Treatment options for DCIS

Doctors recommend all women with DCIS have treatment to reduce the risk of DCIS coming back or developing into invasive breast cancer.

Currently, they cannot tell for certain who will develop invasive breast cancer if they do not have treatment.

After treatment, your doctor will talk to you about regular, long-term follow-up. This may include more frequent clinical examinations and screening.

Surgery for DCIS

Surgery is nearly always the first treatment for DCIS. Options are:

• lumpectomy – also called a partial mastectomy, breast-conserving surgery, or wide local excision – is a common surgical treatment for DCIS. It aims to remove the area of DCIS and a small amount of healthy tissue around it.
• mastectomy to remove all of the breast tissue, which is more common If the DCIS is widespread within the milk ducts.

Tissue is sent to a pathologist to test that all the DCIS has been removed. Read about DCIS grades and pathology.

When the surgeon removes the DCIS, it is possible they may find things they did not expect:

• The area of DCIS may be larger than the tests showed before surgery.
• They may find DCIS that is different from what was in the biopsy.
• They may find invasive breast cancer that did not show up in tests. This may come as a shock but it is important to know that invasive breast cancer is very treatable.

Radiotherapy

After a lumpectomy, radiation is recommended for most people. Radiotherapy destroys any abnormal cells that may be left after surgery, reducing the chance of recurrence or invasive breast cancer. Find out about Radiotherapy for DCIS.

(video) The role of radiotherapy in the treatment of DCIS and early breast cancer

Hormone-blocking treatment

Hormone-blocking therapy is a treatment option for breast cancers that are hormone receptor positive (HR+).

However, most people with DCIS don’t have hormone-blocking treatment. This is because:

• its benefits for DCIS are less clear (than for invasive breast-cancer)
• the treatment may not outweigh the possible side effects.

Research is ongoing to work out which DCIS patients might benefit more from hormone-blocking therapy.

You may want to:

• ask your surgeon if your DCIS is being tested for hormone receptors
• ask your treating team if hormone-blocking therapy should be part of your treatment
• ask for a second opinion from another specialist to understand the possible benefits.

We have information about hormone-blocking treatments. Please note that this is written for people with invasive breast cancer, not DCIS, but the different drugs and side effects are still relevant.

• About hormone-blocking therapy
• Side effects of hormone-blocking therapies.

Treatments not normally recommended

Chemotherapy is generally not used to treat DCIS . If your DCIS is oestrogen receptor-positive, it means the cancer needs oestrogen to grow. In this situation, doctors may recommend oestrogen-blocking treatments such as tamoxifen.

Removal of lymph nodes is generally not recommended for DCIS. Your surgeon may offer sentinel lymph node biopsy if:

• the DCIS is extensive and you require a mastectomy
• they are not sure whether invasive breast cancer is present.

Treatment or no treatment for DCIS?

If high-grade (Grade III) DCIS is not treated, it is likely to develop into invasive breast cancer.

Some low or intermediate grades of DCIS may remain as they are for many years, without changing. It is still possible, though, for low or intermediate grades of DCIS to develop into invasive breast cancer.

Unfortunately, it is not currently possible to know if a person with DCIS will go on to develop invasive breast cancer.

See DCIS and the risk of invasive breast cancer.

Clinical trials into DCIS

Clinical trials are assessing whether it is safe for women with ‘very low-risk’ (slow growing) DCIS not to have any treatment.

Specifically, they are comparing the survival outcomes of regular physical examinations and mammograms, with treatments such as surgery and radiotherapy.

This approach is called ‘active surveillance’. It is sometimes referred to as a ‘watch and wait’ approach.

It is important to understand that there are no national or international guidelines that recommend this approach at this time. This approach is not recommended outside of clinical trials.

If you have been diagnosed with low-grade DCIS, speak to your breast surgeon if you have any questions.

Find clinical trials.