Ductal Carcinoma in Situ | Assignment

Ductal Carcinoma in Situ 1
DUCTAL CARCINOMA IN SITU
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Ductal Carcinoma in Situ 2
Ductal Carcinoma in Situ
Introduction
Ductal Carcinoma in Situ (DCIS) is a non-invasive type of malignant tumor that occurs in
milk ducts of the breast. When DCIS is left untreated, the cancer cells within the milk ducts
could spread and become invasive. Over 6700 people are affected by DCIS in the United
Kingdom (Cancer Research UK, 2020). In this case, early detection and treatment are
recommended to enhance patient outcomes. DCIS is associated with a lump, redness, pain, and
breast swelling. The diagnosis of DCIS is carried out through comprehensive breast imaging.
The use of mammography is recommended because it guarantees the differentiation between
linear and granular calcification (Heywang-Kobrunner et al., 2011). Based on the outcome of the
mammography, a physician could recommend further assessment using techniques such as
pretreatment ultrasound. Ultrasound is a recommended pretreatment imaging technique because
of its numerous advantages. Ultrasound is quick since it does not require prior special
preparations, the results are obtained immediately after imaging, and it does not use radiation.
Shailey (not her real name) is a 59 years old female who visited a breast cancer screening
clinic. Shailey noticed an area on her left breast which appeared red. Shailey does not have any
cancer-related history in her family. A history of cancer in a family is a risk factor for diagnosis.
However, in Shailey’s case, it implies that she is at a lower risk of developing breast cancer.
Upon examination, Shailey had a lump, swelling of breast, redness, and subsequent pain in the
identified area. These symptoms are similar to ductal carcinoma. Therefore, the initial diagnosis
was conducted where Shailey underwent mammography on both breasts. After the mammogram
results came out, Shailey was recalled for further assessment because the clinician suspected a
possible DCIS in her left breast. She was referred to a pretreatment ultrasound, which showed

Ductal Carcinoma in Situ 3
the presence of abnormal lymph nodes within the left breast. A biopsy guided by the ultrasound
was used to determine the malignancy of the lesion, the grading of carcinoma, and whether the
cells were cancerous. After the differentiation of normal and abnormal image appearances,
appropriate treatment was recommended to guarantee a limited chance of reoccurrence while
preserving the breast. Lumpectomy was selected as the preferred treatment as opposed to
mastectomy (Sato et al., 2012). Shailey also consented after the practitioner explained the entire
process and its effectiveness. Lumpectomy was used to remove the cancerous cells followed by
radiology to destroy the remaining cells to prevent the reoccurrence of cancer. A follow-up based
on the mammogram was recommended due to its high sensitivity to check for possible cancer
reoccurrence after a five-year duration.
The objective of this comparative assessment essay is to evaluate the appropriateness of
the imaging technique involved during the diagnosis, treatment, and follow-up among DCIS
patients in line with Shailey’s case. The paper examines the safety considerations, radiation dose,
and imaging modalities. The comparative excerpt also addresses the current working practices
and additional protocols associated with DCIS. Finally, the paper presents the treatment
intervention and follow-up considerations characterizing DCIS as witnessed with Shailey’s case
example.
Discussion of the DCIS Pathway
Imaging Technique Involved: Advantages and Limitations of Mammography
Early detection of breast cancer is associated with a reduction in mortality rate by 25%
and increases treatment efficiency. Mammography has improved early detection of DCIS and
breast cancer (Loberg et al., 2015). This imaging technique is associated with significant
advantages; however, clinical evidence also ascertains that mammography is linked to several

Ductal Carcinoma in Situ 4
limitations. Mammography has a high sensitivity and specificity level estimated at 75% to 90%
and 90% to 95% respectively (Zeeshan et al., 2018). For women between 50 and 69 years of age,
the predictive level is estimated at 60% to 80% with a diagnostic accuracy of 89.3% (Zeeshan et
al., 2018). Mammography is also associated with low radiations, which is less harmful.
Screening of breast cancer has been linked to an increased mortality rate; however, the use of
mammography guarantee mortality reduction. The technique also paves the way for improved
treatment and early detection of DCIS and breast cancer. A study by Heywang-Kobrunner et al.
(2011) also ascertained that the use of mammography improves the quality of patient outcomes
as well as the diagnostic chain process.
On the other hand, mammography has several clinical limitations. Studies have shown
that mammography exposes patients to radiation even though it is in a limited amount. The
glandular dose is estimated at 4 mGy per breast (Heywang-Kobrunner et al., 2011). However, the
beast size determines exposure. In his case, the use of full-field digital mammography reduces
the glandular dose. Additionally, mammography is associated with the risk of false alarm. There
is a chance of detecting abnormalities, which calls for additional intervention measures to
ascertain a diagnosis. Other limitations associated with mammography include interval cancers
and overdiagnosis (Heywang-Kobrunner et al., 2011). In order to overcome the limitation of
mammography, the use of Contrast Enhanced Spectral Mammography (CESM) is recommended
(James & Tennant, 2018).
Based on Shailey’s case, mammography was recommended after careful clinical
examination, which was according to the suggestions when she was referred to the facility. The
process was carried out while adhering to the Ionizing Radiation (Medical Exposure)
Regulations also known as the IR(ME)R. Shailey was asked to take away all the pieces of