NCCN Guidelines for Patients
Breast Cancer - Carcinoma in Situ
, Version 1.2016
Risk reduction treatment
A sentinel lymph node biopsy is a surgery that finds
and removes the first lymph nodes to which breast
cancer spreads. It is also called a sentinel lymph
node dissection. Your doctor may suggest having this
biopsy during the mastectomy if it would be hard to
remove your lymph nodes, if needed, afterward.
Total mastectomy overview
Before the mastectomy, you will be asked to stop
eating, drinking, and taking some medicines for a
short period of time. If you smoke, it is important to
stop. Pain is prevented with general anesthesia.
Often, an oval-shaped cut is first made around the
nipple. Next, the breast tissue will be detached
from the skin and muscle and then removed. A total
mastectomy is finished within 1 to 2 hours. Afterward,
a tube may be placed in your chest to drain fluid.
A total mastectomy will leave a large scar and cause
pain and swelling. You may also have stiffness,
severe tiredness despite sleeping (fatigue), and
uncomfortable crawly sensations as your nerves heal.
Ask your treatment team for a complete list of side
Sentinel lymph node biopsy overview
Sentinel lymph nodes
are the first few nodes to
which breast cancer spreads. To find these nodes, a
radioactive tracer, blue dye, or both will be injected
into your breast. The tracer and dye will drain into
lymph vessels within your breast and then travel to
the breast’s lymph nodes. Most of these nodes are
in the armpit (“axilla”). Often, there is more than one
sentinel node to which the breast drains. After the
dye marks your sentinel node(s), your surgeon will
remove them and likely some other nearby nodes.
The nodes are then sent to a pathologist for testing.
After treatment for DCIS, some women take steps to
lower their chances of having another breast tumor.
This is called risk-reduction treatment. Risk reduction
may help prevent a tumor from growing in either
breast. Risk-reduction treatment is briefly described
Changes in your lifestyle may reduce your chances
of developing another breast tumor. Examples
are eating more healthfully, exercising more, and
achieving a healthy body weight. Your doctor can
suggest lifestyle changes that are specific to you.
Female hormones help some breast cancers grow.
Endocrine therapy includes treatments that stop
cancer growth caused by hormones. Endocrine
therapy is sometimes called hormone therapy but
is not the same as hormone replacement therapy.
Research suggests that endocrine therapy lowers the
likelihood of a second breast cancer among women
with estrogen receptor–positive DCIS. Breast cancer
is less likely whether the breast had or didn’t have
NCCN experts advise that you think about taking
endocrine therapy for 5 years following DCIS
treatment. Research on taking endocrine therapy
for more than 5 years is limited. How well endocrine
therapy works for women who had estrogen receptor–
negative DCIS is unclear. To help you decide, talk
with your doctor about all the pros and cons of
Which endocrine therapy is given may differ between
women who have menstrual periods and those who
don’t. Tamoxifen is advised for women who have
menstrual periods (pre-menopausal). As shown in
, tamoxifen blocks hormones so the growth