefully.

When should I see a doctor?

Don't miss your check-ups and mammograms as prescribed by your doctor. In the meantime, take care of your breasts.

• If you notice a new lump in your breast.
• If you notice changes in the skin of your breasts (redness, dimpling, wrinkling, or an orange peel appearance).
• If you notice a change in your nipple (indentation, redness, skin flaking, discharge).
• If you have persistent pain in your breast or armpit.

If you notice any changes that could be signs of breast cancer , don't panic or delay, but see a doctor immediately.

What questions should you ask your doctor?

When you find out you have DCIS, it's normal to have a lot of questions. Ask your doctor about all of them. Here are some examples:

• What grade of DCIS do I have?
• What kind of treatment do I need? Surgery? Radiation therapy? Hormone therapy?
• What are the side effects of these treatments?
• How long does treatment take?
• Will I be able to work while receiving treatment?
• What is the chance that DCIS will recur?
• How often will I have to come for follow-ups?
• How often will I need to have a mammogram?
• Is my family at risk? What should they do?

Finding out you have cancer is a life-changing event. It's natural to feel scared and anxious because you don't know what to expect. Your doctor is here to help you. DCIS is a type of cancer that has a very high chance of being cured . Your doctor can create a personalized treatment plan that's right for you.

The most important thing for you to remember (Take-Home Message)

Okay, so here are some things you need to remember about the `DCIS` (Ductal Carcinoma in Situ) we talked about:

• DCIS is a very early stage (Stage 0) cancer that is confined to the milk ducts of the breast. This means that it has not yet spread outside the breast.
• Most of the time, it doesn't show any specific symptoms . It's most often discovered through a mammogram .
• Because DCIS has the potential to become an invasive cancer, it is important to detect and treat it early .
• Treatment is usually surgery (lumpectomy or mastectomy) . Radiation therapy and hormone therapy may also be given.
• DCIS is a highly curable condition. So don't be afraid and face the treatment with courage.
• Be sure to have check-ups and mammograms at the scheduled times as advised by your doctor .

The most important thing is that you are not alone. Your doctor, family, and friends are all with you. Talk to your doctor about any questions or concerns you may have about this. Taking care of your health is the biggest help you can do.

` DCIS, Ductal Carcinoma in Situ, Breast Cancer, Milk Ductal Cancer, Mammogram, Biopsy, Lumpectomy, Mastectomy, Breast Health