New Info to Me About DCIS Becoming Invasive

cinnamonsmiles · February 2015

I was searching around Sloan Memorial Kettering which led me to the NCI and found this:

DCIS

A noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues. At this time, there is no way to know which lesions could become invasive. Also called ductal carcinoma in situ and intraductal carcinoma.
http://www.cancer.gov/dictionary?CdrID=44394

This confuses me. It seems to be saying DCIS is abnormal cells but MAY become invasive cancer. I still consider DCIS cancer. Yet radiation is recommended for DCIS. But according to the NCI," radiation therapy

(RAY-dee-AY-shun THAYR-uh-pee)

The use of high-energy radiation from
x-rays, gamma rays, neutrons, protons, and other sources to kill cancer
cells and shrink tumors. Radiation may come from a machine outside the
body (external-beam radiation therapy), or it may come from radioactive
material placed in the body near cancer cells (internal radiation
therapy). Systemic radiation therapy uses a radioactive substance, such
as a radiolabeled monoclonal antibody, that travels in the blood to
tissues throughout the body. Also called irradiation and radiotherapy.
"

So if DCIS isn't cancer, by their definition, then rads shouldn't be used for DCIS since its not cancer. How confusing they are and they have medical degrees!!

Sloan Kettering flip flops with what they call cancer (http://www.mskcc.org/pressroom/press/newly-develop...) and the standard treatments, one of which includes rads and considers it a cancer. I get confused, if DCIS is an abnormal cell (according to one definition by Sloan and NCI), why do they recommend rads for it when they in one breath, say it is abnormal cells and another breath call it cancer?. To me, ADH are abnormal cells and DCIS are cancer cells that evolved from ADH cells. So playing devil's advocate, why not give ADH rads as well? I'm not really expecting an answer, because that will open a whole nother can of worms. but yet in the glossary of terms, it states:

DCIS

A noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive. Also called ductal carcinoma in situ and intraductal carcinoma.

Seems even Sloan and the NCI can't make up it's mind on the subject of DCIS.
Thanks for giving me an outlet for the whirling thoughts in my mind about the links regarding DCIS at SLoan and NCI.

louishenry · February 2015

We all know that DCIS is a pre- invasive cancer. If untreated , it may progress to invasive. And not all DCIS is equal. Some types are just barely DCIS and others are closer to invasive. This article is very general and doesn't address all the details. That's why it can be confusing to us.

I was told that it is a cancer but it doesn't behave like s typical cancer. DCIS is not life threatening and cannot lead to metastatic cancer. That's why some Drs want to change the naming of it. Not a good idea in my opinion because many may forgo treatment. A good team will help the patient with a personal plan. Rads, tamoxifen etc.

As for rads , not everyone needs them. It depends on the cell and size.

They weren't recommended in my case.

Not sure about tomorrow but as of now , it's been almost 8 years. Tamox was fine and I feel pretty good about the future.

MagicalBean · February 2015

I agree. DCIS, by definition, is locked in the duct and has not spread. It is pre-invasive. But it IS carcinoma. Just because it hasn't spread, doesn't mean it's not a serious condition. Some people seem to belittle it's impact.

Mine was <1cm, but because it was grade 3, it was recommended that I have a lumpie followed by rads and Tamoxifen.

It's nice to know you had such an uneventful ride on the Tamoxifen train. I hope I can say the same down the road.

CaliRN · February 2015

I believe the reason radiation is recommended after lumpectomy sometimes is due to the nature of DCIS. It can skip around in the ducts and so if any abnormal cells are missed with the lumpectomy they are destroyed by radiation. This is generally why radiation is not recommended after a mastectomy.

It is frustrating that we are forced to make these life changing decisions when we really don't know the path our DCIS will take. I hope that researchers figure it out soon!

CaliRN · February 2015

I believe the reason radiation is recommended after lumpectomy sometimes is due to the nature of DCIS. It can skip around in the ducts and so if any abnormal cells are missed with the lumpectomy they are destroyed by radiation. This is generally why radiation is not recommended after a mastectomy.

It is frustrating that we are forced to make these life changing decisions when we really don't know the path our DCIS will take. I hope that researchers figure it out soon!

ksusan · February 2015

I have stage 0, grade 3 DCIS, solid pattern in my left breast. It's too diffuse for a lumpectomy, but too potentially problematic to leave alone. Hence, a mastectomy. I also found the DCIS literature confusing--how could something non-invasive warrant removing my breast? But as stated above, not all DCIS is the same.

Annette47 · February 2015

The problem with DCIS is that no one know if or when it will become invasive. If only they had a test to predict that, then treatment options would become MUCH different.

For example, I had way less than a centimeter of DCIS (about the size of a grain of rice is what I was told, so guessing 4-5mm at most - they never gave me a final size). It had comedo necrosis, yet was supposedly only grade 2 and it had already started to become invasive. Yet, I have known of other people who had 6+ cm of grade 3 DCIS which had yet to become invasive. The other issue, along with predicting what is and isn't going to become invasive is that there is no way to tell whether it has broken through the ducts until it has been removed and looked at under a microscope. So EVERYONE needs surgery to remove it, even if it would never had amounted to anything. Again, if our diagnostic and prognostic tools were better, treatment decisions would be very different.

turtlelady · February 2015

One "noninvasive condition in which abnormal cells are found in the lining of a breast duct" is called Atypical Ductal Hyperplasia." It can progress to a DCIS and onward to invasive types. But a DCIS, is in fact a carcinoma, a cancer, not simply "abnormal cells." When it becomes invasive, the name is changed. I've had both ADH and DCIS, right next to each other. My ADH was actually found by pathology following my lumpectomy for the carcinoma. An ADH by itself would often be left alone and monitored. Although ADH is considered benign, it is associated with increased risk of cancer.

So the difference is that ADH is pre-cancerous, while DCIS is a pre-invasive cancer (carcinoma). The latter is usually treated as a cancer, with surgery and sometimes radiation. As others have mentioned, there are different levels and no reliable tests to determine which DCIS might become invasive more quickly. However, it is inaccurate obfuscation to call a DCIS simply abnormal cells, because we already have a name for those non-cancerous cells: atypical hyperplasia. (I suspect that the effort to create controversy and confusion is coming from insurance companies. It serves no beneficial purpose.)

New Info to Me About DCIS Becoming Invasive

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