Breast Cancer

  • Medical Author:
    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Pink Ribbon for Breast Cancer Awareness Month

Quick GuideBreast Cancer Pictures Slideshow: A Visual Guide to Breast Cancer

Breast Cancer Pictures Slideshow: A Visual Guide to Breast Cancer

I have a ductal carcinoma in situ (DCIS), a type of localized cancer. Why have I been advised to have a mastectomy when other women with invasive breast cancer have lumpectomies?

Ductal carcinoma in situ (DCIS) sometimes presents a difficult dilemma. Most patients with DCIS can undergo successful breast-conservation therapy but not all. The diagnosis implies that this is an "early" form of cancer in the sense that the cancer cells have not acquired the ability to penetrate normal tissue barriers or spread through the vascular or lymphatic channels to other sites of the body. It is important to realize that breast cancer is a wide spectrum of diseases, and no comparisons should be made just on the basis that someone you know has "breast cancer" and shares a different treatment approach with you.

However, the millions of cells forming the DCIS have accumulated a series of errors in their DNA programs that allow them to grow out of control. There are varying degrees of disturbance, called "grades," of the normal cellular patterns. Low grades are usually more favorable, and high grades are less favorable.

The DCIS cells originate from the inside of the breast gland ducts (microscopic tubes). As they multiply, the cells fill and spread through the normal ducts of the breast glandular tissue. With many DNA errors already in place and millions of these cells exposed to the usual risks of additional DNA damage, a few cells will ultimately become invasive. This invasive change is the real risk of DCIS.

Treatment that does not physically remove all of the DCIS seems to leave some risk of recurrence and, therefore, invasive disease. In cases where the DCIS has spread extensively through the breast ducts, even though the disease is in a sense "early" because it is not yet invasive, it may still require a large surgical resection, at times even a mastectomy (removal of all or part of the breast).

Your treatment team should be able to discuss the pros and cons of the different approaches and actively include you in the decision process.

Medically Reviewed by a Doctor on 4/25/2016

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