Radiation or Masectomy?

After having an annual mammogram followed by a spot compression, my mother had a biopsy done in June for micro-calcifications.  One of the micro-calcifications was determined to be malignant.  It was non-invasive and very small (2mm).  The doctor suggested that my mother undergo a lumpectomy in order to make sure that she had clear margins.  We were happy to find that everything was clear.  A follow-up mammogram was performed before proceeding with radiation treatment.  The mammogram showed one more micro-calcification.  The surgeon performed a stereotactic biopsy to remove the calcification.  This calcification was benign but the surgeon advised that my mother had 2 occurrences of intraductal carcinoma.  It is still non-invasive and still microscopic but the surgeon now appears to be very concerned about the fact that this malignancy did not show up on the mammogram.  We are planning to meet with the radiologist and the surgeon to discuss options but I am worried now because the surgeon was very concerned about finding this malignancy through biopsy but not being able to find it in a mammogram.  Although the surgeon has mentioned masectomy as an option, she seemed to be discussing it more now.  I was under the impression that the radiation treatment would destroy any remaining cancer cells, so would that take care of any cancer that can

[CCF-RN,MSN-rf]

Dear Sunshine30:  It is not uncommon to see clusters of microcalcifications, rather than the "lump" itself.  From what you say, it appears that only one biopsy showed any evidence of malignancy - this means one occurence (where are the 2 coming from?).  Also, is it correct that this is invasive ductal carcinoma without angiolymphatic invasion?  Or, is this DCIS (ductal carcinoma in situ)?  If it is the former and if there is only the one (2mm) tumor, then radiation should be adequate.  A lumpectomy has already provided clear margins.  Of course, if your mother prefers, a mastectomy will eliminate all need for radiation.  Sometimes, if there are multiple foci (different spots) of cancer, a mastectomy is recommended.  If it is DCIS, radiation would be recommended depending on the grade - it is often recommended as a precaution.

[surgeon]

I'm a bit confused: if the second cancer was the area removed by stereotactic biopsy, then it WAS visibile on mammogram, because that's the only way to do a stereotactic biopsy. Also, you said the area was benign, but referred to non-invasive cancer. It sounds like she had two areas of non-invasive cancer; if they are in different quadrants of the same breast, then some people consider that a reason to consider mastectomy, because it suggests more will occur in other locations. You are correct that radiation is supposed to take care of residual areas, and the evidence is that it does. But nothing is 100%. I think the understanding about what was and what was not visible on mammogram needs to be clarified. Ironically, we have a clearer set of data concerning what to do with the more dangerous -- invasive -- cancer, than we do about the less dangerous non-invasive cancers. In the latter case, mastectomy becomes a consideration depending on the extent of the DCIS (non-invasive cancer), how much is within the given ducts, etc.

[Sunshine30]

To clarify, the surgeon advised my mother that she has DCIS.  The first biopsy was due to microcalcifications seen from the mammogram.  Of the area that was biopsied, one of the calcifications (2 mm) was malignant.  The next week we returned for a lumpectomy in order to get clear margins.  Before beginning radiation treatments, my mother had to get another mammogram.  This mammogram showed there was still one micro-calcification left.  To remove this calcification, the surgeon then performed the stereotactic biopsy.  The microc-calcification that was removed was not malignant but there was a low grade malignancy that the doctor called intraductal carcinoma.  The mammogram that was performed did show the one remaining calcification (that was not malignant) but did not show anything else.  However, this is all within the same area of the breast.

[Lilli]

I am sorry to jump in here but been trying to ask a similar question as the one posted.  If there 2 areas of DCIS in same quadrant, one is 1.3 cm and other is.5 cm with 1 cm between nuclear grade 1 and 3 would mastectomy be the best choice.  There is a 4 mm cyst in another quadrant that when aspirated did not collapse and the FNA (5 slides) pathology said not enough tissue to test.  11 weeks since surgery and being asked for decision.  I can find no stats on DCIS that is multifocal to see what the re-occurance rate is I am thinking it would be different than if it were not multifocal.  Can you comment?

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