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Anthony C. Cahan, MD FACS
Q. What is Stage 0 breast cancer?
A. DCIS (ductal carcinoma in situ), the most common type of Stage 0 breast cancer, involves the proliferation of abnormal cells within a woman’s milk ducts. Left untreated, these cells can develop into invasive breast cancer that spreads outside the duct into surrounding tissue. DCIS is considered malignant but it is non-invasive; it has not spread from where it originated. Approximately 80 to 85 percent of invasive breast cancers initially arise within the milk ducts, the conduits through which milk produced in the breasts’ lobules flows to the nipples.
Q. How is DCIS detected?
A. It rarely presents as a lump you can feel. Typically, DCIS is detected by a screening mammogram as a cluster of calcifications (calcium deposits). If considered suspicious, a biopsy will be performed. For every 100 clusters biopsied, 22 percent will be cancerous; of that group, about 80 percent will be DCIS, and a percentage of these will develop into invasive breast cancer.
Q. What are my treatment options?
A. If a biopsy shows you have DCIS, your breast surgeon might recommend additional testing—such as an ultrasound or MRI—before advising on surgery. You may then undergo surgical removal of DCIS. Most women have a lumpectomy procedure to remove the cancerous tissue. You might also receive follow-up treatment, such as radiation or Tamoxifen hormone therapy. Outcomes for women treated for DCIS are outstanding: Ten-year data shows that their survival rate approaches 100 percent.
Q. What is the controversy concerning DCIS?
A. It stems from the fact that not all DCIS progresses to invasive breast cancer. Some believe we are using today’s high-quality mammography to overdiagnose DCIS—finding lesions a woman might live with permanently without problems. The issue is that once practitioners find DCIS, there is an ethical obligation to treat it. That leads some to question whether large numbers of women are being unnecessarily subjected to surgery and possible additional treatment. However, while DCIS does not always progress to invasive breast cancer, it will do so in many women.
Q. How do I determine the best treatment approach for me?
A. Gather all the facts about the extent of your DCIS. Important factors to consider include grade and estrogen/progesterone sensitivity. For example, low, intermediate, and high grades of DCIS roughly correlate to the degree of likelihood that invasive breast cancer will develop. Your breast surgeon will help evaluate your risk by also reviewing family history and ethnic origin, and might recommend genetic testing. The size of your DCIS influences the surgical approach: If it’s the size of a chickpea, a lumpectomy is probably best. If your DCIS is so extensive that 60 to 70 percent of the breast must be removed, consider a mastectomy and immediate reconstruction.Getting a second opinion is essential, as pathologists often disagree about DCIS. At The Breast Institute at Northern Westchester Hospital, we only proceed if, after our pathology department reviews an outside biopsy report, our own pathologists agree with its findings. Above all, remember that “What if I do nothing?” is a perfectly legitimate question to ask.
Anthony C. Cahan, MD FACS, has been Chief of Breast Surgical Services for The Breast Institute at Northern Westchester Hospital since 2002. His previous experience includes an internship and residency in general surgery at The New York Hospital-Cornell University Medical College, and cancer studies at Memorial Sloan-Kettering Cancer Center and Beth Israel Hospital.
Northern Westchester Hospital
Chief of Breast Surgical Services, The Breast Institute at Northern Westchester Hospital
Learn More About Dr. Cahan
Learn more about diagnosis and treatment of breast cancer
More from Dr. Cahan: Lumpectomy v. Mastectomy
Northern Westchester Hospital is a proud member of Northwell Health (formerly North Shore-LIJ Health System).
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