In most cases, DCIS has no outward signs or symptoms. However, a small number of women with DCIS have symptoms that may include:

• A breast lump
• Nipple discharge

DCIS is usually found on a screening mammogram, in which a radiologist identifies microcalcifications — tiny groups of calcium deposits — that may indicate the presence of a breast abnormality. The microcalcifications appear on a mammogram as irregularly sized and shaped clusters of white spots.

When to see a doctor
Establish a schedule with your doctor for getting routine screening mammograms and clinical breast exams — and make sure you stick to it. Routine screening is the best way to detect the presence of DCIS. In addition, see your doctor if you discover changes in your breast, such as a breast lump, nipple discharge or any other unusual breast changes.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Researchers don't know exactly what triggers the abnormal cell growth that leads to DCIS. A number of factors may play a part, including:

• Genetics. Some genes are considered tumor suppressor genes. Two genes, called BRCA1 and BRCA2, are known to play a role in suppressing breast cancer. A mutated copy of these genes can run in families. If you inherit a BRCA gene mutation, you're at increased risk of breast cancer.
• Environmental factors. Exposure to radiation or to certain chemicals may cause an acquired gene mutation that increases your risk of cancer. Scientists aren't sure yet what causes the acquired gene changes that are linked to breast cancer.
• Hormonal exposure. Your total lifetime exposure to the hormones estrogen and progesterone appears to play a role in your risk of breast cancer. Women with a high total number of lifetime menstrual cycles — for example, who started menstruating early, entered menopause late or never had children — are at increased risk of breast cancer. Taking combined estrogen-progestin hormone replacement therapy after menopause also increases breast cancer risk.
• Diet and lifestyle. Researchers know that moderate alcohol use increases your risk of breast cancer. The amount of red meat in your diet also may play a role, along with other dietary factors that scientists are working to understand. Inadequate exercise and being overweight — particularly when weight gain happens after menopause — appear to increase the risk of cell changes that lead to breast cancer.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

In general, the factors that put you at risk of developing DCIS are the same as risk factors for developing invasive breast cancer.

Things that increase your risk of DCIS include:

• Older age
• Personal history of benign breast disease, such as atypical hyperplasia
• Family history of breast cancer
• Never having been pregnant
• First pregnancy after age 30
• Taking combination estrogen-progestin hormone replacement therapy (HRT) for five years or longer after menopause.
• Genetic mutations, such as in the BRCA1 or BRCA2 genes

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Most cases of DCIS are detected during routine mammograms. The most important thing you can do to catch breast cancer in its earliest, most treatable stages is to follow recommended guidelines for your age group for clinical breast exams and mammography. Ask your doctor how often you should be screened for breast cancer.

If you notice a lump, discharge or any other unusual changes in your breasts, call your doctor.

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down your medical history, including any benign breast conditions with which you've been diagnosed. Also mention any radiation therapy you may have received, even years ago.
• Note any family history of breast cancer, especially in a first-degree relative, such as your mother or sister.
• Make a list of your medications. Include any prescription or over-the-counter medications you're taking, as well as all vitamins, supplements or herbal remedies. If you're currently taking or have previously taken hormone replacement therapy, share this with your doctor.
• Find a family member or friend who can join you for your appointment. Just hearing the word "cancer" can make it difficult for most people to focus on what the doctor says next. Take someone along who can help absorb all the information.
• Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Below are some basic questions to ask your doctor about DCIS. If any additional questions occur to you during your visit, don't hesitate to ask.

• Do I have breast cancer?
• What tests do I need to determine the type and stage of cancer?
• What treatment approach do you recommend?
• What are the possible side effects or complications of this treatment?
• In general, how effective is this treatment in women with a similar diagnosis?
• Am I a candidate for tamoxifen?
• Am I at risk of this condition recurring?
• Am I at risk of developing invasive breast cancer?
• How will you treat breast cancer if it does return?
• How often will I need follow-up visits after I finish treatment?
• What lifestyle changes can help reduce my risk of a cancer recurrence?
• Do I need a second opinion?
• Should I see a genetic counselor?

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

• Have you gone through menopause?
• Are you using or have you used any medications or supplements to relieve the symptoms of menopause?
• Have you been diagnosed with any previous breast conditions, including noncancerous conditions?
• Have you been diagnosed with any other medical conditions?
• Do you have any family history of breast cancer?
• Have you or your close female relatives ever been tested for the BRCA gene mutations?
• Have you ever had radiation therapy?
• What is your typical daily diet, including alcohol intake?
• Are you physically active?

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Mammography is the most beneficial tool in identifying DCIS. Because DCIS may be present in your breast even though you can't feel it, getting regular mammograms can help identify microscopic breast changes that might be associated with DCIS. Ask your doctor when you should begin regular mammograms.

If suspicious areas such as shadows or bright white specks (microcalcifications) are identified on your mammogram, your radiologist likely will recommend additional breast imaging. You may have a diagnostic mammogram, which takes views at higher magnification from more angles, or ultrasound. If the area of concern needs further evaluation, the next step will be a breast biopsy.

You may undergo one of these biopsy procedures:

• Core needle biopsy. A radiologist or surgeon uses a hollow needle to remove tissue samples from the suspicious area. As many as 15 samples, each about the size of a grain of rice, may be taken and sent to a lab for analysis.
• Stereotactic biopsy. This type of biopsy also involves removing tissue samples with a hollow needle, but with the help of stereo images — mammogram images of the same area obtained from different angles — in finding (localizing) the area of concern.
• Surgical biopsy (wide local excision or lumpectomy). If results from a core needle biopsy or stereotactic biopsy show areas of DCIS, you'll likely need to meet with a surgeon to discuss your options for surgically removing a wider area of breast tissue for analysis.

A pathologist will analyze the breast tissue from your biopsy to also determine:

• Grade. In DCIS, grade refers to the appearance of the control centers (nuclei) of the cells. If, when examined under a microscope, the nuclei appear fairly similar to the nuclei of normal cells and very few cells are dividing, the tumor is low grade. If the nuclei are markedly different from the nuclei of normal cells, or if they're dividing rapidly, or both, the tumor is high grade and more likely to become invasive.
• Cell structure. Two major subtypes of DCIS are distinguished by the structure of their cells. One type is characterized by large, atypical cells with a central area of dead or degenerating cells (comedo necrosis). The other type is characterized by the lack of these qualities. The presence of comedo necrosis generally signifies a more aggressive lesion.

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Treatment of DCIS has a high likelihood of success, in most instances removing the tumor and preventing any recurrence, particularly a recurrence that spreads beyond the original site.

In most cases, treatment options for DCIS include:

• Lumpectomy and radiation therapy
• Simple mastectomy

In some cases, treatment options may include:

• Lumpectomy only
• Lumpectomy and the drug tamoxifen

Surgery
If you're diagnosed with DCIS, one of the first decisions you'll have to make is whether to treat the condition with breast-conserving surgery (lumpectomy) or breast-removing surgery (mastectomy).

• Lumpectomy. Lumpectomy removes only a portion of your breast. The procedure allows you to keep as much of your breast as possible, and depending on the amount of tissue removed, usually eliminates the need for breast reconstruction.

  Lumpectomy followed by radiation therapy is the most common treatment for DCIS. Research suggests that, while women treated with lumpectomy have slightly higher recurrence rates than women who undergo mastectomy, survival rates between the two groups are very similar.

  For older women with multiple medical conditions, lumpectomy plus tamoxifen therapy or lumpectomy alone may be an option.

• Mastectomy. For treating DCIS, a simple mastectomy — removing the breast tissue, skin, areola and nipple, and possibly the underarm lymph nodes (sentinel node biopsy) — is one option. Breast reconstruction after mastectomy, if desired, can be performed in most cases. Because lumpectomy combined with radiation is equally effective simple mastectomy is less common than it once was for treating DCIS.

Most women with DCIS are candidates for lumpectomy. However, mastectomy may be recommended if:

• You have a large area of DCIS. If the area is large compared with the size of your breast, a lumpectomy may not produce acceptable cosmetic results.
• There's more than one area of DCIS (multifocal or multicentric disease). It's difficult to remove multiple areas of DCIS with a lumpectomy. This is especially true if DCIS is found in different sections — or quadrants — of the breast.
• Tissue samples taken for biopsy show cancer cells at or near the edge (margin) of the tissue specimen. There may be more DCIS than originally thought, meaning that a lumpectomy might not be adequate to remove all areas of DCIS. If the area of DCIS is large, relative to the size of your breast, lumpectomy may produce unacceptable cosmetic results.
• You're not a candidate for radiation therapy. Radiation is usually given after a lumpectomy. You may not be a candidate if you're diagnosed in the first trimester of pregnancy, you've received prior radiation to your chest or breast, or you have a condition that makes you more sensitive to the side effects of radiation therapy.
• You prefer to have a mastectomy rather than a lumpectomy for any reason. For instance, you might not want a lumpectomy if you don't want to have radiation therapy.

Surgery for DCIS typically doesn't involve removal of lymph nodes from under your arm because it's a noninvasive cancer. The chance of finding cancer in the lymph nodes is extremely small. If tissue obtained during surgery leads your doctor to think cancer may have spread outside the breast duct or you will be having a mastectomy, he or she may then recommend a sentinel node biopsy or removal of some lymph nodes at the time of surgery.

Radiation therapy
Radiation therapy after lumpectomy reduces the chance that DCIS will come back (recur) or that it will progress to invasive cancer. Radiation therapy uses high-energy X-rays to kill cancer cells or damage them to the point where they lose their ability to grow and divide. Because cancer cells multiply rapidly, they're more vulnerable to the effects of radiation than are normal cells. A type of radiation therapy called external beam radiation is most commonly used to treat DCIS.

Women whose cancer has the following low-risk characteristics may be effectively treated with lumpectomy without radiation:

• Small affected area
• Low-grade tumor
• Large, cancer-free surgical margins

Tamoxifen
The drug tamoxifen (Nolvadex) blocks the action of estrogen — a hormone that fuels breast cancer and promotes tumor growth — to reduce your risk of developing invasive breast cancer. Tamoxifen is effective only against cancers that grow in response to hormones (hormone receptor positive cancers).

Tamoxifen isn't a treatment for DCIS in and of itself, but it can be considered as additional (adjuvant) therapy after surgery or radiation in an attempt to decrease your chance of developing a recurrence of DCIS or invasive breast cancer in either breast in the future. If you choose to have a mastectomy, there's less reason to use tamoxifen. With a mastectomy, the risk of invasive breast cancer or recurrent DCIS in the small amount of remaining breast tissue is very small. Any potential benefit from tamoxifen would apply only to the opposite breast. Discuss the pros and cons of tamoxifen with your doctor.

Factors that influence treatment
Several factors may influence treatment of DCIS. Researchers are attempting to identify which women are at high risk of recurrence and which are at low risk, based on the following factors:

• Pathologic margins. If cancer cells extend close to the edge of the tissue samples removed during lumpectomy surgery, there's a higher likelihood that some cancer cells have been left behind. In such a situation, a re-excision — removing an additional, larger area of breast tissue — or a mastectomy may be necessary.
• Tumor size. A small tumor has a better chance of being adequately removed with lumpectomy than does a larger tumor.
• Grade. High-grade tumors have a higher rate of developing into invasive breast cancer than do low-grade tumors.
• Cell structure. Tumors with comedo necrosis have a higher rate of recurrence than do DCIS tumors without comedo necrosis.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Any cancer diagnosis can be overwhelming and scary, even if it's a noninvasive, treatable form of cancer, such as DCIS. To better cope with your diagnosis, it may be helpful to:

• Educate yourself. The more you know about DCIS and your treatment options, the better prepared you'll be to make the best choices. Asking questions of your doctor or other members of your medical team is a good place to start. There are also excellent books on breast cancer and many reputable resources on the Internet. Be sure to look for the most current information because breast cancer treatments change rapidly. It may also help to talk with women who have been through a similar experience.
• Get support when needed. Don't be afraid to ask for help or to turn to a trusted friend when you need to share your feelings and concerns. Talk with a counselor or medical social worker if you need a more objective listener. Join a support group — in real life or online — of women going through a situation similar to yours.

It may take time to sort through your emotions, but you can still be in charge of your life and participate actively in decisions about your treatment.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.