Multifocal - Trying to make decision

[Lilli]

Thank you for this site it has been a valuable source of information.

I have had a segmental and a resection in May outside quadrant 3 o'clock position. Saw Oncologist in week 10 final Path on surgery tissue proved to be multifocal DCIS. 1.3 cm and .5 cm, nuclear grade 1 & 3, cribriform. Found after surgery a cyst in inside quadrant 9 o'clock deep behind nipple. Aspirated cyst did not collapse. FNA path came back as insuffient tissue.
I want to make a decision that is going to serve me best long term. I am 12 weeks past surgery and my surgeon wanted to speak to me about the oncologist report and final pathology before we proceeded with the other area in my breast. He is away until Sept and I have an appt on the 11th. Oncologist wanted a decision last week. I need to decide radiation or mastectomy with immediate reconstruction. I am concerned about re-occurrence and this other area in my breast. I had a hysterectomy at 26 I am now 48 and postmenopausal.

Thank you.

[CCF-RN,MSN-rf]

Dear Lilli:  Please see answer to earlier post.

[surgeon]

There's no perfect answer: it's a personal balance between the loss of a breast and the concern for adequacy of treatment. When it's multifocal the risk of recurrance within the treated breast is higher after excision/radiation. But when it's multifocal within one quadrant only -- in the area removed only -- theoretically local treatment is still effective. We don't have all the answers for DCIS; initial treatment choices are still not perfect, since we really don't have a reliable way of assessing in advance those for whom local treatment is sufficient or is not. In my opinion, when it's multifocal and the areas are large (one of your areas was sort of large), the SAFEST choice is mastectomy. However, it's clear that many women in your situation will be just fine with radiation instead. So you must decide between the issues regarding loss of a breast versus the issues of uncertainty. For some women, the former outweighs the latter; for others, it's the other way around.

[Lilli]

Thank you for your comments.  The oncologist told me that they like to do radiation in the first 12 weeks for the radiation to be most effective.  Is this the same in the US as in Canada?  If this is the case can you explain to me why that is?   If I decide to have radiation it will be 20 weeks post surgery - is there in point in doing it with this length of lag time?

[surgeon]

I'm not aware of studies of such lag times which address the issue; so I can't give a meaningful answer. The best person might be the radiation oncologist.