Aa
DCIS
I have DCIS 7 mm non invasive low grade. I had surgery now have to decide on treatment. I would like to hear from women who only had surgery & nothing else . How they are doing some years later. I went for another opinion & was told to have another surgery to get a larger margin if cleared no radiation . Please let know any info about any aspect of this. Thank you
I had a lumpectomy in Feb for 2 cm intermediate grade dcis with a wide margin. My radiation oncologist told me that there were no bad choices concerning treatment or not having any treatment. He told me that if it were someone in his family he would advise radiation, probably because he is biased in that he only gets to see the recurrences. As long as I get regular mammos, if anything comes up it will be treated. My medical oncologist was pretty adamant that I take tamoxifen. I'm going to try to follow up with someone else who is more open minded. I just got an all-clear on my first 6 month mammo. The breast center said that they recommend that I come back in one year. It's all a matter of how much risk that you're willing to take. Here is a web page for people with dcis:
www.dcis411.com
I found it helpful
ellen
www.dcis411.com
I found it helpful
ellen
You are entirely welcome.
Some additional research info to weigh into your decision-making process: Retrospective studies of women with DCIS have compared breast conserving surgery (lumpectomy) to mastectomy and found that survival rates are similar. However, women who have lumpectomy alone, without further treatment, are at higher risk of developing invasive breast cancer in the same breast. Women with DCIS who later develop invasive breast cancer in the same breast are at higher risk of dying from breast cancer than those who do not develop invasive disease, according to a study published online March 11 in the Journal of the National Cancer Institute.
The highest level of safety would probably involve obtaining a wider clean margin, followed by radiation, and then hormone-suppressing medication, If you were able to tolerate it. Some would consider this "overkill," while others would consider it worthwhile, believing it's best to do all that's possible to reduce risk the first time around, rather than havinf ti deal with a recurrence.
When there are various recommended treatment options, the decision often comes down to the individual's personality/philosophy of life (risk tolerance versus need for whatever degree of certainty is available).
Whatever you decide, I wish you well, and hope you will keep us updated regarding how things are going for you, by adding additional comments to this same thread.
Regards,
bb
Some additional research info to weigh into your decision-making process: Retrospective studies of women with DCIS have compared breast conserving surgery (lumpectomy) to mastectomy and found that survival rates are similar. However, women who have lumpectomy alone, without further treatment, are at higher risk of developing invasive breast cancer in the same breast. Women with DCIS who later develop invasive breast cancer in the same breast are at higher risk of dying from breast cancer than those who do not develop invasive disease, according to a study published online March 11 in the Journal of the National Cancer Institute.
The highest level of safety would probably involve obtaining a wider clean margin, followed by radiation, and then hormone-suppressing medication, If you were able to tolerate it. Some would consider this "overkill," while others would consider it worthwhile, believing it's best to do all that's possible to reduce risk the first time around, rather than havinf ti deal with a recurrence.
When there are various recommended treatment options, the decision often comes down to the individual's personality/philosophy of life (risk tolerance versus need for whatever degree of certainty is available).
Whatever you decide, I wish you well, and hope you will keep us updated regarding how things are going for you, by adding additional comments to this same thread.
Regards,
bb
Your advise has been extremely helpful. I had surgery did see an 2 oncologists who did recommend anti/ estrogen 1 recommend further surgery to widen the margins & if clear no radiation , the other recommended radiation. I have to make a choice!!!!
Thank you for your help & advice .
Thank you for your help & advice .
p.s. I mentioned the size of your tumor as a consideration, related to the following information from Dr. Susan Love:
"Breast conservation surgery will be done with a wide excision, which means taking out the microcalcifications along with a centimeter-wide rim of normal tissue around it. Sometimes this is done in the first operation and other times it is necessary to go back and remove more tissue (a re-excision). There is no reason to remove lymph nodes for small areas of DCIS since precancer can't spread at this stage. But if the lesions are big (greater than 5cm), some experts think they may hide microinvasion and recommend removing the lymph nodes as well."
"There is currently a controversy about whether radiation is necessary following breast conservation surgery... The National Comprehensive Cancer Network treatment guidelines recommend that radiation only be skipped if the margins are negative and the tumor is low grade and small (less than 1/5 inch)."
bb
"Breast conservation surgery will be done with a wide excision, which means taking out the microcalcifications along with a centimeter-wide rim of normal tissue around it. Sometimes this is done in the first operation and other times it is necessary to go back and remove more tissue (a re-excision). There is no reason to remove lymph nodes for small areas of DCIS since precancer can't spread at this stage. But if the lesions are big (greater than 5cm), some experts think they may hide microinvasion and recommend removing the lymph nodes as well."
"There is currently a controversy about whether radiation is necessary following breast conservation surgery... The National Comprehensive Cancer Network treatment guidelines recommend that radiation only be skipped if the margins are negative and the tumor is low grade and small (less than 1/5 inch)."
bb
Some additional points for consideration:
1) 7 cm is a rather large tumor; are you certain there was no invasive component according to the path report from the lumpectomy/excision biopsy?
2) Tamoxifen and the AIs are hormone suppressing drugs, not hormones. Since it is doubtful that you have ever been on this type of medication, there is no way you could know with certainty whether any, or all, of them would have intolerable side effects.
3) If you have not yet had a consultation with a medical oncologist, and perhaps a radiation oncologist, that could provide additional perspectives useful in arriving at a tx plan.
I have provided some general information on treatment options, but specific medical advice regarding an individual's case can only come from his/her treatment team, which would have both the expertise and all the details of that person's case needed to make appropriate recommendations.
Best wishes,
bb
1) 7 cm is a rather large tumor; are you certain there was no invasive component according to the path report from the lumpectomy/excision biopsy?
2) Tamoxifen and the AIs are hormone suppressing drugs, not hormones. Since it is doubtful that you have ever been on this type of medication, there is no way you could know with certainty whether any, or all, of them would have intolerable side effects.
3) If you have not yet had a consultation with a medical oncologist, and perhaps a radiation oncologist, that could provide additional perspectives useful in arriving at a tx plan.
I have provided some general information on treatment options, but specific medical advice regarding an individual's case can only come from his/her treatment team, which would have both the expertise and all the details of that person's case needed to make appropriate recommendations.
Best wishes,
bb
If I have surgery for wider margins since it is 7 cm found early low grade noninvasive could I just monitor the breast. Taking any drug concerning hormones gives me severe migraine headaches . I am 62 yrs old & am post memepossul there am alternative drug or something other I could take to lower my estrogen .
Approriate tx for DCIS is by no means a clear-cut decision.
With only lumpectomy (not mastectomy) you would definitely need to get clear margins. Lumpectomy alone carries special concerns and considerations. Because the remaining breast tissue is not treated with any other intervention, there is the possibility that if the woman lives many more years, she can develop cancer — either DCIS or invasive cancer in the same breast. This option is only effective for carefully selected patients with early, small DCIS lesions with very easily interpreted mammograms. Comedo-type DCIS tends to be more aggressive and careful judgment needs to be used in offering lumpectomy alone in women with this cell type of DCIS.
Radiotherapy confers a nearly 60% reduction in diagnoses, compared with no radiotherapy; with benefits limited to decreases in ipsilateral (same breast ) invasive cancer and ipsilateral DCIS, with no effects on contralateral (opposite breast) disease. In addition, tamoxifen (if the DCIS was hormone receptor positive) confers about a 30% reduction in diagnoses, with benefits seen for ipsilateral DCIS and contralateral disease.
Simple mastectomy is usually considered appropriate management for all kinds of DCIS. It is the only recommended treatment for multifocal DCIS, extensive DCIS, or DCIS that has recurred after lumpectomy and radiation therapy. This procedure is a relatively short surgery, requires general anesthesia, with a short hospital stay followed by a quick recovery. Reconstructive surgery to recreate the breast can be done immediately at the time of mastectomy or at a later date. The recurrence rate and overall chance of dying from cancer after simple mastectomy is between 0 and 2%.
On the other hand, some feel we may be overtreating DCIS, given that larger, higher-grade tumors pose the greatest recurrence risk. They suggest that for lower-risk disease, "the best course might be to monitor for recurrence and offer adjuvant treatment only as needed."
Best wishes,
bluebutterfly
With only lumpectomy (not mastectomy) you would definitely need to get clear margins. Lumpectomy alone carries special concerns and considerations. Because the remaining breast tissue is not treated with any other intervention, there is the possibility that if the woman lives many more years, she can develop cancer — either DCIS or invasive cancer in the same breast. This option is only effective for carefully selected patients with early, small DCIS lesions with very easily interpreted mammograms. Comedo-type DCIS tends to be more aggressive and careful judgment needs to be used in offering lumpectomy alone in women with this cell type of DCIS.
Radiotherapy confers a nearly 60% reduction in diagnoses, compared with no radiotherapy; with benefits limited to decreases in ipsilateral (same breast ) invasive cancer and ipsilateral DCIS, with no effects on contralateral (opposite breast) disease. In addition, tamoxifen (if the DCIS was hormone receptor positive) confers about a 30% reduction in diagnoses, with benefits seen for ipsilateral DCIS and contralateral disease.
Simple mastectomy is usually considered appropriate management for all kinds of DCIS. It is the only recommended treatment for multifocal DCIS, extensive DCIS, or DCIS that has recurred after lumpectomy and radiation therapy. This procedure is a relatively short surgery, requires general anesthesia, with a short hospital stay followed by a quick recovery. Reconstructive surgery to recreate the breast can be done immediately at the time of mastectomy or at a later date. The recurrence rate and overall chance of dying from cancer after simple mastectomy is between 0 and 2%.
On the other hand, some feel we may be overtreating DCIS, given that larger, higher-grade tumors pose the greatest recurrence risk. They suggest that for lower-risk disease, "the best course might be to monitor for recurrence and offer adjuvant treatment only as needed."
Best wishes,
bluebutterfly
Have an Answer?
You are reading content posted in the Breast Cancer Community
A quick primer on the different ways breast cancer can be treated.
Diet and digestion have more to do with cancer prevention than you may realize
From mammograms to personal hygiene, learn the truth about these deadly breast cancer rumors.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
