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DCIS - Ductal Carcinoma in Situ Breast Cancer

DCIS and Tamoxifen

The drug tamoxifen has been used for over a quarter of a century to treat breast cancer. More recently, tamoxifen has been used to treat early stage breast cancer after primary treatment (lumpectomy or mastectomy). To grow and reproduce, breast cancer cells require the female hormone estrogen. Tamoxifen is an "anti-estrogen" and works by competing with estrogen to bind to estrogen receptors in breast cancer cells. Tamoxifen is formally known as a selective estrogen receptor modulator (SERM). By blocking estrogen in the breast, tamoxifen helps slow the growth and reproduction of breast cancer cells. Click here to learn more about tamoxifen.

Breast Reconstruction

Breast reconstruction is an important topic for women to discuss with their doctors before cancer treatment begins. Mastectomy (removal of the breast) will cause physical alterations to the breast.  Since DCIS is not an emergency condition requiring immediate action, there is time to weigh reconstructive options and become more informed. A procedure to rebuild the breast such as a TRAM Flap may be included at the end of mastectomy. This typically adds a few days to the recovery period. Women may also choose to have reconstructive surgery almost any time following recovery from mastectomy.

The standard options for breast reconstruction include: skin expansion followed by the use of implants, or flap reconstruction. Skin expansion involves the insertion of a balloon expander beneath the skin and chest muscles following mastectomy. The surgeon will periodically inject a salt-water solution into the balloon to fill the expander for the next several months. After the breast skin has been sufficiently stretched, the balloon expander is removed and replaced by a permanent implant. Today, some initial expanders serve as final implants. TRAM Flap breast reconstruction is also common after a mastectomy. In TRAM Flap reconstruction, a flap of the lower abdominal wall fat is transferred to the intended breast area with its own blood supply. Normally the blood supply comes from the rectus muscle(s) attached at the lower edge of the rib cage. A TRAM flap leaves a horizontal scar on the abdomen.

  Breast Reconstruction Options Include:

  • Skin expansion: insertion of balloon expander followed by silicone or saline implants 
  • TRAM Flap: abdominal wall fat transferred to breast area

Click here for more information on mammography and imaging guidelines after breast cancer surgery:  http://www.imaginis.com/breasthealth/after_surgery.asp

DCIS and Breast Cancer Recurrence

Occasionally breast cancer can return (recur) after primary treatment. Breast cancer most commonly recurs in the same area as the original cancer had occurred. Women with ductal carcinoma in situ (DCIS) who are treated with breast-conserving therapy (lumpectomy) are at a slightly higher risk of experiencing a recurrence than those women who are treated with mastectomy (removal of the affected breast).

However, several studies have shown that women treated with breast conserving therapy who have local recurrence of DCIS are not at any significantly greater risk of dying from the disease than women treated with mastectomy. DCIS is a common type of cancer that is confined to the milk ducts of the breast.  Click here to learn more about breast cancer recurrence.   

Additional References and Resources