DCIS (DUCTAL CARCINOMA IN SITU)
DCIS BREAST CANCER
DCIS is also referred to as STAGE 0. There’s a stage between having a healthy (non-breast cancer) body and early signs of invasive tumor growth. It’s where signs of cancer can be seen, but it remains situated within a cell, not doing any particular harm at that stage. If it were to stay in situ, that would be ok, I think?
The problem is that oncologists have to anticipate whether DCIS will leave that cell and spread into the surrounding breast tissue. Once it starts to spread, the danger begins. So,
Do you pre-empt by taking chemical treatment at this asymptomatic stage – DCIS is not something you’ll feel?
Do you take other preventative alternative action?
Should you do both, or
Should you do nothing?
There’s very little research on women of African heritage with DCIS, but there has been some. It’s better to go backwards here. International research seems to accept the global phenomena that women of African heritage have an overall much higher incidence of aggressive breast cancer than other women in the world. So, DCIS is probably our first warning. It would be helpful to know what percentage of us develop invasive breast cancer from a DCIS diagnosis. However, research outcomes vary except that black women with DCIS develop into invasive breast cancer at much higher and faster rates than white women.
Some other things are known. There are two types of DCIS.
LOW GRADE – low-grade DCIS progresses to low-grade invasive cancer.
Up to fifty per cent will develop into invasive cancer if left untreated. However, undergoing treatment for DCIS by removing pre-tumors has not reduced the invasive breast cancer rates in western countries overall. Therefore, we must assume that invasive breast cancer can develop entirely independently of DCIS.
HIGH GRADE – high-grade DCIS leads to high-grade invasive cancer.
Invasive cancer is more often high-grade in us as black women, but I know this will sound contradictory, but there is no evidence that this is due to race. High-grad invasive breast cancer might also be due to other things like our socioeconomic conditions. Or to be the disproportionate quality of medical attention received by black women. For example, the medical follow-ups after mammograms are much lower for black women of African ancestry than for white European women.
IS DCIS RELATED TO THE BRCA GENE
This is a difficult question to answer from a black female perspective in the absence of comprehensive studies. General research is inconclusive, but DCIS may have connections with the BRCA gene where,
A hereditary factor is present with
Early-onset invasive breast cancer in younger women.
An early taking of oral contraceptive (Estrogen related DCIS)
On the other hand, it’s also argued that all stages of breast cancer occur when the mutated BRCA gene is present. Things just move faster so that DCIS can have occurred so quickly it went unnoticed in conventional screening tests such as mammograms.
What does any of this tell you?
Don’t make an automatic decision that you’re genetically predisposed based on being a black person until you have more information about your body and family history. Genetic screening will provide you with the most accurate personalised assessment. Mammograms fail black women thirty per cent of the time but genetic screening is still very expensive (About £1.500). Either way, you must ask more questions of your doctor and yourself. Be as informed as you can before making your decision.
ALSO:
Recurrence of DCIS comes back significantly earlier compared to white women
Comorbidities with DCIS are aggravating factors
Black tend to be much older than white women on diagnosis
Invasive breast tumors in African Americans grow faster and metastasize earlier than those in white women.
Compared to U.S. white women, African American women are more than twice as likely to die from DCIS. I would wager that a similar pattern is mirrored in all ‘developed’ countries.
For estrogen-related DCIS, body composition (BMI) could be a factor – low in adolescence/young women, and high in postmenopausal obesity in older women. This is not conclusive.
Breast cancers that arise in younger women, tend to be more aggressive.
