Stage 0 (DCIS) Breast Cancer

This is the beginning of a story. The gene set performed as a prognostic test well here. This needs to be confirmed but even more important is the need to demonstrate that it predicts, or does not predict, the benefit of radiation therapy for DCIS. This is the beginning of a story. The gene set performed as a prognostic test well here. This needs to be confirmed but even more important is the need to demonstrate that it predicts, or does not predict, the benefit of radiation therapy for DCIS.

Microcalcifications on a mammogram are a very common finding. They appear as tiny white specks or granules, composed of the element calcium. Most calcifications on a mammogram are perfectly normal and we just include them in the catchall diagnosis of "fibrocystic changes". They are not related to your dietary intake of calcium and you may continue with any dietary calcium you take.

Because cancer can lay down calcium, as well, it is the job of the radiologist to differentiate between the normal, innocuous calcium and the worrisome calcium. When calcifications are punctate and "round and regular" they can be dismissed. Calcifications within cysts are also normal. Calcifications which are potentially of concern are clustered, and their morphology is pleomorphic, appearing brached or irregular in shape, size and density. Clustered calcifications which are not definitively benign will either be watched at 6 month intervals, or biopsied. The best mode of biopsy for mammographic calcifications is a Stereotactic guided vacuum-assisted core needle biopsy. This is a minimally invasive needle procedure performed by the radiologist, or in some instances by a surgeon, that takes 20-40 minutes.

Results of this evaluation commonly are: normal (I won't go into all of those pathologic entities), ADH (atypical ductal hyperplasia), DCIS (duct carcinoma in situ), or invasive ductal carcinoma (IDC). Other important entities such as papilloma and radial scar will not be discussed here.

ADH is atypical cells. That means the pathologist visualizes abnormal cells, but they do not fulfill the criteria of cancer. ADH is significant because women with this diagnosis have an increased risk of breast carcinoma compared with the general population (about 4 times normal). If ADH is identified on needle biopsy, an excisional (surgical) biopsy is required to further evaluate this area. The tissue in this area is removed in order to see if there is any additional disease which was not removed by the needle sampling, such as DCIS or IDC, and to remove the remaining ADH. Statistically most women with ADH will never develop an invasive cancer, but they must be watched carefully because of the increased risk. Tamoxifen, an anti-estrogen drug, may sometimes be an option to reduce risk of breast cancer in these patients.

DCIS (duct carinoma in situ) is an early caner, stage 0. It is not a pre-cancer, it is an early cancer. It refers to cancer cells which are confined within the [basement membrane of the] duct. If cancer cells break through the basement membrane, it is refered to as IDC, invasive duct carcinoma. If DCIS is identifed on needle biopsy is must be surgically removed. The patient's prognosis is excellent. There are different subcategories of DCIS, some more aggressive than others. A women diagnosed with DCIS has an increased risk of developing a second DCIS later, or an invasive carcinoma. Because DCIS is confined to the ducts it should never metastisize or spread to other organs (but we never say never in medicine). Newer studies are characterizing DCIS by protein markers or genetics to identify the more aggressive ones, which have higher risk of the patient developing an invasive cancer in the future. Medical treatments such as Tamoxifen can be considered. Mastectomy is indicated in a small number of cases including depending on the size of the DCIS and the family history. Your diagnosis of DCIS supercedes your diagnosis of ADH, so there is no reason to mention the ADH. Your diagnosis is DCIS.

Good luck, I am confident you will do fine! Microcalcifications on a mammogram are a very common finding. They appear as tiny white specks or granules, composed of the element calcium. Most calcifications on a mammogram are perfectly normal and we just include them in the catchall diagnosis of "fibrocystic changes". They are not related to your dietary intake of calcium and you may continue with any dietary calcium you take.

Because cancer can lay down calcium, as well, it is the job of the radiologist to differentiate between the normal, innocuous calcium and the worrisome calcium. When calcifications are punctate and "round and regular" they can be dismissed. Calcifications within cysts are also normal. Calcifications which are potentially of concern are clustered, and their morphology is pleomorphic, appearing brached or irregular in shape, size and density. Clustered calcifications which are not definitively benign will either be watched at 6 month intervals, or biopsied. The best mode of biopsy for mammographic calcifications is a Stereotactic guided vacuum-assisted core needle biopsy. This is a minimally invasive needle procedure performed by the radiologist, or in some instances by a surgeon, that takes 20-40 minutes.

Results of this evaluation commonly are: normal (I won't go into all of those pathologic entities), ADH (atypical ductal hyperplasia), DCIS (duct carcinoma in situ), or invasive ductal carcinoma (IDC). Other important entities such as papilloma and radial scar will not be discussed here.

ADH is atypical cells. That means the pathologist visualizes abnormal cells, but they do not fulfill the criteria of cancer. ADH is significant because women with this diagnosis have an increased risk of breast carcinoma compared with the general population (about 4 times normal). If ADH is identified on needle biopsy, an excisional (surgical) biopsy is required to further evaluate this area. The tissue in this area is removed in order to see if there is any additional disease which was not removed by the needle sampling, such as DCIS or IDC, and to remove the remaining ADH. Statistically most women with ADH will never develop an invasive cancer, but they must be watched carefully because of the increased risk. Tamoxifen, an anti-estrogen drug, may sometimes be an option to reduce risk of breast cancer in these patients.

DCIS (duct carinoma in situ) is an early caner, stage 0. It is not a pre-cancer, it is an early cancer. It refers to cancer cells which are confined within the [basement membrane of the] duct. If cancer cells break through the basement membrane, it is refered to as IDC, invasive duct carcinoma. If DCIS is identifed on needle biopsy is must be surgically removed. The patient's prognosis is excellent. There are different subcategories of DCIS, some more aggressive than others. A women diagnosed with DCIS has an increased risk of developing a second DCIS later, or an invasive carcinoma. Because DCIS is confined to the ducts it should never metastisize or spread to other organs (but we never say never in medicine). Newer studies are characterizing DCIS by protein markers or genetics to identify the more aggressive ones, which have higher risk of the patient developing an invasive cancer in the future. Medical treatments such as Tamoxifen can be considered. Mastectomy is indicated in a small number of cases including depending on the size of the DCIS and the family history. Your diagnosis of DCIS supercedes your diagnosis of ADH, so there is no reason to mention the ADH. Your diagnosis is DCIS.

Good luck, I am confident you will do fine!

It all depends on how 'big' that one area of microcalcifications is. the goal is to get around the 'area' with clean tissue surrounding. You will need radiation afterward but may be able to get a shortened course - accelerated partial breast irradiaton. Also you may need hormonal therapy - anti-estrogen depending if your DCIS has estrogen receptors in the cells. It all depends on how 'big' that one area of microcalcifications is. the goal is to get around the 'area' with clean tissue surrounding. You will need radiation afterward but may be able to get a shortened course - accelerated partial breast irradiaton. Also you may need hormonal therapy - anti-estrogen depending if your DCIS has estrogen receptors in the cells.

Whether you use the term survivor, warrior, or some other descriptor, your cancer experience is no less "real" than someone diagnosed in a more advanced stage. When you hear the word cancer, and they're talking about you, the fears, concerns, and emotional ups and downs are no different regardless of the stage at diagnosis. It is a confusing diagnosis. Some would argue it's not "real" cancer since it hasn't spread (yet)--my running joke with my oncologist was "It's close enough! Someone sign me up for the fake mastectomy!" At first I didn't think I had earned the right to call myself a survivor since I wasn't in a fight for my life. Then I realized my experience counts for something, and as I mentioned elsewhere, no one with advanced cancer has ever made me feel like I had a lesser version. Talking to others who have been through it helped a lot too. I talked to a friend who had had early-stage cancer (not stage 0) and she said she felt the same way and she thinks it's normal for it to take awhile to consider ourselves survivors. Just hearing that helped a lot.

Well, that would take a book--ha ha--but a highlight would be that I had never heard of stage 0 breast cancer. I thought it only came in stages 1 through 4. The first thing my doctor told me was that my DCIS (ductal carcinoma in situ) is not life-threatening. So I felt very lucky. When three different doctors recommended a mastectomy I went from feeling lucky to feeling very sorry for myself. I had to make my peace with something I considered pretty drastic for a non-life threatening cancer. Once I did, I went back to feeling lucky.

It's a wonderful diagnosis to have because the prognosis is so good, but you still have emotions and treatment choices that are similar to more advanced cancers. One thing I think is unique to stage 0 cancer is that you can feel a bit sheepish about it, and wonder if you're entitled to call yourself a survivor. I felt that way for awhile and I've talked to other women with stage 0 cancer who did too. But it's a big tent and the members are welcoming. I've never met a woman with advanced cancer who made me feel like I had "Cancer Light." Well, that would take a book--ha ha--but a highlight would be that I had never heard of stage 0 breast cancer. I thought it only came in stages 1 through 4. The first thing my doctor told me was that my DCIS (ductal carcinoma in situ) is not life-threatening. So I felt very lucky. When three different doctors recommended a mastectomy I went from feeling lucky to feeling very sorry for myself. I had to make my peace with something I considered pretty drastic for a non-life threatening cancer. Once I did, I went back to feeling lucky.

It's a wonderful diagnosis to have because the prognosis is so good, but you still have emotions and treatment choices that are similar to more advanced cancers. One thing I think is unique to stage 0 cancer is that you can feel a bit sheepish about it, and wonder if you're entitled to call yourself a survivor. I felt that way for awhile and I've talked to other women with stage 0 cancer who did too. But it's a big tent and the members are welcoming. I've never met a woman with advanced cancer who made me feel like I had "Cancer Light."

DCIS is often more difficult to deal with surgically than invasive cancer, although the prognosis is much better. It generally does not form a lump or mass, and sometimes there are not even any calcifications, so it is often difficult to get an appreciation of just how much disease is present. MRI may not always even be helpful in determining the extent of disease. I often tell my patients that DCIS may not be a threat to your life but it can be a threat to the breast.

However if you have a small focus of DCIS that can be removed with lumpectomy (and a good cosmetic result), it is very reasonable to consider lumpectomy with radiation therapy. When I was initially diagnosed with DCIS, I was told I would probably need a lumpectomy and radiation. Later, the breast surgeon recommended a mastectomy. I had a hard time understanding why I needed such a radical procedure. My doctor explained that the micro-calcification fields were extensive - thus a lumpectomy would leave me deformed. Also, the radiologist couldn't say for sure that a lumpectomy would successfully remove all of the micro-calcifications. When I realized that the mastectomy was necessary both for my health and as a means to a more successful reconstruction, I made the decision for mastectomy.