DCIS, LCIS – Do I have breast cancer?

contributed by Annette Schork, R.N., BSN, OCN, CBCN, Cancer AnswerLine™

Lobular Carcinoma in situ (LCIS) and Ductal Carcinoma in situ (DCIS) are abnormalities that doctors call "stage zero" breast cancer. Women with either of these diagnoses often ask us, "Do I have breast cancer?"

Despite the fact that its name includes the term "carcinoma," LCIS is not a true breast cancer. Rather, LCIS is an indication that a person is at higher-than-average risk for getting breast cancer at some point in the future. For this reason, some experts prefer the term “lobular neoplasia” instead of “lobular carcinoma.” A neoplasia is a collection of abnormal cells. LCIS is restricted to the lobules.

DCIS is the most common kind of carcinoma (cancer) in situ. In DCIS, cancer cells are only in the ductal walls. If DCIS is not treated, it will likely grow into an invasive cancer. Here is a side-by-side comparison of the two conditions:

LCIS (lobular Carcinoma in situ)

Symptoms
LCIS usually does not cause any signs or symptoms, such as a lump or other visual changes to the breast. Doctors usually find LCIS through an abnormal mammogram.

Treatment

1. Observation if surgical biopsy

2. Surgery if needle biopsy

Tumors of this kind are located only in the lobules of the breast.

A lymph node biopsy is not needed for LCIS.

DCIS (Ductal Carcinoma in situ)

Symptoms
DCIS generally has no signs or symptoms. It's not common, but some women will feel a lump or have nipple discharge; but typically DCIS is found on a mammogram.

Treatment:

1. Lumpectomy only

2. Lumpectomy followed by whole breast radiotherapy.

3. Total mastectomy with or without breast reconstruction.

Lymph node surgery is generally not done with DCIS.

After LCIS Treatment
After surgery, most women choose observation since LCIS is not an invasive cancer. Even so, women with LCIS have an increased risk of developing invasive breast cancer in either breast.

Ways to reduce your risk of breast cancer returning are important options to consider. If you are premenopausal, taking tamoxifen for 5 years will lower your recurrence risk. Postmenopausal women can take either tamoxifen or raloxifene.

Having family members with breast cancer puts you at very high risk for invasive breast cancer. If you are at high risk, a prophylactic bilateral mastectomy is another treatment option. Your doctor can help you decide whether to have this treatment. You should undergo genetic tests before deciding to have a prophylactic mastectomy.

Yearly mammogram and physical exam every 6 to 12 months after treatment.

Yearly gynecologic exam for women taking tamoxifen.

After DCIS treatment
To reduce your risk of recurrence, tamoxifen is an option. If you were treated with lumpectomy, consider taking tamoxifen for 5 years, especially if you have an estrogen-receptor-positive tumor. For any woman with DCIS, use of tamoxifen for 5 years can reduce the risk of breast cancer developing in the other breast.

Medical history and physical exam every 6 months for 5 years every year.

Yearly mammograms starting 6-12 months after finishing radiotherapy (if received).

Yearly gynecologic exam for women taking tamoxifen.

Source: National Comprehensive Cancer Center Guidelines™: Breast Cancer

Ask your doctor questions about your diagnosis and your pathology results. You and your doctor will decide what treatment is best for your situation. Whether you are diagnosed with LCIS or DCIS, it can be overwhelming. 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. Make healthy changes to your lifestyle, so you can feel your best.