Should I do radiation therapy (second question with this title)

I originally posted this as a reply under the question "Should I do radiation therapy?" but thought I'd post it as a separate question also

I'm in a similar situation to that of web_lady.  I'm 46 and had a mammogram in May that showed 1.5 cm area of pleomorphic calcifications (no mass was seen or felt).  I had stereotactic biopsy with results showing grade 3 DCIS with comedo necrosis and no invasion.  An MRI showed activity in the area of the biopsy but nothing else.  

On June 18, I had partial mastectomy (surgeon removed a little more than with lumpectomy but breast still looks the same) along with removal of sentinel nodes due to grade 3 pathology. The pathology showed 4mm of intermediate grade DCIS with no invasion and normal lymph nodes.  (What a relief.)  The pain from the underarm surgery was far worse than the breast surgery.

I was feeling OK until I had my radiation planning appointment on Tuesday.  Since then, I am having major anxiety about having radiation.  In doing some research, it sounds like overall the risk of recurrence with breast conserving surgery alone vs. BCS with radiation goes from 15% to 7-8%, but I'm wondering if my risk is higher with the grade 3 cell type.  I'm also worried about side effects of radiation (especially fatigue that can last after the treatments end.)  Also, if there is a recurrence, radiation isn't an option the second time around and it sounds like reconstruction can be difficult after radiation.  I'm actually thinking I might want to opt out of the radiation and go with a simple mastectomy with reconstruction since no radiation is needed with that option.  

If you (or anyone else) have any words of wisdom, please comment.  What a way to spend the summer.........

[PaulMD]

Hi there.

A grade 3 DCIS indeed increases your risk of developing a recurrence in the future.  For any one with these types of lesions who underwent any procedure less than a total mastectomy, it is indeed recommended that radiation treatment be given to decrease the chance of recurrence.  

Aside from decreasing local recurrence, some study shows that after about 15 years, there could also be a benefit in over-all survival, and thus, longevity.  Radiation therapy would indeed have an effect on future reconstruction efforts, but I think this hurdle is nothing modern day surgeons can't handle.  Mastecomy with reconstruction is also a viable option.  You can ask your doctor about nipple and skin sparing mastectomy, to achieve optimal cosmetic effect.

Regards and God bless.