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CURE COMMUNITY
Ductal carcinoma in situ: Is it cancer?
BY KATHY LATOUR | SEPTEMBER 29, 2009
Ductal carcinoma in situ: Is it cancer?
The argument rages on about whether ductal carcinoma in situ (referred to here as "breast cancer light") should be treated as breast cancer when, some researchers argue, no one agrees on whether it will become bad breast cancer if left alone. First, a visual to help you see what we are talking about.
If you imagine the inside of the breasts to be like broccoli, the flowering part would be the lobules that hold milk to feed a baby, while the stalks are the ducts that carry the milk to the lobules. Cancer cells can be found in the ducts and in the lobules, but the most common location is the ducts. When the cancer is contained inside the ducts, it is called ductal carcinoma in situ (DCIS). When it has broken through the walls of the ducts into the surrounding tissue and blood supply, it is called invasive ductal carcinoma.
The invasive kind is what can kill us as it moves from the breast through the lymph system to vital organs, such as the lungs, bones, or brain, where it can set up shop and eventually takes over the organ. In situ breast cancer, if detected by one of a number of methods, is not deadly until it becomes invasive, which is the rub here because some folks say that it may never become invasive.
Before I state my case in this argument and because I believe in full disclosure, I have to say that I am definitely not your casual bystander in this discussion, having had both the big C and the little c in my cancer journey. My first diagnosis of breast cancer in 1986 at age 37 was clearly invasive, and surgery revealed I had one malignant lymph node under my arm, meaning the cancer had already left the breast and was romping elsewhere in my bloodstream. What followed was four months of chemotherapy followed by years of terror that it would come back.
Then in 2007, my annual mammogram on my remaining breast showed some calcifications, a fancy name for spots of dead cells, that in some instances indicated cancer. That biopsy came back DCIS in more than one spot in my breast.
Some friends found it strange that I was hoping for a clearly malignant pathology report, because I had already decided that if the report was benign I was going to fight to have the breast removed. There was one spot they couldn't biopsy and, well, I don't mess around with the word carcinoma in my life.
Which brings us to the latest comment from a panel of researchers about DCIS. The panel was convened to discuss DCIS and their recommendation was for better ways to determine if and when in situ will become invasive.
Of course, as they often do, the writer didn't lead with this information, but instead began with the group recommending removing the word carcinoma since, technically speaking, DCIS is precancerous. And, said the researchers, the word is too SCARY.
I guess my 23-year history with breast cancer has skewed my perspective a little but I thought our goal with breast cancer was to keep women acutely aware that cancer can kill you. Perhaps it's all those funerals I have attended that have brought me to the conclusion that we need to err on the side of caution when it comes to anything remotely connected to breast cancer.
But, as often happens, the detail that says it all was in the last line of this news piece.
"More than 400,000 women in the world die from breast cancer each year."
Maybe they should start each piece about breast cancer with that statistic, unless they think it's too scary.
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Surviving breast cancer now and for the rest of my life, I don't see how a "panel" has the right to decide if any cancer can be a carcinoma. All cancers can turn deadly and all cancers are scary. The is the message we need to get out there.
- Posted by Karla Brown 10/15/09 11:03 AM
My doctor shared with me several abstracts that showed how DCIS is much more dangerous than previously thought. I was diagnosed almost 3 years ago and am glad I had a mastectomy when I did.
- Posted by Carol 10/15/09 11:21 AM
Please don't suggest that all diagnoses of DCIS are equivalent. My tumor was ER-, PR- and HER2 highly positive, with a nuclear grade of 3 (undifferentiated). The margin at the chest wall was 1 mm. Due to a prior MI in my 50s I am not a candidate for treament with Herceptin. My oncologist recommended a bilateral mastectomy.
- Posted by Jean M 10/15/09 11:48 AM
I was diagnosed with DCIS almost three years ago: calcifications in two distinct locations in one breast. My surgeon did call it cancer, and recommended an aggressive approach to insure a positive prognosis. My lab results showed the cancer to be ER/PR-, HER2 highly Positive, and grade 3. Sorry, but that says cancer to me. Some 2 years, 11+ months later, following a lumpectomy and radiation, I sit at my computer, and can happily announce that there is currently no evidence of the cancer...right now. I realize that someday the news might not be so good, but in the meantime, I am grateful every day for a cancer care team that treated my diagnosis with the respect it deserved!
- Posted by Colleen 10/15/09 12:29 PM
At age 47,seven years ago, through a series of errors, I was diagnosed with 2 areas of DCIS in my right breast. A MRI followed on the left breast and 2 suspicious areas were discovered. I elected to have a bilateral mastectomy with a TRAM reconsruction. My maternal grandmother had had breast cancer diagnosed at the age of 90 and 2 years later died of a metastisis to the liver (we believe.) My doctor had always said that, "Old people die of something," and that it was of no concern to me. Two years later my mother was diagnosed with BC of three varieties (DCIS, Invasive Ductal, and Invasive Lobular.) I would be insulted to have someone suggest that my DCIS was not cancer! If 40% of diagnosed DCIS develop into invasive ductal than I have no doubt I would have been in that 40%!! My fear is gone and my trust and gratitude is in the Lord for my early diagnosis.
- Posted by Marilyn 10/15/09 1:09 PM
I was diagnosed with DCIS about 5 years ago. The doctor that did the biopsy strongly recommended that I be agressive in fighting this. I chose to have a mastectomy. The hospital routinely does a sentinel node check before removing a breast because once the breast is gone there is no way to mark the nodes. They were surprised to find one node positive, as it was beleived to be contained in the ducts. When they removed the breast they found an undetected tumor at the back of the breast against the chest wall. I then had chemo and radiation. I often wonder where I would be today if I had opted for anything less than the mastectomy. I am forever grateful to the original doctor who did my biopsy and suggested I be very agressive. In any cancer diagnosis I would agree with being as agressive as you can. It can save your life!
- Posted by Darlene 10/15/09 2:04 PM
You all bring up great points -- DCIS isn't one diagnosis just as breast cancer, we are learning more and more, is not one diagnosis. I hope you all stay involved in the issue to keep women aware and on top of their health care.
- Posted by KathyLaTour 10/15/09 3:00 PM
I was diagnosed @ age 71 with DCIS after calcifications were discovered in my annual mammo. I had a lumpectomy and the sentinal lymph node was positive so I had the full chemo and radiation as well as 52 weeks of Herceptin. I was HER2 positive w/score of 13, the highest my oncologist had ever seen. I was ER,PR-.
- Posted by Joan 10/15/09 3:03 PM
I WAS DIACNOSED WITH BREAST CANCER ON APRIL 28th 2006 AND I WAS TREATED WITH SIX WEEKS OF RADIATION AND I HAVE BEEN OK EVERY SENSE.SO EVERY WOMAN NEEDS TO LISTEN TO THERE ONCOLOGIST. POSTED ON 10/15/2009 AT 6:40 PM
- Posted by judy 10/15/09 4:38 PM
As a seven year survivor of DCIS, or the "garden variety of breast cancer" as one surgeon called it, Cancer is Cancer, big, little. Let's address the elephant in the room and call it what it is. Deal with it, don't hide your head in the sand. My fear is some women may try to "forget" about DCIS if it is not given the C word.
- Posted by Benita (Bonnie) Lynn Ricci 10/15/09 9:05 PM
Like an earlier commentor, I was diagosed with DCIS fully tow years ago. My husband is military and so i was diagnosed and treated at Walter Reed. Their attitude was unequivocal that DCIS IS cancer and must be treated agressively. I had the standard 33 radiation treatments following two lumpetomies and was lucky that the cells were homomone positive so i avoided chemo but am on Tamoxifen for 5 years. I am greateful that no one at WR considers "DCIS cancer or not?" a sensible question. The breast care center there is wonderful and has been supportive in every way - even in helping me make non-cancer related appointments. They also see their job as reducing stress in their patients.
- Posted by Rebecca Myers 10/16/09 9:09 AM
DCIS is very much cancer. Just because it's contained to the ducts and hasn't spread dosen't make it any less cancer. I was diagnosed at age 37 with Her2 and Estrogen + DCIS. I had 2 lumpectomies with bad margins then a bilateral mastectomy. My sister died from invasive carcinoma of the breast and I didn't want to take any chances. I had an early stage aggressive cancer, so I took an aggressive approach to treatment. It has been 3yrs. since my diagnosis, Praise the Lord, he let it be found early.
- Posted by Andrea Demianovich 10/16/09 7:35 PM
I had cancer at 45 in 2005. two spots clearly cancer (Ductal, her2 negative)in left breast
I wanted a double mastectomy (it took two weeks to find the second cancer in the left breast My surgeon agreed.
After the removal of both they found DCIS in the microscopic examination of both breasts after the surgery.
I figure that saved me from going through all the chemo and other treatment twice, and I am glad I did it that way. I have no regrets.
I had implants put in 8 months after.
No problems, I just worry when I go to the surgeon and oncologist, and I take my tamoxifin regularly.
- Posted by Sandra Isenburg 10/18/09 4:38 PM
Last year I was diagnosed with Invasive Ductal Carcinoma. Futher test show mets, tumors on spine, at that time so bad, stage IV radiation to shrink tumors first, pain was so bad, still with me, take meds but never goes away. Now taking treatments, herceptin, Abraxane, Zometa and the drs are amazed at how well the treatment working. Cancer not active and so now doctors want to remove both breast and at first nodes under right arm, but was told at this point that would cause too many problems for mw with the arm, and Lord knows I don't need that. I was told that while cancer under control, remove Breasts so WHEN cancer comes back I would not have as such a hard time and removal would give me better survival rate. The docs have put surgery off twice, stress on me at time dealing with so much pain that the tumors did to my spine and back. I don't know what to do, and would like to talk to someone other than drs, friends and family, someone who is where I am or been there. I want the Breast gone. The right breast looks like a orange peel and the left one swollen and inflammed, but I am affraid of after surgery, infections that would hurry up the inevatable. I know God never promised us tomorrow, but if I could have chance of living 5 more even 10 I would take it, but no assurance there. I know I don't want to leave my 9 year old grandson anytime soon, but this pain is also not a way to live either. Sorry so long, just hope answers will come to me and want u to know that I get comfort and knowledge from u, and Cure Magazine. Thanks Judy
- Posted by Judy 10/22/09 11:41 AM
For all the people that think for one minute that DCIS is not cancer or can not be deadly, well read this!!!
I at the age for 44, found a lump in my right breast went to the doctor had all of the test, test results came back DCIS, so has half of my breast removed (only because doctor did not or would not removed whole breast) so had half of it removed went through 6 weeks of radiation, 1 year to the day i was back in surgery for another lump removal, "A typical" ok so was told it was fine, "nothing to worry about" this past firday 5/14/2010 after having pain in my back and hip now have bone cancer, in my right hip, 4 places in my spine, and my pelvis, so people, my point is here if ANYONE tells you that you have DCIS and they try to tell you its not cancer, That is TOTAL BULL!!! find a doctor that will listen to you, push for those test that a doctor may say "you do not need" it could save your life in the long run, STAND UP FOR YOURSELF, YOU KNOW YOUR BODY BETTER THEN ANY DOCTOR DOES!! HUGS to all of you people that have been through it,
- Posted by Diane 5/16/10 11:10 AM