It’s not just about lumps

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Recently, Martina Navratilova, nine time Wimbledon singles champion was diagnosed with Ductal Carcinoma In Situ (DCIS), an early form of breast cancer. A 53-year-old, she had skipped her annual screening mammogram for four years, despite the fact that women over 40 must have them done. She admits her healthy lifestyle and status created a certain complacency when it came to following through with her annual checkups.
Sure, everyone gets busy, but despite leading a healthy lifestyle, chances are you could developed DCIS. In fact in India, 100,000 new cases of breast cancer are diagnosed each year, although there are no precise statistics for DCIS. Luckily, for Martina it was detected at an early stage. But not everybody may be as lucky. s

What is DCIS?
The breast is made up of ducts, lobules and fatty tissue. DCIS is an early form of breast cancer where the cancer cells are inside the ducts (that carry milk to the nipple). This is a pre-cancerous condition where cancer cells have not developed the ability to spread beyond the milk ducts into the normal surrounding breast tissue

Symptoms
What sets DCIS apart is that it does not have very obvious symptoms. In some cases, the symptoms could be a blood stained discharge from the nipple, a rash around the nipple (referred to paget’s disease) or very rarely with a lump.

Diagnosis
DCIS is detected with a routine breast screening assessment. Assessment includes clinical breast examination, breast imaging and a needle core biopsy.
As DCIS very rarely presents with a lump, clinical breast examination is not usually helpful. The mammogram, usually shows a cluster of abnormal looking microcalcifications. However, that not all microcalcifications are cancerous. Finally, to make a diagnosis, a piece of tissue is removed by doing a core needle biopsy.
If DCIS is left untreated, the cancer cells may eventually develop the ability to spread from the ducts into the surrounding breast tissue. This is known as invasive breast cancer.

Treatment
The aim of treatment is to remove all DCIS in the breast to prevent the development of invasive breast cancer. The treatment depends upon the factors such as the extent of the DCIS within the ducts and the grade.
Breast surgery is the first line treatment for DCIS. If it is localised and confined to one area of the breast, breast conservation surgery can be performed. A mastectomy is surgical treatment of choice if the DCIS affects a large area of the breast; or if it hasn’t been possible to get a clear area of normal tissue around the DCIS using breast conserving surgery, or if there is more than one area of DCIS in the breast.
Further treatment is required following surgery. This is referred to as adjuvant therapy and includes radiotherapy and hormone therapy. If the patient has had mastectomy, radiotherapy is not required.
Usually, in cases of DCIS, chemotherapy is not required.

Is it life threatening?
If detected and treated on time, the cancer does not spread beyond the milk ducts into any normal surrounding breast tissue. Hence, it is not life-threatening. The long term survival rate for women with DCIS is excellent, close to 100 per cent.

The writer is director KIMS-USHALSKHMI Centre for Breast Diseases, Hyderabad.