Advantages and Disadvantages

Surgery and Active Monitoring are different initial approaches to treating low-risk DCIS. Each approach has advantages and disadvantages.

With Surgery, the DCIS area and tissue around it are removed. The risk of future invasive breast cancer is reduced. Depending on the type of operation you have, some or all of your breast will be removed. The tissue that is removed in the operation is carefully examined. At this stage, invasive cancer is found in a small number of patients. More surgery (re-excision) or radiation therapy may be required. You may experience side-effects from the surgery and/or radiation. Some side-effects may affect your daily life and some can be long-term. Surgery (and radiation if given) may cause pain and change the look and feel of your breast. This may affect you physically and emotionally. Some patients choose to have additional surgery to reconstruct the breast; this can have other side-effects. All side-effects will be assessed and managed carefully by your clinical team.

With Active Monitoring, you have a check-up and mammogram every six months to look for any changes in the breast. Most patients should be able to stay on Active Monitoring for at least 10 years. A small number of patients will have invasive cancer that may worsen. You may experience anxiety from wondering whether your DCIS is growing or changing. If any changes are seen in your breast that concern your doctor, you will be advised to have further tests, such as a biopsy. You might be able to stay on Active Monitoring. However, if the changes are suggestive of invasive breast cancer, you will be advised to have surgery (and radiation if needed). It is possible that you might need more extensive treatment at this stage than if you had surgery when your DCIS was first diagnosed.

With both Active Monitoring and Surgery, it is important to note that there are risks of invasive cancer developing in the breast with DCIS, the other breast, or somewhere else in your body. The side-effects and experiences of each treatment approach are summarized in Table 2.

Table 2. Side-effects and experiences of the Surgery and Active Monitoring treatment approaches
	Surgery Approach	Active Monitoring Approach
Common side-effects or experiences	Scar (small from lumpectomy, larger from mastectomy). Pain in breast, chest or arm, which may be long lasting. Loss of skin sensation around scar or across breast. Blood or clear fluid collections in the wound that slow recovery process. Concern about the new physical appearance of your breast. Uneven breasts. Worry about DCIS recurrence or cancer development or progression despite having had treatment. Radiation therapy causes fatigue, a sunburn like effect, and changes in the texture of the breast.	As active monitoring is the first course of treatment, the natural breast remains unchanged. Missing work and usual activities for each 6-month mammogram and check-up. Discomfort during mammogram. Anxiety while waiting for results of mammogram. Worry that more DCIS could be found, or that the DCIS could grow, or invasive cancer might be found.
Less common side-effects and experiences	Swelling in the breast or arm (lymphedema) if nodal surgery is performed. Wound infection requiring antibiotics. Shoulder pain and reduced ability to move arm and shoulder. Difficulty adjusting to new body image. Negative impact on sexuality or sexual activity. Complications from reconstruction (if undertaken) Rare serious side effects of anesthesia	If you change to surgery later, you may experience the same risks of side effects as listed to the left.