Stage 0 Breast Cancer

DCIS is very slow growing and highly treatable

If you’re diagnosed with cancer, asking which stage is likely one of your first questions. Stage 1 is the earliest, most treatable stage of cancer, while stage 4 is the most advanced and difficult to treat — as it means the cancer has spread to other parts of the body.

But have you ever heard of stage 0 breast cancer?

“Stage 0 breast cancer is the earliest, noninvasive form of breast cancer,” says Erin Miller, DO, breast surgeon at Geisinger. “In stage 0 breast cancer, there are abnormal cells with cancer characteristics in the milk ducts of the breast tissue, but the cells haven’t spread to healthy tissue.”

The good news about stage 0 breast cancer? It’s highly treatable and if you can detect it, you can take steps to prevent further development. While stage 0 breast cancer is very slow growing and may never progress to invasive cancer, you shouldn’t ignore it. Catching any cancer early — before it has a chance to grow and spread — is key to improving outcomes.

DCIS vs LCIS: What are the types of stage 0 breast cancer?

The most common type of stage 0 breast cancer is DCIS, or ductal carcinoma in situ. It occurs when abnormal cells are found in tissues lining the milk ducts, the tubes milk flows through while breastfeeding. Paget’s disease — a rare condition where abnormal cells are found in or around the nipple and areola — is also classified as DCIS.

LCIS, or lobular carcinoma in situ, used to be considered stage 0, but is now classified as pre-cancer instead — as it’s not a precursor to invasive breast cancer. LCIS occurs when abnormal cells develop in the breast lobules, the glands that produce milk.

While their names include the word carcinoma, DCIS and LCIS aren’t truly breast cancer. They’re noninvasive and highly treatable, and they aren’t life threatening. In fact, the 5-year survival rate is nearly 100%, according to the American Cancer Society.

“However, left untreated, abnormal changes can continue, increasing a person’s risk for developing breast cancer later on,” says Dr. Miller. “That’s why they should be closely monitored and treatment usually is needed.”

What are symptoms of DCIS and LCIS?

DCIS and LCIS typically don’t have symptoms. While it’s possible to feel a small, hard lump or have nipple discharge, most people discover they have the condition through regular mammograms — which can detect abnormal changes before symptoms appear.

“In some cases, LCIS isn’t detected on a mammogram, but instead is found after a biopsy or test is conducted for another abnormality,” says Dr. Miller.

However, Paget’s disease can cause noticeable symptoms, including:

Burning or itching around the nipple or areola
Red, crusty or scaly skin around the nipple and areola
Nipple discharge that’s yellow or bloody
A flat or inverted nipple

How are DCIS and LCIS treated?

Because providers can’t predict whether stage 0 breast cancer will invade the tissues surrounding it, ongoing monitoring and/or treatment are key to reducing the risk of developing breast cancer.

“There are many factors that will determine your treatment plan, such as your age, family history and size of the tumor,” says Dr. Miller. “If you’ve been diagnosed with stage 0 breast cancer, you and your doctor will discuss treatment options to put together a plan that’s right for you.”

A common treatment for DCIS is a lumpectomy, where the abnormal cells and surrounding tissue are removed from the breast, but most of the breast is preserved.

In most cases, surgery is followed by radiation therapy to destroy any abnormal cells that may have been left behind. Since stage 0 breast cancer has not spread to other parts of the body, chemotherapy is typically not necessary.

Another option is a mastectomy, where the entire breast is surgically removed. A mastectomy may be necessary if the DCIS tumor is very large or your breast has several separate areas of DCIS, or you have high risk factors for breast cancer.

If the DCIS is found to be hormone-receptor positive, your doctor may also prescribe hormone-blocking medication, which is typically taken for 5 years to prevent abnormal cells from growing again.

“Hormonal therapy medicines can help reduce the risk of breast cancer developing because DCIS is often hormone-receptor positive, which means that estrogen or progesterone can promote abnormal cell growth,” says Dr. Miller.

Unlike DCIS, LCIS doesn’t require treatment, but rather close monitoring through mammograms and other imaging tests, such as a breast MRI or ultrasound.

Can stage 0 breast cancer be prevented?

Early detection is the most effective defense against developing breast cancer. Mammograms and clinical breast exams help providers find and treat stage 0 breast cancer earlier, before it has a chance to progress.

If you’re in your 20s or 30s, start getting a clinical breast exam annually from your primary care provider or gynecologist. If you’re over age 40, talk to your provider about risk factors that determine how often you should have a screening mammogram.

It’s also helpful to know your family history, so you can take preventive steps like early screenings and minimizing risk factors. You can lower your risk for breast cancer by following a healthy lifestyle, including:

Eating a healthy, balanced diet
Exercising regularly
Limiting alcohol
Not smoking
Maintaining a healthy weight

If you notice any changes in your breasts, talk to your provider to determine the next best steps.

“And if you’re diagnosed with stage 0 breast cancer, know you’re facing the best-case scenario by catching it early,” says Dr. Miller. “You can work closely with your provider to develop a treatment plan and move forward knowing DCIS and LCIS have excellent prognoses.”