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NCCN Guidelines for Patients


Breast Cancer - Carcinoma in Situ

(stage 0)

, 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.

Risk-reduction treatment

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


Lifestyle changes

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.

Endocrine therapy

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

cancer before.

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

endocrine therapy.

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

Figure 3.3

, tamoxifen blocks hormones so the growth