Ductal Carcinoma in Situ (DCIS)

February 1, 2017

DCIS is an early form of breast cancer, where the cancer cells have developed within the milk ducts but remain there ‘in situ’ having not yet developed the ability to spread outside the ducts into the surrounding breast tissue or to other parts of the body.

The structure of the female breast is important in understanding this cancer –

The interior of the female breast consists mostly of fatty and fibrous connective tissues.
It is divided into about 20 sections called lobes.
Each lobe is further subdivided into a collection of lobules, structures that contain small milk-producing glands.
These glands secrete milk into a complex system of tiny ducts. The ducts carry the milk through the breast and converge in a collecting chamber located just below the nipple.
Breast cancer is either noninvasive (referred to as in situ , confined to the site of origin) or invasive (spreading).

DCIS is the most common type of non-invasive breast cancer. It may also be called intraductal carcinoma or non-invasive ductal carcinoma. Nearly all women diagnosed with this early stage of breast cancer can be successfully treated.

In situ, or “in place,” describes a cancer that has not moved out of the area of the body where it originally developed. With DCIS, the cancer cells are confined to milk ducts in the breast and have not spread into the fatty breast tissue or to any other part of the body (such as the lymph nodes). DCIS is often first detected by a mammogram (an x-ray examination of soft breast tissues used to identify lumps, cysts, tumors, and other abnormalities). DCIS may appear on a mammogram as tiny specks of calcium (called microcalcifications), generally too small to notice by physical examination.

f DCIS is left untreated, it may, over a period of years, spread into (invade) the breast tissue surrounding the ducts. It is then known as invasive breast cancer. DCIS is not harmful in itself, but it is usually treated to prevent it developing into an invasive breast cancer. Not every woman with DCIS will go on to develop breast cancer if it is left untreated, but it is not possible to predict reliably which women with DCIS will go on to develop invasive breast cancer. Doctors haven’t yet reached a consensus about the nature of this disease and its management, although research is underway to inform this.

Types of DCIS

DCIS may be classified based on what the cells look like when viewed under the microscope. There are 2 main subtypes of DCIS: comedo and non-comedo.

Comedo – The term comedo is used to describe the appearance of DCIS cells. When examined under a microscope, the cells have dead material (necrosis) that plugs the middle. This material can be squeezed or expressed out of the cells, like a blackhead (comedo) on the skin.

Non-comedo – Non-comedo DCIS grows more slowly than the comedo type of DCIS, and is less likely spread into the surrounding breast tissue. The most common non-comedo types of DCIS are –

Solid DCIS – cancer cells completely fill the affected breast ducts.
Cribiform DCIS – cancer cells do not completely fill the affected breast ducts.

Causes

Genetic Factor – It’s not clear what causes DCIS. DCIS forms when genetic mutations occur in the DNA of breast duct cells. The genetic mutations cause the cells to appear abnormal, but the cells don’t yet have the ability to break out of the breast duct.

Sometimes, DCIS is linked to an inherited breast cancer gene. This is more likely if there’s a strong history of breast cancer in the family. The chances of there being a breast cancer gene in the family increase if –

two or more close blood relatives on the same side of the family have had breast or ovarian cancer – close relatives are the parents, children, brothers, sisters, aunts, uncles and grandparents
a close relative has had breast or ovarian cancer at a young age (under 40)
a close relative has had breast cancer in both breasts.

The genes most commonly linked to an increased risk of breast cancer in families are BRCA1 and BRCA2.

Hormone – Long, uninterrupted periods of exposure to the hormones oestrogen and progesterone can increase the risk of breast cancer. This may happen if –

When the period started at an early age
When the menopause starts late
When they don’t have children or have them later in life.

Other Conditions – The risk of developing DCIS is also higher when –

Breast cancer before
A type of non-cancerous (benign) breast disease called atypical ductal hyperplasia.

Lifestyle Factors – The following lifestyle factors may slightly increase the risk:

Drinking more than two units of alcohol every day over many years
Being overweight after the menopause.

Environmental Factors –

Exposure to Estrogen-like Industrial Chemicals – Chemicals with estrogen-like effects, called xenoestrogens, have been under suspicion for years. There has been particular concern with pesticides containing organochlorines (DDT and its metabolites, such as dieldrin) and pyrethroids (permethrin), but at this time evidence of any causal association is very weak.
Exposure to Diethylstilbestrol – Women who took diethylstilbestrol (DES) to prevent miscarriage have a slightly increased risk for breast cancer. There may also be a slightly increased risk for their daughters (commonly called “DES daughters”), who were exposed to the drug when their mothers took it during pregnancy .
Radiation Exposure – Heavy exposure to radiation is a significant risk factor for breast cancer. Girls who receive high-dose radiation therapy for cancer face an increased risk for breast cancer in adulthood. Low-dose radiation exposure before age 20 may increase the risk for women with BRCA genetic mutations

Risk Factors

It’s not clear exactly what causes breast cancer but different things can increase a woman’s risk of developing it.

These include –

Increasing age – The risk of DCIS increases with age. It’s rare in women under the age of 35.
Previous breast cancer and some non-cancerous (benign) breast conditions – Having one of these can increase the risk.
Dense breast tissue – Women are slightly more likely to develop cancer when the breasts have more glandular and connective tissue, with very little fatty tissue.
Not having children – Women who haven’t had children are slightly more likely to develop breast cancer than women who have.
Not breastfeeding – Women who have never breastfed are slightly more at risk than women who have breastfed for more than a year.
Early periods or a late menopause – Women whose periods started before they were 12 or who’ve had a late menopause (after the age of 50) are at a slightly higher risk.

Symptoms

Most people with DCIS have no symptoms. However, some people may notice a change in the breast such as a lump, discharge from the nipple or more rarely, a type of rash involving the nipple known as Paget’s disease of the breast.

However, DCIS can sometimes cause signs and symptoms, such as:

A breast lump
Bloody nipple discharge

Treatment

Lumpectomy followed by radiation therapy – This is the most common treatment for DCIS. Lumpectomy is sometimes called breast-conserving treatment because most of the breast is saved.
Mastectomy – Mastectomy, or removal of the breast, is recommended in some cases.
Lumpectomy alone
Hormonal therapy after surgery – These treatments, which block or lower the amount of estrogen in the body, are typically used if the DCIS tests positive for hormone receptors.

Alternative Treatment

Antineoplaston therapy – Uses amino acid derivatives to inhibit the growth of cancer.

Shark Cartilage therapy – Blocks the creation of new blood vessels which are required for cancer to grow and thus starves the tumor.

Immune System Treatments/Immunologic Therapies – Bolsters the immune system to combat & destroy cancer cells using a whole body program of detoxifying the body by diet, uncontaminated water and vitamins.

Metabolic Therapy – This uses detox, colon cleansing, anti-cancer diets based on whole foods plus vitamins, minerals and enzymes.

Nutritional Supplement Therapies –

Fats – Research is still mixed on the role that fats, and which specific types of fats, play in breast cancer risk and prevention. According to results from the Women’s Health Initiative study of dietary fat and breast cancer, there is no definite evidence that a low-fat diet will help prevent breast cancer. However, the study suggested that women who normally eat a very high-fat diet may benefit by reducing their fat intake.

Fruits and Vegetables – Fruits and vegetables are important sources of antioxidants, which may help protect against the tissue damage linked to increased cancer risk. Antioxidants include vitamin C, vitamin E, and carotenoids such as beta-carotene and lycopene. Richly colored fruits and vegetables — not supplements — are the best sources for these nutrients. These fiber-rich foods are an essential part of a healthy diet. However, it is not clear whether fruits and vegetables can specifically prevent breast cancer development or recurrence.
Calcium and Vitamin D – Eating lots of foods rich in calcium and vitamin D (such as yogurt and milk) may modestly reduce the risk of breast cancer for premenopausal women. Low-fat or non-fat dairy products are a healthier choice than high-fat ones.
Soy – The American Cancer Society recommends that women with breast cancer eat only moderate amounts of soy foods and avoid taking dietary supplements that contain high amounts of isoflavones.

Detoxification Therapies – To remove toxic substances from the body. Toxic substances may be natural or synthetic, and occur in a wide variety of strengths.

Ozone and Oxygen Therapies – Cancer cells die when exposed to oxygen (cancer cells are anaerobic). There are many oxygen and ozone treatments, however, this article will discuss two of the best known and most effective “Stage IV” treatments – infusion bottle and ozone I.V.

Ozone therapy using an infusion bottle involves removing part of the blood from the body, saturating this blood with oxygen (i.e. ozone – O3), then putting this oxygen rich blood back into the body.

Lifestyle Therapies –