DCIS - What is it? Is that really "not cancer"?

In a recently released video. actor Mahima Chaudhary narrates that during an annual screening, she was detected with 'DCIS'. 

What is DCIS? Is it cancer? Is it not?

I thought I owe this explanation to my readers. So, here I go. Read on to find out. 

Why did she need an annual screening? 

Why did  Mahima go for that annual screening? Was there a real need when she showed no symptoms? 

Screening means getting tests to detect cancer as early as possible - even before you have any symptom. 

Read more about cancer screening tests here and talk to your doctor to know whether you should be annually screened for breast cancer. 

What is DCIS?

DCIS is the short form for 'ductal carcinoma in situ'. 

It is also called intraductal carcinoma. 

Is DCIS cancer? 

Yes, DCIS is cancer. 

It is a very early stage of breast cancer. 

Let's understand the term 'ductal carcinoma in situ'. 

Carcinoma, as you may recall, is just a more technical terminology for cancer. 

Ductal carcinoma refers to the detection of cancer cells inside the milk ducts of the breast. 

'in situ' means it is situated 'in its original place'. 

'in-situ carcinoma' is a term used for cancer that is non-invasive or 'pre-invasive' which means it has not yet reached a stage when it has spread to through the walls of the milk duct. 

This is very early stage of breast cancer. The cells inside the milk duct have become abnormal or changed to cancer cells but they have not yet spread through the walls of the milk duct to the nearby breast tissue. 

Should I be bothered about DCIS?

DCIS is usually found during a screening mammography. It is detected as small irregulat clusters of calcification on the mammogram. 

Typically, it does not have any signs or symptoms. It can sometimes cause signs such as

 

*  Breast lump

*  Bloody discharge from the nipple

DCIS still has not spread outside the duct. As it has not spread into the adjoining breast tissue, it cannot metastasize (or spread to distant parts of the body). 

DCIS can sometimes become an invasive cancer. When this happens, the cancer can spread to adjoining breast tissue as well as to cause distant metastasis. 

Currently, there are no sure-shot ways to know which DCIS cases will turn into invasive cancer and which will not. 

How is DCIS treated?

A woman with DCIS can choose to get only the affected area removed (lumpectomy or breast-conserving surgery) or get all the breast tissues removed (simple mastectomy) as a preventive measure. 

Usually, after a breast-conserving surgery, radiation is given. Radiation therapy kills the cells in the margin of the operated area to prevent growth of abnormal cells there. 

If the DCIS is hormone-receptor positive, the doctor may suggest medicines that can arrest the growth of cancer cells.  

The bottom line

DCIS is cancer which is in a very early stage and has not spread to the adjoining breast tissues. 

A close watch and an early and effective treatment can cure DCIS. Thus, DCIS is a curable stage of breast cancer. It is, therefore, also called stage 0 breast cancer. 

Rushing a person having a heart attack can endanger his life further.

The videos are going viral. By now, you have probably watched the last video of the popular singer KK. When he complained of chest discomfort, he was rushed out of the concert where he was performing and immediately taken to Calcutta Medical Research Institute. He was declared "dead on arrival". 

This may sound shocking but the organizers and managers might have actually endangered KK life further by making him run to the car. 

Take a look at the video once again.

KK was visibly in discomfort. He was showing typical signs of a a heart attack. 

During a heart attack, a person's heart rate may be increased or may remain the same. An increased heart rate is not a specific sign of a heart attack. 

Do not panic

When someone near you has signs or symptoms suggestive of a heart attack, the first thing for you is to stay calm while taking measures to help the person. 

By creating a panic situation around KK and making him run, what people did was this. They put his body in a further stressful condition. This is expected to have increased his heart rate. 

When the heart rate increases, it means the heart is beating faster. It is working harder to pump the blood. As a result, the heart's own need for oxygen increases. 

Damage to the heart

When a heart attack occurs, the heart muscles are damaged due to lack of oxygen. The amount and severity of the damage depends on several factors. 

According to the American Heart Association, it depends on: 

• Size of the area supplied by the blocked artery
• Oxygen need of the heart muscles
• Time between the heart attack and the start of treatment

The damaged area of the heart heals over several weeks by forming a scar tissue. Heart is a very powerful muscle. Even if some part of the heart may be scarred after a heart attack, the rest of the heart continues to pump blood into different parts of the body. 

The damage however, makes the heart weak and it is unable to pump blood as efficiently as before. 

Heart rate can sometimes predict death rate. 

According to a study published in the European Heart Journal, when the heart rate at admission is high (more than 80 beats per minute), it is significantly associated with in-hospital death. 

Exercise and stress are both known to increase the heart rate. Stress during a heart attack also increases the blood pressure and the heart's need for more oxygen. 

What to do?

If you think someone is having a heart attack, here are some things you can do. 

** Have the person sit down, rest and try to keep calm. Ensure they are comfortable, sitting on the floor and leaning against a chair or a wall. Ask them to keep their knees folded. Place pillows below the knees. Sitting eases the strain on the heart. It will also ensure they do not hurt themselves if they collapse.

**Loosen any tight clothing such as a belt or a necktie. This will make it easier for the person to breathe. 

**People who have angina (a squeezing chest pain) are at an increased risk of heart attack. They are prescribed angina medications such as nitroglycerin. Ask if the person takes any chest pain medicines, such as nitoglycerin for a known heart condition. Help them take the medicine. 

**If the pain does not go away promptly with rest or within 3 minutes of taking the chest pain medicine, it is safer to pressume that it is a heart attack. Call emergency. That's 911 if you are in the USA and 102 for ambulance service in India. 

**A tablet of nitroglycerine will usually relieve the pain within 1 to 5 minutes. If it does not, while you are waiting for emergency help to arrive, give another nitroglycerine tablet after 5 minutes. 

**If the person is not on an angina medication or the medicine is not available, ask them if they are allergic to aspirin or have any medical condition where aspirin must not be given. Once you know it is okay to give them aspirin, you can give them 325 mg of aspirin tablet. Ask them to chew it slowly. Time is critical during a heart attack. Instead of swallowing the whole tablet, if they chew it slowly and then swallow, it will be absorbed faster and will be more effective. Aspirin is a blood thinner. It helps to remove the blockage in the artery. Aspirin takes about 15 minutes to start its effect. So, remember to call an ambulance. 

**If the person becomes unconscious or unresponsive, start CPR without delay. 

What not to do?

Do not give aspirin without checking. Give an aspirin only if you know the person is not allergic to aspirin or does not have a medical condition where aspirin is contraindicated or can cause serious side effects. 

Do not leave the person alone except to call for help, if needed. 

Do not allow the person to convince you not to call for emergency help. 

Do not wait to see if symptoms go away. A heart attack is an emergency. 

Do not panic though. Only if you are calm can you keep the person calm and rested till help arrives. 

A sudden cardiac arrest is not the same as a heart attack

Popular Bollywood singer KK was merely 53 when he suddenly died after performing at a concert at Kolkata this week. As I flipped through news posts today, I noticed that some news headlines say he died of a heart attack while other headlines say the cause of the death was a sudden cardiac arrest. A sudden cardiac arrest is not the same as a heart attack. 

For the benefit of my readers, let me try and make it clear why the two terms cannot be used interchangeably. Also, we need to remind ourselves that just two steps taken as an emergency measure could have increased the chances of KK's survival. 

Singer KK was merely 53 years old when he suddenly died after a concert on 31 May 2022. Could prompt emergency measures have prevented the casualty? 

The heart is a muscular pump that pushes blood into different parts of the body through a network of blood vessels. The heart muscles get their nutrition and oxygen supply through blood vessels called coronary arteries. 

What causes the heart to beat? The heart beats due to contraction and relaxation of its muscles.  Different parts of the heart contract and relax when an electrical signal passes through them like a wave. This wave-like signal is generated in the right upper chamber of the heart and then passes to its other areas. 

Simply put, a heart attack is when the blood flow to a part of the heart is blocked as one or more of the coronary arteries or their branches is blocked. 

In contrast, a sudden cardiac arrest (SCA) is when the heart does not beat normally and suddenly stops beating because the wave-like electrical signal that generates heart beats is disrupted. 

Heart attack represents a problem in the circulation of oxygen-rich blood to parts of the heart whereas an SCA represents a problem with the electrical signalling that makes the heart beat. 

Heart attack

When an artery in the heart is blocked due to cholesterol or fat deposits or due to a blood clot, oxygen-rich blood does not reach the specific area of the heart that the artery supplies. 

If the blocked artery is not reopened quickly or a bypass route is not created, the cells in the part of the heart which is normally supplied by that artery start to die due to lack of oxygen. If the person goes without treatment for a longer duration, more areas of the heart get less oxygen and nutrition and more cells die. 

'Myocardium' means the muscle tissues of the heart. "Infarction" means the death of tissue due to loss of blood supply. Now you know why a heart attack is also called a 'myocardial infarction' or simply 'MI'!

Symptoms of a heart attack or MI can be immediate and intense but more often, the symptoms start slowly and persist for hours, days, or weeks before the intense chest pain we often associate with a heart attack. 

Common symptoms of a heart attack include chest discomfort, discomfort in other parts of the upper body, shortness of breath, cold sweat, nausea, and breathlessness. Men and women can have different symptoms suggestive of a heart attack. 

If you notice any of these warning signs, and even if you are not sure this is a heart attack, please call emergency. Every second matters. Consult a cardiologist even if the symptoms do not persist for long. 

The cardiologist will run a few tests to confirm if it was a heart attack and then, treat the blockage to prevent future heart attacks.

Sudden Cardiac Arrest

An SCA occurs suddenly without much warning. It occurs when either the heart stops beating completely or when the heart is not beating sufficiently to pump blood to different parts of the body. 

Like I explained before, heart beats are a result of the contraction and relaxation of the heart muscles.

An electrical impulse generated inside the right upper chamber of the heart travels to other parts of the heart. As this impulse passes through different parts of the heart, it causes a wave of contractions and relaxations. As a result, the heart beats and pumps the blood. 

When there is a disruption in these electrical impulses, the heart stops beating or beats insufficiently. The heart is unable to push blood to the brain, lungs, and other parts. When the brain is deprived of oxygen, within seconds, the person loses consciousness and you may not be able to feel their pulse. Death can occur within minutes if the person does not receive immediate care. 

The Link

Though an SCA is not a heart attack, the two are linked. 

SCA may occur after a heart attack or during the recovery from a heart attack. 

Most heart attacks do not lead to SCA but when an SCA occurs, a heart attack is a common cause. An SCA may occur due to a heart attack or due to other causes as well. 

Other causes of sudden cardiac arrest

A sudden cardiac arrest may also ocur due to inherited abnormalities in the signal pathway that causes the heart to beat.

It can also occur due to abnormalities or dysfunction of the heart muscles. The medical term for this is 'cardiomyopathy'. Alcohol consumption, obesity, fibrotic diseases and inflammations can increase the risk of cardiomyopathies. 

Heart failure, valve disorders and some congenital abnormalities can also increase the risk of SCA.

How can you help?

When you see some one showing symptoms suggestive of a heart attack or an SCA, do not waste any time. 

Call emergency immediately. 

That's 911 if you are in USA . 

If you are in India, call 102 for ambulance service. 

A person having a heart attack may still be breathing and talking. They do not need a cardiopulmonary resuscitation (CPR). But they still need to be sent to the hospital immediately. So, call emergency or ambulance service. 

In contrast, if the person is not breathing and has become unconscious, it is probably an SCA. Call emergency and start hands-only CPR immediately. Even if you are alone with the person, you can start hands-only CPR. 

1. Call emergency. 

2. Start CPR immediately. 

In case of a heart attack, follow step 1. In case of an SCA, follow steps 1 and 2  without delay. These two steps can increase the chances of survival. Cardiac arrest is reversible if CPR is done within minutes. 

Continue the CPR till professional help arrives. With swift action, you can help revive a person from cardiac arrest.  

CPR uses chest compression to mimic heart beats and forces blood into different body parts. It keeps enough oxygen in the lungs and gets it to the brain till normal heart rhythm is restored by professional emergency service providers. 

When the professional emergency service providers arrive, they may use an electric defibrillator to send an electrical impulse to the heart. This electric shock provides an external electrical signalling that can get the heart to beat on its own once again. 

It's an emergency!

You do not need to be professionally trained to do a CPR. 

If you see someone falling down unconscious, without wasting time, just bend down and try to wake them up. Check if they are breathing. If they do not seem to be breathing and you do not feel their pulse. start CPR immediately. 

While kneeling beside them, use both your hands to press on the middle of their chest. Push hard at a rate of about 100-120 times a minute. Keep doing that till help arrives. You can continue CPR for about 10 minutes without stopping in between. 

Here are a few helpful videos that tell you how to do a hands-only CPR while waiting for an ambulance to arrive. 

• A 1-minute video by the American Heart Association that gives you just the basics about hands-only CPR
• A nearly 2.5-minute video  of cardiologist Late Dr. KK Aggarwal showing you the details and some alternative ways to do a CPR in case you cannot use both your hands. 

If you found this post helpful, do leave me a comment. 

If you have seen a person revive from an SCA due to prompt action, tell us about it.