Ductal Carcinoma in situ (DCIS)

DCIS is a non invasive breast cancer. The cancer arises from the cells inside the milk ducts. “In-situ” means “in its original place” The cancer cells has not spread beyond the milk duct nor invade into any normal surrounding breast tissue therefore it not an invasive cancer.

credit source : breastcancercare.org.uk

DCIS is pre-cancer and not dangerous but it increases the risk of developing into an invasive cancer later on. The risk of recurrences can happen 5-10 years later and the chances of recurrence are about 20-30%

DCIS can present as a breast lump or detected from screen-detected mammographic micro-calcifications *

DCIS is graded according to the type of cells seen under microscope.

low grade (Grade 1) : slow growing cells
intermediate grade (Grade 2): moderate growth rate
high grade (Grade 3) : cancer cells looks changed and at fast-growing rate

IF DCIS is left untreated, it can potentially develop into invasive carcinoma.
However, some low grade may never develop or it grows slowly that it will cause no harm in a person’s lifetime. Higher grade DCIS has a higher potential to develop into invasive carcinoma if left unattended. As such, treatment is usually recommended but it could possibly lead to unnecessary or overtreatment for some cases.

VAN NUYS prognostic index (VNPI) for DCIS

Van Nuys Prognostic index is a simple scoring system that can be used to predict the risk of local recurrence and guide decisions on the best treatment options for patients with DCIS. It looks at 4 factors that could predict the probability of the DCIS aggressiveness ie. tumor size, margin width, tumor grade and age.

The most important predictor of local recurrence after wide local excision is the margin width. The wider the margin width, the lower the recurrence risk therefore, those with smaller margin width will benefit from radiotherapy.

VNPI scoring system	Score 1	Score 2	Score 3
Size tumor	<15mm	16-40mm	>41mm
Margin width	<10mm	1-9mm	<1mm
Grade	1	2	3
Age	>61 years	40-60 years	<40 years

Score (points)	Low (4-6)	Intermediate (7-9)	High (10-12)
10Y recurrence free survivial	97%	73%	34%
10Y Br Ca survival	100%	98%	98%
Treatment recommendation	Wide local excision (WLE)	WLE & Radiotherapy (RT)	Total mastectomy with SLNB