Our Summary

This research paper is about the treatment of a type of breast cancer known as ductal carcinoma in-situ (DCIS). In the past, DCIS was treated in the same way as invasive breast cancer, but this has changed over time. With advancements in technology and a better understanding of the disease, the way DCIS is managed is changing rapidly. It’s now important to use a team approach to treatment, where the aim is to reduce the amount of therapy to lessen any side effects. The paper discusses the different ways DCIS can be diagnosed and treated in today’s medical field.

Screening guidelines suggest that women should start having annual mammograms from 45 years, or from 40 years if they choose. However, since DCIS treatment does not affect survival rates, some recommend screening every two years from age 50 to 74. DCIS is mainly diagnosed through mammograms, and checking lymph nodes is not usually needed. The tissue sample taken during a biopsy should be checked following certain guidelines.

Treatment options include surgery to remove a small part of the breast, removing the whole breast, or possibly removing the nipple too. Sometimes a sentinel lymph node evaluation is done before surgery. Radiation therapy is usually suggested after surgery, but in those with a low risk, it might be left out. Efforts are made to minimize the side effects of radiation.

Hormonal therapy can be offered to women with hormone-positive DCIS after surgery to reduce the risk of recurrence. This can also lower the chance of cancer in the other breast. Some new studies have looked into using targeted treatments like trastuzumab for DCIS with HER2 overexpression.

The future of DCIS treatment may involve tailoring therapy to the specific characteristics of the patient and the tumor. With so many different treatment options, it’s important to include the patient in the decision-making process. This will ensure the right balance is struck between controlling the disease and managing side effects, cost, appearance, and quality of life.

FAQs

  1. What is the current recommended age for women to start having mammograms for early detection of DCIS?
  2. What are some of the treatment options available for ductal carcinoma in-situ (DCIS)?
  3. How is the future of DCIS treatment expected to change with advancements in technology and understanding of the disease?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lumpectomy is to follow up with regular mammograms and clinical exams to monitor for any signs of recurrence. It is also important to maintain a healthy lifestyle, including eating a balanced diet, exercising regularly, and avoiding smoking, to reduce the risk of cancer returning. Additionally, discussing any concerns or questions with your healthcare provider and staying informed about new treatment options can help make informed decisions about your care.

Suitable For

Patients who are typically recommended lumpectomy for the treatment of DCIS include those with small, low-grade tumors that are confined to a small area of the breast. Lumpectomy is often recommended for patients who have early-stage DCIS and who wish to preserve as much of their breast tissue as possible. Patients who have larger or high-grade tumors, or who have DCIS that is more widespread in the breast, may be recommended for a mastectomy instead.

It’s important for patients to discuss their treatment options with their healthcare team and to consider their own personal preferences, values, and goals when making decisions about their care. Lumpectomy may not be suitable for all patients, and individualized treatment plans should be developed based on the specific characteristics of the patient and their tumor.

Timeline

  1. Screening mammograms are recommended for women starting at age 45 or 40 if they choose, with some guidelines suggesting screening every two years from age 50 to 74.

  2. DCIS is diagnosed mainly through mammograms, and a biopsy is usually needed to confirm the diagnosis. The tissue sample should be checked following specific guidelines.

  3. Treatment options include surgery to remove part or all of the breast, sometimes with a sentinel lymph node evaluation before surgery. Radiation therapy is commonly recommended after surgery, but may be omitted in low-risk cases.

  4. Hormonal therapy can be offered to women with hormone-positive DCIS after surgery to reduce the risk of recurrence, and targeted treatments like trastuzumab may be considered for DCIS with HER2 overexpression.

  5. The future of DCIS treatment may involve personalized therapy tailored to the patient and tumor characteristics. Involving the patient in decision-making is crucial to balancing disease control, side effects, cost, appearance, and quality of life.

What to Ask Your Doctor

  1. What are the different treatment options available for DCIS, and what are the pros and cons of each?

  2. How will the choice of treatment impact my long-term prognosis and quality of life?

  3. Are there any alternative or complementary therapies that may be beneficial in conjunction with traditional treatment options?

  4. How will the treatment plan be personalized to my specific case of DCIS?

  5. What are the potential side effects of each treatment option, and how can they be managed?

  6. How will the decision to undergo a lumpectomy versus a mastectomy be made, and what factors will be considered in this decision?

  7. Will I need radiation therapy after undergoing a lumpectomy, and if so, what does this entail?

  8. Are there any clinical trials or new advancements in DCIS treatment that I should be aware of and consider?

  9. How will my risk of recurrence be assessed, and what follow-up care will be necessary after treatment?

  10. Can you provide me with information about support resources or patient advocacy groups that may be helpful during my treatment journey?

Reference

Authors: Doke K, Butler S, Mitchell MP. Journal: J Mammary Gland Biol Neoplasia. 2018 Dec;23(4):279-291. doi: 10.1007/s10911-018-9415-1. Epub 2018 Sep 29. PMID: 30267199