new breast cancer

[dammie]

I was dx with IDC, DCIS, and LCIS in the right breast in Aug, 2003 by an excisional biopsy.  I had wide re-excision with lymph node dissection in 9/03 with 1 of 22 nodes positive. Started chemo 11/03 (4 cycles AC and 4 cycles of Taxol).  I finished chemo in 2/04 and decided not to go with radiation  of the breast and had a bilateral mastectomy with tissue expanders on 3/17/04 due to strong family history (I am 42) and other factors.  The pathology of the bilateral mastectomy showed DCIS in the right breast (the original cancer breast).  This has really frightened me since I was told that the re-excision gave clear margins.  My surgeon stated that it could have grown during chemo.  Is this characterized as a recurrence?  If so, having one only 7 months after original diagnosis terrifies me and makes me think that the chemo did not work. My surgeon says that additional chemo is not necessary. I am currently taking tamoxifen (ER positive).   How does having another breast cancer so soon affect prognosis?  I was told that all margins are clear from the mastectomy (left breast did not have any cancer).  Any comments you can give are truly appreciated.

[CCF-RN,MSN-rf]

Dear dammie:  Technically, this is not a recurrence as it is not invasive cancer.  It is curious that it either developed during chemotherapy, after chemotherapy, or resisted chemotherapy.  Nevertheless, since the tumor was DCIS definitive treatment would be either lumpectomy +/- radiation or mastectomy.  Chemotherapy is not indicated in DCIS.  So, since you had the mastectomy, you have had definitive treatment for your DCIS.  Tamoxifen is already prescribed, so any additional treatment is already underway.  As this was DCIS, your prognosis is based on the original node positive, invasive cancer.  This finding would not change the original prognosis.

[surgeon]

The reason either mastectomy or radiation/lumpectomy is done is that it's known that when a cancer is present, even if fully removed by lumpectomy, there's a high chance that other spots can exists elsewhere in the breast. The fact that you had an area does not in any way change your original prognosis. Nor can it be concluded that chemo had no effect: it's not really known to what extent chemo affects DCIS, and most people don't have it in the sequence you did. It could well be that if they did, many cases like yours would be noted. What is known is that your data suggest a very high cure rate. The finding of DCIS in the removed tissue doesn't change that.

[lizziecee]

I am in same position, with invasive ductal carcinoma, grade 2 stage 2, with DCIS. I had 2 surgeries, lumpectomy and total node removel 3 out of 18 positive. Did 6 of FEC chemo, 45 grays rads, now on Arimidex.Just had annual post op mammo, thankfully clear, but am concerned that breast that had cancer is red and hot, nipple crusted. I have been "discharged" by the Oncologist. What could be the problem? I live in England and they don't do tumour markers or scans unless you have symptoms. Next mammo is scheduled for one year - should I contact the Oncologist or breast surgeon?

[lizziecee]

Sorry, I forgot to say my original path report stated I had a 2cm invasive tumour along with DCIS.