Management and Treatment of Ductal Carcinoma in Situ (DCIS)
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- Опубликовано: 1 июн 2024
- Join Dr. Swati Kulkarni, FACS, Breast Surgery, Northwestern Medicine, and Professor of Surgery, Northwestern University, Feinberg School of Medicine, to learn about the management and treatment of Ductal Carcinoma in Situ (DCIS)-the presence of abnormal cells inside a milk duct in the breast.
DCIS is considered the earliest form of breast cancer. DCIS is noninvasive, meaning it hasn't spread outside of the milk duct. While DCIS isn't an emergency, it does require an evaluation and a consideration of treatment options.
According the American Cancer Society, "About 1 in 5 new breast cancers will be ductal carcinoma in situ (DCIS). Nearly all women with this early stage of breast cancer can be cured."
► For more information about "The Promise Study" for women with newly diagnosed Ductal Carcinoma in Situ (DCIS), which was mentioned by Dr. Kulkarni, visit Facebook.com/ThePromiseStudy.
► For a helpful visual of DCIS and IDC that corresponds with Dr. Kulkarni's presentation, visit bit.ly/LW_DCIS.
► Follow us on / livingwellcrc and livingwellcrc.org to keep up to date on all LivingWell online programming.
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Attorney here. Isn't the treatment choice (lumpectomy + radiation + hormone therapy) vs. mastectomy) supposed to be up to the patient? Radiation and hormone therapy have significant and often permanent side effects. Patients shouldn't be coerced or bullied into having a specific type of treatment. Survival rate and DISEASE FREE survival rates aren't the same thing. When patients are told about survival rates, are they told about DISEASE FREE survival rates? Not providing this information arguably is misrepresentation by omission. Would the patient have made a different treatment choice knowing about disease free survival vs. general survival rates.
Doctors as a general rule just treat current symptoms. They really do not focus on long term side effects. They often just wave it off as a non issue. So they do not tell women that they can have permanent damage from the treatments that can have devastating effects on the when they approach their 50's or 60's or golden years. When people are focused on enjoying time with grandkids, want to travel and enjoy all those years of hard work. They just worry about lets clear up the tumor and clear out any adjacent cancer cells. But they do not tell you that you are at increased risk of an andeocarisinoma. A fast growing deadly cancer tumor that often by the time it is discovered it is too late to treat it. Granted the risk is low. But then women's risk of getting breast cancer is supposed to be low if you don't have any risk factors or family history. But guess what. You automatically have an increased risk for cancer after radiation treatments and that does not go away. If anything it increases with age. Lovely, just lovely.
Thankyou for your comment.
You are correct.
It seems to me that holistic healing is never, ever discussed with cancers. I was diagnosed with zero stage, non invasive ductal carcinoma in situ (dcis). However, I'm in the higher range and estrogen positive. It's being recommended that I receive radiation therapy and endocrine therapy using Tamoxifen. The potential side of effects of Tamoxifen raise concerns with me. Of course my Dr. said that most women do fine on the drug. It's concerning to me that medications are always presented to the patient as apposed to changing the diet and such. Is it because of the copious amounts of money that the drug companies throw at Dr.s? It's not a mean question just one that raises concerns with me. I know that healthier eating is encouraged along with the chemical therapies. Never just eating organic and juicing. Is it because the chemical therapies provide a quick fix for some people? I want to forgo the chemical treatments in favor of the healthy living lifestyle. It seems that patients are never given the either or. I'm really torn on this and find it all so overwhelming. Thanks.
We are on the same boat Cassie. Have u undergone BCS/mastectomy?
Reply from Dr. Kulkarni: Casse Wonderalke - Thank you for your question. I can understand that you would be overwhelmed with all the information about treatments. Certainly, diet and exercise are helpful reducing the risk of developing a recurrence, but we recommend medications such as tamoxifen because we have conducted clinical trials that show a significant benefit in reducing the risk of recurrence in women diagnosed with ER+ DCIS and treated with lumpectomy. At this time, we do not have studies that show diet and exercise alone has the same benefit the medications and radiation to treat DCIS.
Yep I agree. I’m all about the holistic and being healthy without taking westernize medicine. You can definitely heal yourself the holistic way. You have to think about the business Dr’s are in. They are in the business to make money so they will throw different studies for different medicines at you because they are in the business to sell. Medical companies are in the business to make money. They use a east fix approach that necessarily doesn’t heal you but give you a bandage. My mom recently just had a bean size cancer remove with some lymphnodes on 6/29/2021-yesterday. The Dr said she has stage 0 cancer. I am not sure of the terminology but i was so shocked when she told me and my siblings last month. She said she ask her Dr. about taking the holistic route and her Dr. look at her crazy. That said everything. I have been on my mom eating healthier and working out more. I have been through my own health challenges as a young woman and the holistic route is what changed my life not medicine because it’s a temporary fix!!! Juicing, eating healthier working out and not stressing will be just fine. Just continue to do your research!
@@Tiffthefashionista Did my research and learned mammograms and treatments are a multibillion dollar industry therefore not going anywhere. I also learned that until the 80's when mammogram testing came into being DCIS was rarely ever detected, maybe 2% of the time. Most was found due to autopsy following an accident. That all changed when mammograms began detecting it sending the nbr of findings through the roof (mo money, mo money) as it is then treated like full blown cancer. The stage 0 rating is an oxymoron. With all the findings i.e. early cancer detection, one would think breast cancer rates would have gone down but they haven't. On the contrary, nothing has changed just more DCIS being found and "treated" when the teal reality is that up until the time mammograms came along and began detecting it almost all the women who had it never knew it and lived their whole lives with peace of mind never knowing it was there (as mention autopsies were the only reason some were found to have it) Please check out Chris Beat Cancer; Dr. Pamela Popper-DCIS Overtreatment, Mammograms; and Dr McDougall-Mammograms.
I was recently diagnosed with DCIS ( Stage 0) low grade and ER + in Sep 2022. I underwent a lumpectomy and radiation. I am post menopausal women with no history of health issues and no genetics of cancer in the family. I am
going to try natural methods to lower my estrogen ( I found many online) instead of taking the Aromatase inhibitor with too many side effects. I hope someone has a answer to the holistic methods.
Thanks for the review
This is such a thoughtful, thorough explanation. Thank you.
Thank you for the information.
Thank you so much . This has been helpful . I’m needing surgery
Thank you! Very informative.
I have watched so many women in my family go through torturous treatments for breast disease.
I really learned a lot and thank you for the information. This helps me a lot in making my treatment decision about my DCIS stage 0 ( low grade). I have finished my lumpectomy and radiation 5 times. I do not want to take AI and I am ER/PR + . I am thinking of naturally reducing my estrogen levels. The side effects are more than the benefits. No family history either. I am healthy vegetarian with healthy weight. I was shocked to hear this DCIS diagnosis.
I am taking grape seed extract which is a natural aromatase inhibitor. I found some research papers on PubMed. I am not taking Armidex (aromatase inhibitor) which will give me side effects. All DCIS do not progress to cancer so I am taking the risk. Continuing my exercise and diet and l left the rest to God.
Hi. Any news from the clinical trials? Where can we see the result? Thank you
What are the odds of having seeding after a biopsy? Have the sample place it outside the sample area after sample taken?
Can cryoablation be used to treat DCIS?
Dr Kuikami would you recommend systemic chemo for a 5-cm er/pr + her2 - dcis? Thank u
THC.Phoenix
What if you have a triple negative DCIS? Still only surgery and radiation?
I began taking hormones five years ago, once a week. Three years later, I developed chronic mastitis on one breast. A year after that, I developed invasive DCIS on the other breast. Will eliminating hormone intake prevent recurrence (assuming that that’s the source of cancer, genetics test is negative)?
Are there any new findings for the other 50-75% of women who have DCIS with low to intermediate grades who don't need surgery?
Hellow Ma'am let me ask Do you have a patient Angelina Osborn
can you tell me please its emergency thanks and Godbless
I have high grade DCIS in the right breast they did an MRI and found two spots on the left now waiting to do biopsy December 3.
my prayers for you 🙏
High grade dcis
Lump Is 4cm
Plan is modified radical mastectomy.
Should we go for sentinel lymph node biopsy for axillary clearance !? Is sensitivity of slnb is good? If we don't go for axillary clearance level 1 and level 2 will there is chance of recurrence?
Good morning, What is Invasive Ductal Carcinoma Not tingham Grade ll? Anf possible treatment? Thank you so much Doctor.
Did you have treatment yet?
What is er & pr status measurements?
Dr Kuikami will you recommend systemic chemotherapy for 5 cm dcis? Thanks
Reply from Dr. Kulkarni: Yenski2012 Thank you for your question. Without knowing your case in detail, I cannot specifically provide a recommendation for your DCIS. However, in general, for women who have a lumpectomy to remove their DCIS, we do recommend tamoxifen for premenopausal women and aromatase inhibitors for postmenopausal women if there DCIS is ER+ to reduce the risk of local recurrence. These two medications are considered endocrine therapy or targeted therapy. We do not recommend systemic chemotherapy for DCIS.
@@NorthwesternMedicineLivingWell Thank you for your response Dr. Kulkami. I am turning 48 next month, perimenopausal. I had simple mastectomy last january (tumor size post excisional biopsy is 4x5x1.8cm), 6mm surgical margin clear, no other tumor seen and no lymphovascular invasion identified. My DCIS is intermediate nuclear grade II, noncomedo, solid, cibiriform, paplillary, micropappilary, no necrosis. My IHC is 80% ER/PR positive and HER2 negative. will I benefit from PMRT? And is it ok if I don’t take endocrine therapy and just follow healthy lifestyle and active surveillance. Thank u
@@yenski2012 Check out Dr Pamela Popper on RUclips Mammogram DCIS Treatment and Dr John Mcdougall Mammograms
What do you have to get both breast removed. From dcis
How do you get recurrence in the breast after removing both..makes no sense.
Could it be the treatment?
how many of the people who eventually develop cancer in the 10 years had a biopsy? could the biopsy "break the seal", release the once encapsulated pre cancer?
Great question
Any answer to your great question yet?
Same question
Good question.
True.
I have been diagnosed with DCIS(Intermediate) in right breast..I also have a calcination in left breast but it has been found out to be harmless at the moment!My consultant wants to do a lumpectomy plus radiation in right breast!!I am dead against radiotherapy point blank!I have my personal reasons..I would like to try cannabis oil treatment,if not I would have to have a double mastectomy as they can't tell me whether the calcification in left breast could turn into DCIS!I have a family history of cancer on both sides!
I've had the double mastectomy after having the dcis and thankfully no radiation or chemotherapy hope this helps done a year ago .God bless and good luck.x❤
I declined radiation too.
I did have chemo..maybe too much of it. How did you go?
@stephp7778 I started Cannabis OIL treatment which my consultant was not happy about at all.She kept saying to me,it won't work.There was only one person who I really spoke to about it and he was the one who was agreeing with me to continue with the oil treatment.He knew all about it,like myself but I was still being pushed by my consultant and everyone else at the hospital to have a lumpectomy,at one point I was even offered a mastectomy buy only the right breast because I was adamant I wasn't having radiotherapy.This was very stressful for me as I didn't know whether the oil treatment was working or not.Unfortunately after using the oil for some time I couldn't source any more.I didn't know what to do.At my next appointment my consultant had basically made her mind up that I was having a lumpectomy but no radiotherapy.This put me in a very difficult situation as I was so against surgery but not being able to source more oil I basically had no choice.I had to get a frequency wire inserted to mark where the tumour was.While I was there j happened to ask what size the tumour was and to my surprise it had reduced in size,I believe that was due to the oil.Reluctantly I went in for a lumpectomy,I was only supposed to be in overnight but ended up being there for 4 days.I went into urine retention and had to be catheterized twice.I was sent home with the catheter still in situ and was told the district nurse would come and see me.I really didn't know where my head was.I was angry,upset,I felt I had been bullied into getting the surgery which I didn't think was right at all but I was scared just to leave it considering it was intermediate grade.I don't know why but I was in pain for quite some time afterwards,I kept looking at this horrible wound on my breast,really regretting why I let it happen.I then developed a really bad urine infection due to having the catheter which was supposed to stay in for 2 weeks after my surgery.It got so bad I went to my local pharmacy and asked them for a syringe to take the water out the balloon so I could take the catheter out.I knew what I was doing because I used to be a Registered Nurse.I ended up having to phone my GP to get antibiotics for the urine infection.At my follow up appointment with my consultant,she told me my wound was looking good,she took away 60 grams out my breast,was confident everything was fine and told to come back in a year for a repeat mammogram.That was last November and still today I regret letting them put me through all that.I am now left with a horrible scar despite all the exercises I had to do plus I have one breast bigger than the other,not by much but it really bothers me.I am really dreading my next mammogram,I just hope and pray that everything is alright considering I refused point blank to have radiotherapy.
@@denisemain1028 omg...what a nightmare....I hope your healing well.
I avoided radiation and tamoxifen.
I'm done with the whole fear of recurrence. If it comes back I will deal with it then. 16 rounds of chemo was ample damage. No wonder they have the 5 year rule from diagnosis.
ruclips.net/video/EL25nbWqHpc/видео.htmlsi=CyQY4PV87f00y-OK
How do we determine DCIS? Will it test cancerous with biopsy ??
Yes
Hello and how long one should stay on endocrine pills after surgery and radiation? Thanks
They typically recommend at least five years of estrogen suppressants.
It's pure hell.
I was recently dx with dcis on the right breast while on anastrazole for previous cancer invasive ductal carcinoma ..why would this happen
I had 2 areas of high grade dais 4 years ago . I had a local wide excision followed by 3 weeks of radiation. I really wish that I had a mastectomy as I am now suffering with very hard painful breast . . They have told me that I have damage to my chest wall from the radiotherapy. I have asked for a mastectomy now to get rid of the pain BUT they will not do it . Cant wear a proper bra as my breasts are different sizes .
Mastectomy at the onset might have been the best option for you. What are you told when you've asked for mastectomy now? What are you supposed to do regarding your problems? Are you dismissed and ignored?
@@jeanniesabol5410 their idea of pain management is wearing plasters which had a local anesthetic potion in them , which do help a bit , but they won’t remove ‘healthy’ tissue . Which yes it is because there is. No cancer . Fortunately BUT air does not feel healthy to me .. the opinion is get on with it as think yourself lucky you no longer have cancer. (Which I am am very grateful for ) obviously . It’s just dealing with pain all the time gets you down .
@@jeanniesabol5410 I must also add that I have recently seen a private breast surgeon and she was amazingly supportive and empathetic .she has arranged for me to speak to a plastic surgeon to get his opinion on doing more fat grafting to try and help with the pain . So fingers crossed that will help . But if that fails this time I will not go through it again As my whole torso was bruised for weeks last time from the top of my thighs to under my arms .
Had an ultra sound guided biopsy-can’t this create a path for the cells to “escape” the milk duct?
I wonder the same thing and believe this may have happened to me
My DCIS was 12 plus years ago treated with lumpectomy and tamoxifen. Now in 24 months same breast has calcifications bio rad 1 now bio rad 3 another Mamo is in June 2021 is another lumpectomy or simple mastectomy now. My mother died from breast cancer and she took DES for 2 to 3 weeks and I was born @ 10 weeks early in 1958.
Please check out Chris Beat Cancer; Dr Pamela Popper - DCIS Over Treatment, Mammograms; and Dr John Mcdougall.
Only my opinion , I would go for a mastectomy.just to make sure you don’t have to go through the stress again. Hope your ok
I breast fed both of my babies each for over a year. I have cancer in my breast! I don't smoke, or drink! I eat vegetables and fruit. I drink a lot of water. I have three friends that are newly diagnosed with cancer. Could the covid vaccines be causing it?
great question
@@alisecraft8307 thank you! And guess what... Even though I've had three Pfizer shots, I caught covid this past week. I'm hoping it doesn't get any worse than it is. So far it's mostly sinus, aches, sore throat, swollen glands behind my ears, ringing in my ears, dizziness, headache, some mild coughing, I had a fever the first day. So, I guess I'm thankful I had the shots, or I could've been worse.
I'm praying for you 🙏 Thank You Jesus for blessing and keeping you & your family through all of this.
I was diagnosed with DCIS 3/31/22. I've yet to have a double mastectomy but I will keep trusting God through it all. God bless J Catlover.❤
@@alisecraft8307 Thank you so very very very much ✝️🙏🏻❤️
I’m in the process to have a treatment after my biopsy.
My only concern is why this happen to my left breast just because I was falling down from my home stairs?
Hi…. I just got my result that i got DCIS, how’s the whole process?
What is the normal timeframe after they find DCIS to get surgery?
I'm wondering as well
I was diagnosed on 22nd August 2017 and had surgery on 3rd October 2017 , so not long .
@@angelaharnett6437 is that the recommendation of a doctor or your iwn desicion when to undergo surgery.
Mine was about 6 weeks due to scheduling and needing the biopsy site to heal.
I was diagnosed November 17 I just had surgery December 22, 2023I feel a little pressure from the Dr to get the Surgery I wanted to think about my options between parcial Or full mastectomy I had Dcis in Citu stage 0 grade 2 I do not want to go through treatment I just think is not necessary I want to do the natural way. Do anyone choose that path and how you guys doing? I am ER positive 😢
Mam I'm 44 yr Infiltrating ductal carcinoma trement 🙏
2:19/2023 - Dear Doctor, please, at the beginning of a video, state the date.
Also, you equivocated on whether DCIS is cancer. So, tell us, is DCIS cancer or not?
It is cancer. But stage o. It is activity of cancer cells eventually turning into stage 1 and progression
It’s no such thing as stage 0 being a cancer, that’s just like being kind of pregnant, you’re either pregnant or not, now answer that!