DCIS, short for ductal carcinoma in situ, is a non-invasive breast condition where abnormal cells have formed inside a milk duct but have not spread into the surrounding breast tissue. If those four letters have appeared on your biopsy result, the terminology can be difficult to take in. This guide explains what DCIS means, how it is diagnosed, the treatment options that may be discussed and what to expect when seeking care for DCIS on the Gold Coast.
The key point: DCIS is contained within the milk ducts. It is treated because some DCIS can develop into invasive breast cancer, and it is not currently possible to predict with certainty which individual cases would progress if untreated.
What DCIS Means in Plain English
Think of the milk ducts as a network of fine tubes running through the breast towards the nipple. With DCIS, some of the cells lining those ducts have changed and started multiplying abnormally, but they remain contained within the duct.
The name can be broken down into three parts:
- Ductal: the abnormal cells are located in a milk duct.
- Carcinoma: the cells have cancer-like characteristics.
- In situ: means "in place", because the abnormal cells remain within the duct.
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Non-invasive DCIS remains within the milk ducts rather than invading the surrounding breast tissue. |
50-59 Cancer Australia reports that DCIS is most commonly found in women aged 50 to 59. |
Stage 0 Cancer Australia notes that Stage 0 is the stage used to describe DCIS. |
About 4 times Women diagnosed with DCIS have about four times the future risk of invasive breast cancer compared with women of a similar age who have not had DCIS. |
Source: Cancer Australia: Ductal carcinoma in situ and Cancer Australia: Diagnosis of ductal carcinoma in situ.
How DCIS Differs from Invasive Breast Cancer
Every milk duct is surrounded by a boundary. With DCIS, the abnormal cells remain inside that boundary. With invasive breast cancer, cancer cells have moved through it into the surrounding breast tissue.
| Feature | DCIS | Invasive breast cancer |
|---|---|---|
| Where are the abnormal cells? | Contained within the milk ducts | Have entered surrounding breast tissue |
| Can it involve lymph nodes? | Not while it remains DCIS | It can |
| Usually felt as a lump? | Usually not | Sometimes, but not always |
| Chemotherapy? | Not generally used for DCIS | May be recommended depending on the type and stage of the cancer |
| Main treatment focus | Treating the DCIS in the breast and reducing the risk of future invasive disease | Treatment depends on the type, stage and other characteristics of the cancer |
Why DCIS is treated: DCIS itself has not spread outside the milk ducts. Treatment is recommended because some DCIS may develop into invasive breast cancer and it is not currently possible to predict with certainty which individual cases will do so.
How DCIS Is Usually Found
DCIS usually cannot be felt. Cancer Australia reports that it is commonly identified through breast imaging. On a mammogram, it may appear as tiny calcium deposits called microcalcifications.
A diagnosis is made by examining a sample of breast tissue under a microscope.
1. Breast imaging identifies an area that needs further assessment.
This may be a group of calcifications or another change seen on imaging.
2. Further imaging may be performed.
Additional mammogram views, ultrasound or other imaging may be used depending on the finding.
3. A biopsy provides tissue for diagnosis.
A pathologist examines the sample and reports whether DCIS or another breast condition is present.
4. The imaging and pathology are considered together.
The size, location and grade of the DCIS help guide the discussion about treatment.
Breast screening in Queensland: BreastScreen Queensland provides free breast screening for eligible women. Women aged 50 to 74 are encouraged to have a breast screen every two years. Women aged 40 to 49 and women aged 75 and over can also access screening and can discuss the benefits and limitations with their doctor.
If you have a breast symptom: breast screening is intended for people without symptoms. If you notice a new breast lump, nipple discharge, skin or nipple change or another breast change, arrange an assessment with your GP rather than waiting for a routine screening appointment.
Source: BreastScreen Queensland.
Understanding Your DCIS Pathology Report
Your pathology report contains information about the DCIS that helps your treating team plan your care. Some information may be available from the biopsy, while other information becomes available after surgery.
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Grade 1 Low grade The cells tend to grow more slowly. |
Grade 2 Intermediate grade The features sit between low and high grade. |
Grade 3 High grade The cells tend to grow more quickly. |
Size and locationThe report may describe how much of the breast is involved and where the DCIS is located. This information can affect which type of surgery is considered. |
GradeThe grade describes features of the cells under the microscope. DCIS is commonly classified as low, intermediate or high grade. |
Surgical marginsAfter breast-conserving surgery, the pathologist examines the tissue around the DCIS to determine whether DCIS reaches the relevant edge of the specimen. |
Hormone receptorsThe report may state whether the DCIS cells are positive or negative for hormone receptors. This can affect whether hormonal treatment is discussed. |
Useful for your consultation: keeping a copy of your imaging and pathology reports can make it easier to work through the findings with your surgeon and understand which details affect your treatment options.
Is DCIS Cancer?
DCIS may be described as Stage 0, non-invasive breast cancer or a non-invasive breast condition. This terminology can understandably be confusing.
The abnormal cells remain contained inside the milk ducts. They have not invaded the surrounding breast tissue. Cancer Australia explains that DCIS is treated because some cases can develop into invasive breast cancer if they are not treated.
It is not currently possible to determine with certainty which individual cases would progress or how long that progression might take.
Surgical Options for DCIS
Surgery is usually part of treatment for DCIS. The type of surgery considered depends on factors including the size and location of the DCIS, the amount of breast tissue involved, the pathology findings and your individual circumstances.
Breast-conserving surgeryBreast-conserving surgery, also called a wide local excision or lumpectomy, removes the DCIS together with an area of surrounding tissue while retaining the remainder of the breast. Potential benefit: the breast is retained while the area containing DCIS is removed. Risks and limitations: risks can include bleeding, infection, changes in breast shape and the possibility that another operation may be recommended if the margins are not adequate. Results vary from person to person. |
MastectomyMastectomy removes the breast and may be discussed if the DCIS involves a large area, occurs in more than one area, or cannot be adequately removed with breast-conserving surgery. Potential benefit: removing the breast can address extensive DCIS when breast-conserving surgery is not suitable. Risks and limitations: risks can include bleeding, infection, wound-healing problems, altered sensation and changes in body shape. Reconstruction options can be discussed where appropriate. Results vary from person to person. |
Treatment decisions are individual: your surgeon considers the imaging, pathology, breast size, extent of DCIS and your preferences when discussing which operation may be suitable.
Why Clear Margins Matter After DCIS Surgery
After breast-conserving surgery, a pathologist examines the edges of the removed tissue. These edges are called surgical margins.
| Pathology finding | What it means | What may happen next |
|---|---|---|
| Clear margin | DCIS is not identified at the relevant edge of the removed tissue. | Your treating team considers the margin together with the rest of the pathology and planned treatment. |
| Margin not considered clear | DCIS is present at, or sufficiently close to, a relevant edge according to the clinical circumstances. | Further surgery may be recommended to remove additional tissue. |
Further surgery is sometimes required because DCIS can extend along the duct system beyond what can be seen on imaging.
Potential benefit of further surgery: additional tissue can be removed when the original margin is not considered adequate.
Risks: another operation carries surgical risks including bleeding, infection and further change to the shape of the breast. Results vary from person to person.
Radiotherapy After Breast-Conserving Surgery
Radiotherapy is commonly recommended after breast-conserving surgery for DCIS. Its purpose is to reduce the chance of DCIS or invasive breast cancer occurring again in the treated breast.
At least half
Relative reduction in recurrence risk
Breast Cancer Network Australia reports that radiotherapy after lumpectomy reduces the risks of recurrent DCIS and invasive breast cancer by at least half. This is a relative reduction in risk rather than an estimate of any individual person's absolute risk.
Benefit and risks need to be considered together: radiotherapy can reduce the chance of DCIS or invasive breast cancer returning in the treated breast. It can also cause side effects, including skin changes and tiredness during treatment. Your radiation oncologist can explain the expected benefit and possible short-term and longer-term effects in your individual circumstances.
Radiotherapy is not usually recommended after a mastectomy performed for DCIS alone.
Hormone-Blocking Treatment and DCIS
If the DCIS is hormone receptor positive, hormone-blocking medication may be discussed in some circumstances.
Potential benefit: hormonal treatment may reduce the risk of another breast event for some people with hormone receptor positive DCIS.
Risks and limitations: hormonal medicines can cause side effects and are not appropriate for everyone. The likely benefit and possible adverse effects depend on the medicine and your individual circumstances, so these should be discussed with your treating team.
When a Sentinel Lymph Node Biopsy May Be Considered
Because DCIS remains within the milk ducts, most women with DCIS do not need lymph nodes removed from the armpit.
Cancer Australia notes that lymph node surgery may sometimes be considered when DCIS covers a large area or is high grade. Sentinel lymph node biopsy may also be discussed when mastectomy is planned and there is concern that invasive cancer could be identified in the final pathology.
Potential benefit: when clinically indicated, sentinel lymph node biopsy can provide information about the lymph nodes if invasive cancer is identified.
Risks: possible complications include pain, numbness, restricted shoulder movement, infection and lymphoedema. Your surgeon can explain why lymph node surgery is or is not being recommended for you.
Questions to Ask About Your DCIS Diagnosis
Writing questions down before your appointment can make it easier to work through the information with your treating team.
- What grade is my DCIS?
- How large is the area?
- Where in the breast is it located?
- Is it confined to one area?
- Is breast-conserving surgery an option for me?
- In what circumstances would a mastectomy be discussed?
- What does my pathology report say about the margins?
- Could I need further surgery after the first operation?
- Will I need a sentinel lymph node biopsy?
- Has the DCIS been tested for hormone receptors?
- Is radiotherapy likely to be recommended?
- What are the expected benefits and risks of each treatment option in my case?
- What should I expect during recovery?
Managing the Worry That Can Come with a DCIS Diagnosis
A new diagnosis can involve a large amount of unfamiliar information. It can help to write questions down and bring a family member, partner or friend to appointments so there is another person listening to the discussion.
Breast Cancer Network Australia provides information and support resources for people affected by DCIS and breast cancer.
Cancer Council Australia also provides cancer information and support through its 13 11 20 service.
Follow-Up After DCIS Treatment
Follow-up after treatment depends on the treatment you have received and your individual circumstances. Your treating team will explain when clinical reviews and breast imaging are recommended.
Between scheduled reviews: if you notice a new breast lump, nipple discharge, nipple or skin change or another breast symptom, speak with your GP or treating team rather than waiting for the next planned review.
DCIS on the Gold Coast: Preparing for a Surgical Consultation
Dr John Gault provides breast cancer surgery on the Gold Coast. He has been a member of Breast Surgeons of Australia and New Zealand, BreastSurgANZ, since 2010 and consults at Pindara Place in Benowa.
Breast care nurse support forms part of the Gault Surgery breast care team. The breast care nurse is not named on this page so that staffing changes do not make the information inaccurate.
Public and private care: Seeing Dr Gault privately does not change your place on a public hospital waiting list.
Before your consultation
- Gather your reports. Keep your mammogram, ultrasound, biopsy and pathology reports together if they are available to you.
- Arrange a referral. Ask your GP or another treating doctor for a referral if you would like to claim the applicable Medicare specialist consultation rebate.
- Write down your questions. Bring the questions you want addressed so they can be discussed during your appointment.
- Contact the rooms. Gault Surgery can be contacted on (07) 5539 3999 to arrange a consultation.
Frequently Asked Questions About DCIS
Can DCIS spread to other parts of the body?
DCIS remains contained within the milk ducts. While it remains DCIS, it has not invaded the surrounding breast tissue and has not spread to other parts of the body. Treatment is recommended because some DCIS can develop into invasive breast cancer.
Does DCIS usually cause a breast lump?
No. Cancer Australia states that DCIS usually cannot be felt and is commonly found through breast imaging.
Does DCIS mean I will need a mastectomy?
No. Breast-conserving surgery is commonly used for DCIS. Mastectomy may be discussed if the DCIS involves a large area, occurs in multiple areas or cannot be removed adequately with breast-conserving surgery. Each procedure has potential benefits, risks and effects on the breast that should be discussed with your surgeon. Results vary from person to person.
Is chemotherapy used for DCIS?
Chemotherapy is not generally used for DCIS because the abnormal cells have not invaded beyond the milk ducts. If invasive breast cancer is identified, the treatment plan is reassessed according to the invasive cancer.
Will I need radiotherapy after DCIS surgery?
Radiotherapy is commonly recommended after breast-conserving surgery because it can reduce the chance of DCIS or invasive breast cancer returning in the treated breast. It can also cause side effects, including skin changes and tiredness. It is not usually recommended after mastectomy for DCIS alone. Your treating team can explain the expected benefit and risks in your circumstances.
What does a clear surgical margin mean?
A clear margin means DCIS is not identified in the relevant margin of healthy-looking tissue around the removed area. If a margin is not considered clear, further surgery may be recommended. Further surgery can help remove additional affected tissue but carries risks such as bleeding, infection and further change in breast shape. Results vary from person to person.
Do lymph nodes need to be removed for DCIS?
Most women with DCIS do not need lymph nodes removed. Lymph node surgery may be considered in particular circumstances, including some cases involving a large area or higher-grade DCIS, or when mastectomy is planned. Sentinel lymph node biopsy has potential benefits when clinically indicated but also carries risks including pain, numbness, infection, restricted shoulder movement and lymphoedema.
Where can I discuss a DCIS diagnosis on the Gold Coast?
Dr John Gault consults at Pindara Place in Benowa. You can bring your imaging, biopsy and pathology information to the consultation so the findings and available treatment options can be discussed in the context of your individual diagnosis.
Discussing a DCIS Diagnosis on the Gold Coast
Sources and Further Reading
- Cancer Australia: Ductal carcinoma in situ
- Cancer Australia: Diagnosis of ductal carcinoma in situ
- Cancer Australia: Treatment options for ductal carcinoma in situ
- Breast Cancer Network Australia: Treatment options for DCIS
- Breast Cancer Network Australia: Radiotherapy for DCIS
- BreastScreen Queensland
- Cancer Council Australia
This page provides general information only. Your imaging, pathology, medical history and individual circumstances need to be considered by your treating medical team when treatment is planned.