DCIS - cancer or Pre-cancer?

holland---DCIS is by definition non-invasive (stage zero bc); once it becomes invasive, it is then referred to as IDC. Perhaps you have some of both?

My doc said DCIS was 'precancer' -- shows you how docs have their own opinions and stick to it.

I forgot to add that my DCIS was estrogen+ as well as progesterone+.

Hi geebung!

Actually, tamoxifen is the hormone treatment of choice for those of us who are premenopausal. Here's a link to a couple of tamoxifen discussions:

• One on this site
  
• A Q&A on Tamoxifen from the NIH's National Cancer Institute
  
• A page from Cancer Research UK on Tamoxifen

One of the things to be aware (from the NIH/NCI site) is that while it can bring on menopausal-type symptoms, it can actually enhance fertility. However as it also causes fetal harm, pregnancy should be avoided while on tamoxifen.

HTH,

LisaAlissa

LisaAlissa - thanks for those links. Boy - the more I learn about all this, the more I find there is to learn! I suppose the reason why I have not been prescribed Tamoxifen is because I had a mastectomy and was node-negative. I am quite happy to abide by that. Interesting about the possible increase in fertility. I'd hate to have to worry about that again!

My surgeon also called DCIS precancer. He said, "The cells are not cancer and they are not normal. Sort of an "in between stage".

Catherine

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Hi. I'm new as of today. Dx with low/intermediate grade DCIS in May. Biopsy showed 4mm and removed it all. Lumpectomy showed no residual disease of any kind. I was very lucky the radiologist wasn't asleep. Onc (3 different opinions) said no rads or tamox. Just annual MRI and digital mammo every 6 months for 2 years. Called DCIS a pre-malignancy, as well. I feel ok, but should'nt I be doing more for such a potentially serious cond?

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Louishenry, How large were your margins? As long as they were adequate, your follow up plan sounds reasonable. Four mm and low/intermediate grade is very favorable for DCIS.

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It's my understanding that DCIS "are" cancer cells. They just haven't moved beyond the duct. Atypical duct hyperplasia (ADH) would be an example of "in-between cell," which is why ADH is considered a risk factor.

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Jo, you are mirroring what my surgeon has said for the past 2 years to me. I was dx with ADH Feb 2005 left, ADH Aug 2006 right, DCIS April 2007. That is why I chose bi-lat June 1, 2007 to not let the cancer have another chance.

Sheila

This is what my path report on my biopsy said about my ADH:

"The changes as evaluated in these levels do not fully satisfy quantitative criteria for a diagnosis of ductal carcinoma in situ, though qualitative criteria are met."

If you really look at that sentence, it's saying that my "ADH" meets the criteria for DCIS in quality (what the cells look like), but not in quantity - not enough of them.

Anyway, some doctors prefer to say that DCIS is pre-cancer, because no one knows which DCIS is just going to stay in the duct and never cause problems, and which will grow beyond the duct.

I suspect there's a lot of DCIS that never grows beyond, which is why it's such a hard decision to have a masectomy. It's just now with newer technology that more DCIS and ADH is being diagnosed.

I am very intrigued by this question as well. I was diagnosed with stage 0 DCIS low grade in June. When the doctor called me to tell me, he said "we found a very low grade cancer". And explained that it IS cancer, but pre-invasive cancer. Carcinoma, by definition IS cancer.

But then, so many say it's NOT cancer. Even the newest article about MRI's and DCIS that just came out last week says "DCIS is a non-malignant tumor". ?????????? Confusing, for sure. And frustrating because I feel like do I really have cancer, and if not, why am I letting the people who love me be so upset about this if it isn't really cancer? when you tell your friends/family that you have this, most IMMEDIATELY think the worst, and don't know about DCIS vs. IDC. Myself included! Now I feel more informed. Not until I was diagnosed did I learn about all the different types, stages, grades, etc.



Leslie

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What I guess kind of gets to me it the idea that I don't have "legit" cancer, but I have all the treatment challenges. I sometimes feel like a want-to-be member of the bc club, when I certainly didn't ask to be included. My doc put me in this club with his diagnosis, but he says I'm only a "pre-member." It's more a feelings on how I view myself in relationship to others who have breast cancer. For me personally, it's a feelings question.

I'm just glad that there is this thread where I can ask questions and air these feelings without guilt for not being "cancerous enough."

Cyd

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Hi Cyd,

thanks for being so honest about your feelings. I've felt like I'm "not cancerous enough" because I haven't had radiation or chemo, "only" a unilateral mastectomy and aromatase inhibitor for my Stage 1 invasive ductal carcinoma (involved the nipple, therefore lumpectomy not recommended by any doctors whose opinions I sought)!

So, in my book, anyone undergoing 25 radiation treatments "really" has breast cancer compared to me!

On another note -- I hope everyone considering tamoxifen is aware of the fairly new genetic testing to see how well you can metabolize the drug. (See discussion here: http://community.breastcancer.org/ubbthr...e=0#Post677097)

This is an interesting discussion! I was recently diagnosed, by a doctor who used the words "I'm sorry, it's cancer". She explained that it was high grade DCIS, in 3 areas. The breast surgeon I subsequently saw also referred to it as simply "cancer", as did the plastic surgeon. Each also said "If you're going to have cancer, this is the kind to get".

While some doctors may use other terms, possibly in an attempt to avoid scaring you (?), mine seemed think that scaring the patient into action was a good thing, perhaps because my questions included a lot of "What if I do nothing?" (BTW, I'm definitely not going to "do nothing".)

I can understand why one might be concerned with the terms. Who wants to feel that they've had a mastectomy or unpleasant drug treatments for something that isn't actually cancer? I'm calling it cancer in my own mind, because it helps me to feel comfortable with the rather drastic medical treatments. I say go with what works for you!

Take care,
Reader Girl

I think a lot of the ambivalence among doctors is that NIH/NCI refers to DCIS as a "pre-cancer," which is why many doctors do so as well. In a discussion with my ins. agent, he suggested just using "DCIS" on any insurance applications--ins. companies do use the NIH definition and attach the pre-cancer ID on the condition. DCIS does contain the word "carcinoma" but so does LCIS which is clearly a a pre-cancerous condition.

Hi, I was also dx with dcis in feb. had surgery to remove calcifications in both breasts and had a second surgery in left breast to remove more calcifications and create a clean margin. Path report came back clear. also have ADH in right breast. I agree that this dx is confusing. Surgeon described it as pre cancer but oncologist said it is definitely cancer. He said it is a matter of semantics when a surgeon talks about it to a patient. Just had mammo for right breast and my doctor wants a repeat mammo in oct.

Joanne, after my second dx of ADH last fall, my surgeon put me on Tamox to try to prevent any additional reoccurances. I also have a strong family history of ovarian and breast cancer. As luck would have it, after 6 months on Tamox, I was dx with DCIS and I opted for bi-lat mast with recon/expander. Sometimes taking the medicine to reduce the chances is like going to a duck hunt - sometimes you get the duck, sometimes you miss the duck.

Sheila