An Overview of Stage 0 Breast Cancer

Understanding DCIS

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Stage 0 breast cancer, often called ductal carcinoma in situ (DCIS), is an early form of breast cancer that originates in the milk ducts of your breast. About 20% of all newly diagnosed breast cancers are DCIS. "In situ" means that the cancer is contained in the ducts or lobules and has not spread to other areas of the breast or lymph nodes.

When caught and treated at stage 0, DCIS has an excellent prognosis.

This article will outline the symptoms, treatments, and advice for coping with early-stage breast cancer.

stage 0 breast cancer
Verywell / Gary Ferster

Overview

Ductal carcinoma in situ, whether it is found in the lining of your milk ducts or inside the lobes where breast milk is produced, is a contained clump of abnormal cells. Oncologists call it stage 0 because it hasn't broken out of place (has not spread beyond what's called the basement membrane) or invaded other tissues.

Precancer or Noninvasive Cancer?

There is some debate over whether to consider DCIS precancer or noninvasive cancer. Generally, DCIS is considered noninvasive cancer, while lobular carcinoma (LCIS) is considered a precancerous condition, also called lobular neoplasia.

Learning that your condition is precancerous may make you worry that it will inevitably progress to cancer. This is not always the case, however, precancerous conditions like LCIS should be monitored closely.

Diagnosis

A mammogram will detect the abnormal cells in DCIS. The next step is to have a needle biopsy, which is performed to remove the cells in question and have them analyzed under a microscope by a pathologist. Your doctor will help you translate the pathology report to help you make decisions about whether to treat immediately or "watch and wait."

You can ask for a copy of your pathology report to get a second opinion, and most pathologists will encourage you to do this. Getting a second opinion can be done by telehealth instead of having to have an-person visit in a lot of cases.

Staging

The staging system most often used for breast cancer is the American Joint Committee on Cancer (AJCC) TNM system. The TNM Staging System is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of metastasis (M). Numbers or letters after T, N, and M provide more details about these classifications. Using this classification system, stage 0 can be grouped as follows:

  • Tis: This indicates carcinoma in situ (DCIS, or Paget's disease of the breast).
  • N0: Cancer has not spread to the nearby lymph nodes.
  • M0: X-rays (or other imaging tests) have concluded that cancer has not spread to other parts of the body (metastasized).

Once the T, N, and M are determined, they are combined, and an overall stage of 0, 1, 2, 3, or 4 is assigned. 

Treatment

Not all stage 0 breast cancers require treatment. Some oncologists may recommend active monitoring, or a watch-and-wait approach, to see if the carcinoma will remain stable or if it will progress. Others recommend standard cancer treatments such as surgery, radiation, or chemotherapy.

In terms of patient perspectives, some people would prefer having any suspicious areas removed if there is a chance that stage 0 could become invasive cancer, whereas others are more comfortable with a conservative approach of waiting, along with careful follow-up.

Numerous factors will affect your treatment plan. Some of these include:

  • Age: Younger women are more likely to be at risk for local recurrence and may opt for treatment sooner.
  • Fertility: A woman may want to preserve her eggs before starting treatment.
  • Hormone status: Breast cancers tend to be positive or negative for both estrogen and progesterone receptors.
  • Genetic risk: Having a mother, aunt, or sister with breast or ovarian cancer ups your risk.
  • Menopausal status
  • Personal preferences

Treatment options may include a lumpectomy (surgery to remove the cancerous tissue and a rim of normal tissue around it), followed by radiation (using high doses of radiation to kill cancer cells), or mastectomy (surgery to remove the breast) if there's a concern that there may be other regions of cancer in the breast or if there's a strong family history of breast cancer.

Hormone therapy may follow for at least five years, with tamoxifen often used for premenopausal women and aromatase inhibitors for those who are postmenopausal, as they block estrogen in hormone-receptor positive breast cancers.

Breast Cancer Healthcare Provider Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Old Woman

Survival Rates

The outlook is good for people diagnosed with stage 0 breast cancers. When localized stage 0 breast cancer is detected early and treated, the five-year relative survival rate is 90%, according to the American Cancer Society.

Follow-Up Care

After treatment for stage 0 breast cancer, you face a small risk of recurrence or the future development of invasive breast cancer. Your healthcare provider may recommend more frequent exams and/or tests so any future cancers can be caught and treated early.

Coping

Better understanding of what stage 0 breast cancer is (and isn't) is one of the best steps you can take to cope with your diagnosis. It puts your condition in perspective and can help temper worries.

Although it's common to feel helpless at first, know that the more you educate yourself about treatment options and the emotional aspect of the diagnosis, the better prepared you'll be to deal with the road ahead.

An organization called CancerCare.org has individual counselors and support groups to help connect you with others in the same situation. They also offer education and financial assistance.

Summary

Stage 0 breast cancer, DCIS, is the earliest stage of localized breast cancer, affecting approximately 49,290 women this year. Being diagnosed at this early stage sets you up for an excellent outcome. After getting a diagnosis, the pathology report and a second opinion will help you and your medical team make the best decisions for your treatment and follow-up care.

A Word From Verywell

A cancer diagnosis can be overwhelming. But with a stage 0 diagnosis, you're facing the best-case scenario by catching it early. Work closely with your healthcare provider to create a treatment plan that's best for you, and move forward with the knowledge that what you have is not only treatable but highly curable.

Frequently Asked Questions

  • Can stage 0 breast cancer come back?

    Yes, and recurrence may be related to age. Younger women are more likely to be at risk for local recurrence and may opt for treatment sooner.


  • Is surgery necessary for stage 0 breast cancer?

    Not always. Some physicians recommend a wait-and-see approach. If the cancer does not stay localized, surgery—whether it is a lumpectomy or mastectomy—may be recommended.

  • Who is at risk for stage 0 breast cancer?

    Anyone can be at risk for stage 0 breast cancer. Risk increases if you have a direct relative with breast cancer or if you carry genetic mutations for breast cancer, like BRCA1/BRCA2.

  • Should I have a mastectomy for DCIS?

    Having a mastectomy is a very personal decision. You should talk with your physician and an oncology surgeon who specializes in breast cancer to talk about your options. If you have a family history of breast cancer, you may have a higher sense of urgency to have this procedure rather than waiting it out.

Originally written by
Pam Stephan
Pam Stephan is a breast cancer survivor.
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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Barrio AV, Van Zee KJ. Controversies in the Treatment of DCIS. Annu Rev Med; 68: 197–211.

  2. American Cancer Society. Lobular Carcinoma in Situ (LCIS).

  3. American Cancer Society. Understanding Your Pathology Report: Ductal Carcinoma In Situ (DCIS).

  4. Gradishar WJ, Anderson BO, Balassanian R, et al. Breast Cancer, Version 4.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018;16(3):310-320. doi:10.6004/jnccn.2018.0012

  5. American Cancer Society. Survival Rates for Breast Cancer.

  6. McCormick B, Winter K, Hudis C, et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 2015;33(7):709-715. doi:10.1200/JCO.2014.57.9029

  7. Breastcancer.org. U.S. Breast Cancer Statistics.

Additional Reading