DCIS Behaviour.

Has anyone had any metastasis from DCIS some months or years down the line?

I have read in various medical journals over the past few months that a mastectomy for DCIS strangely and seemingly inexplicably has a slightly higher mortality rate due to breast cancer than just receiving a lumpectomy + radiotherapy for DCIS. Preventing a recurrence of DCIS and/or an invasive breast cancer does not seem to prevent death from breast cancer, and as said, death from breast cancer has a slightly higher rate after a mastectomy than after a lumpectomy + radiotherapy.

It seems, according to research, that breast cancer does not spread in a predictable sequence by stage as assumed in past decades  i.e. out of duct wall, within and throughout breast, infiltrating lymph nodes and then out to distant organs, but instead it can sometimes  mysteriously spread in other ways not really known or understood by medics or scientists at this time. Research papers advise early chemotherapy for DCIS because of these findings published in 2018.

Has anyone had any experience of these issues? Have you received chemotherapy straight off for DCIS despite no sign of invasion or microinvasion just to be on the safe side? Are any oncologists taking this route out of an abundance of caution? Have you had spread without recurrence of DCIS or a recurrence of invasive breast cancer? 

  • Hello Gwendoline66 ,  

    I'm afraid that I don't know if anyone will come along and post because it is very unusual to develop any metastasis following treatment for DCIS.  By definition, DCIS doesn’t spread because it isn’t an invasive type of cancer, however cancer invasion can develop within an area of DCIS and occasionally this might not be recognised. DCIS can also come back after treatment and start to invade. In addition, both DCIS and invasive cancer can occur later in the other breast. 

    In general, guidelines don’t recommend chemotherapy in pure DCIS as it isn’t needed because the outlook is usually very good.  

    I am not sure what you have been reading, but I would say to be cautious about the conclusions you draw. This is just because research is so complex and DCIS isn’t all the same. Different sorts of studies can carry more weight than others so some findings might not be as reliable as others. I hope you don’t mind me saying this. It can be useful sometimes to look at guidelines as they are based on an expert consensus about the research evidence so far.

    We have information about DCIS and how it is treated in the UK on our website. NICE (National Institute for Health and Care Excellence) and European Society of Medical Oncology (ESMO) clinical guidelines are mentioned at the bottom in references.

    Do talk to your own specialist team if you have concerns as a result of what you have read, I am sure they would be happy to give you some context and explain things.  They can also be give more information about the chance of the DCIS coming back in your case.

    Please get back to us if you need any more information or support.  You may find it helpful to talk things through with one of the nurses on our helpline.  The number to call is Freephone 0808 800 4040 and the lines are open from 9am till 5pm Monday to Friday.

    Yours sincerely,

    Sarah

  • Hi Sarah,

    Thanks so much for your reply. 

    The studies that I mentioned can be viewed in places like PubMed and similar publications and were based on many decades of statistics. 

    What you say is all very true though and I really appreciate it 

    Best wishes

    Gwendoline