widespread DCIS

About two weeks ago I had a small lump removed and biopsied with the following results (in part): "There is a firm tan mass in the center of the biopsy which measures approx. 1 cm in greatest diameter. There is intraductal papillomatosis and several scattered foci of cribriform ductal carcinoma in situ. No invasive carcinoma. No DCIS at the inked surgical margins." My surgeon recommended wide(r) excision because the original biopsy was so small. On 3/27 he took out a piece of tissue about the size of a golf ball and called me two days later with the following information: The sample was divided into nine sections, eight of which contained DCIS. I did not have my wits about me enough to ask whether these samples had the same characteristics as the first biopsy (non-comedo, no necrosis etc.), but he did make it a point to tell me twice that there was no invasive cancer found.

My question is whether or not DCIS this "rampant" would be almost automatic indication for mastectomy. (My surgeon's office is in the process of setting up an appt with an oncologist and a radiation therapist.) Additionally, I have been doing some reading about Sentinal Lymph Node Biopsy, and am wondering whether this might be indicated here as well. I would really appreciate any insight you could provide. Thank you so much. (49 year old otherwise healthy female.)

[CCF-RN,MSN-JS]

Dear Varvie,  Whether or not mastectomy is indicated is not automatic.  Information such as if there were clear margins (area
surrounding the DCIS of normal tissue) may influence whether more tissue is removed.  Most likely radiation therapy would be given to the remaining breast tissue, since this significantly reduces the chances of additional cancer developing in the same breast (this is an option other than mastectomy).  If there was any indication of invasive cancer the treatment would be based on that finding.  In the past axillary lymph nodes were usually removed, but several studies have shown that positive nodes are rare for DCIS, based on these studies lymph node sampling is usually omitted.  Further disucussion with the oncologist and radiation therapist should help to clarify this with the findings in your individual situation.