Is DCIS cancer?

Robby

According to some recent reports:

' The term carcinoma in the phrase ductal carcinoma in situ (DCIS) is misleading and troubling and ought to be dropped, or at least its dropping should be considered, suggest some recent editorials in major journals.

Both editorials also suggest that DCIS is a possible candidate for management by active surveillance, a treatment strategy of growing importance in prostate cancer in which low-risk patients do not receive radiotherapy or surgery unless they progress to higher risk. "

http://www.medscape.com/viewarticle/715586?sssdmh=dm1.582995&src=nldne&uac=121910CN 

I don't buy this, just as my husband and I don't buy active surveillance for early stage prostate cancer. 

diana50

when i was diagnosed in 2002, my pathology report stated that my tumor was both invasive and dcis. it was a variety of different cellular structures. i think it all depends on the cellular structure..the growth percent ...etc. of the cancer.

IronJawedBCAngel

As I had a friend on the Komen boards that was diagnosed with DCIS at the same time I was, but was dead two years later as the cancer aggressively progressed and metastasized, I believe DCIS should be treated as cancer.  No, not all DCIS will become invasive, but I don't want to be the one they play russian roulette with.  My DCIS was grade III.  One of the studies on mets that I read a few years ago stated that they believed that a cancer released its "rogue" cells out into the bloodstream or lymph system long before a group of cancer cells formed a tumor.  I was very grateful to have my cancer diagnosed early.  I was able to keep my breast and avoid chemo.  Until they can positively identify which DCIS will become invasive, and which will not, I believe the protocol needs to remain the same.

CoolBreeze

What if they can't tell which will become invasive and which won't until they watch it to find out why it becomes invasive?

If I'd had only DCIS I would have happily done watchful waiting.  It should be a choice offered.

sweatyspice

It is a choice.  No one puts a gun to your head.  You have the right to refuse treatment.  Though at your age, and with anything other than grade 1, I'd think you were a complete a**hole.  If you were 79, they probably would advocate watchful waiting, figuring you'd die of something else first.

BTW - you probably did have DCIS and waited, you just weren't watching.

Don't you think not treating and "waiting until it becomes invasive," thereby putting patients lives at risk almost by definition, is ethically problematic?  The drug companies would love it though - more chemo!!!!!

BTW - when they find out how and why it becomes invasive, they'll have basically cured cancer.

sweatyspice

For those who are interested and haven't seen this yet - in September the NIH held a "State of the Science" Consensus Conference on DCIS.   'Should we change the name' was hotly debated, as were many other things, like when radiation is/isn't necessary.  The three day conference is archived as video online here:  http://consensus.nih.gov/2009/dcis.htm

CoolBreeze

The theory is that not all DCIS becomes invasive - and they have no idea which ones will and which ones won't.  You are operating under the idea that ALL DCIS becomes invasive, and isn't proven by medical fact and almost certainly isn't the case.

Of course, with current knowledge it would be ethically wrong not to treat it - but what the medical community is saying that it's time to explore the idea that many women with DCIS will not progress to invasive cancer.  I didn't see anybody say "don't treat."

Like with prostate cancer, it should be a choice the individual makes.  My dad (dx'd at 64 by the way) chose watchful waiting.  My boss's husband, dx'd at 63, chose to treat with radiation.  It should be up to the patient in all cases.

Assuming my cancer started as DCIS, and I would have caught it at that stage, I would have chosen watchful waiting.  I have the temperment - I'm not a worrier. But,  watchful waiting doesn't mean ignoring it.  It means whatever it will mean - mammograms every 3 months, MRIs every six, whatever.  When it became invasive, then I would have treated it.  

And, wouldn't it be nice for the medical community to have people like me to watch?  Because, mine would have turned invasive but maybe somebody else's wouldn't.  Studying why one does and one doesn't can lead to new knowledge that prevents the agony that  many women with DCIS, like you, go through that *could* be needless.

A woman with DCIS would be crazy to refuse treatment right now, because there are no watchful waiting protocols and absolutely no way of knowing if it's going to become invasive.  You have to treat it like it will. 

But, someday there might be studies to determine it - and then what's wrong with choosing that?  

sweatyspice

I am not operating under the idea that all DCIS becomes invasive.   And as I see it, the medical community is not saying "let's finally explore the idea that some DCIS may not become invasive," they're saying let's change the name to alleviate patient anxiety (and maybe insurance triggers will be turned off - without a cancer diagnosis, will mastectomies, reconstructions, etc. still be covered?)

There are absolutely clues about which DCIS may not turn invasive, or will take a longer time to do so:   nuclear grade and age at diagnosis.  The surgeon who is most passionate about my having a mastectomy said if I were in my 70's, he would not feel the same way.

If the mouse model or other studies are successful and they figure out a chart allowing them to  say "you only have a 10% chance of becoming invasive before the next scheduled exam" of course watch and wait would make sense as long as you were fine with the quoted probability.  (Bearing in mind that the standard for "watch and wait for 6 months" for an abnormal mammogram requires a likelihood of malignancy of less than 2%.)

As I see it, ALL treatment decisions are the patient's choice.  A woman can absolutely refuse treatment in the USA.  You can certainly say "nope, not gonna do it," treatment cannot be legally forced upon you.  Or you could say, "I will only agree to having a biopsy every 3 months, and only after you can prove it's progressed to invasive cancer will I go any further."  I don't see anything stopping someone from insisting on that, though it might take some effort finding a surgeon who would agree to work with you.  

"Assuming my cancer started as DCIS, and I would have caught it at that stage, I would have chosen watchful waiting. . . . When it became invasive, then I would have treated it."  

"A woman with DCIS would be crazy to refuse treatment right now, because there are no watchful waiting protocols and absolutely no way of knowing if it's going to become invasive." 

I see those as inconsistent statements.  If you weren't going to treat it until it became invasive, then knowing beforehand whether or not it would become invasive should not be a problem.  When it was proven to be invasive, you'd have treated it - whether you knew the timeline beforehand or not.

If that's really the way you'd have wanted to go, sure, it's too bad you didn't catch it at the DCIS stage and been my guinea pig.  I'd think you were nuts, but what I think about your personal treatment decisions shouldn't matter.  I'm only concerned about public policy being somewhat in line with what I think is reasonable.

quinnie

I think what everyone can agree upon is the unknown. How can we really know which cancer will progress and which one won't? My father in law was diagnosed with Prostate CA at age 65, and with the advise of his MD, decided on watchful waiting. He saw his urologist frequently, and less than one year later, his prostate CA had spread beyond the prostate and he died 4 years later. Had I known what I know now I would have pushed treatment. My Dad was diagnosed with Prostate CA 10 years ago at age 74 and I pushed agressive treatment and my Dad celebrates his 84th birthday this year. When I was diagnosed, I did not go overboard. I did my research and decided on my treatment based on what I read, statistics, and the suggestion of both my surgeon and oncologist.

 I hope they can find a way to test the cell to find out which cancers will progress but until they do, I think active treatment will be my choice.

Quinnie

redsox

The current state of knowledge of DCIS is that there is no way to predict which cases will become invasive and which won't.  Although some characteristics such as size and grade may be favorable, even those may predict a longer average time to progression rather than whether or not they become invasive.  These are also only a couple of the many factors that affect the prognosis for each individual.  Numerous studies have tried to identify in advance which patients can safely be treated with just excision and have failed so far to find such a group of patients reliably.  The bottom line is that any woman has the choice of no treatment or minimal treatment and many who choose that will be lucky and have no further breast cancer.  All of them are accepting a higher risk of recurrence, some will have invasive breast cancer,  and some will die of it.  

Watchful waiting would mean frequent mammograms, ultrasounds, MRIs, and biopsies until, for many women, the cancer is caught at a later stage and requires much more extensive treatment.   

For women who are elderly with other health problems and a short life expectancy, e.g. 5 years or so, minimal treatment may be reasonable.  However, I cringe when I see young women on this board talk about minimal treatment for DCIS.  There is no reason to think that DCIS will sit around with no advancement for 25 years or more in most cases.

Coolbreeze -- I have admired your comments and postings and have even visited your blog, but I think you are mistaken if you think you have any idea what you would do if you had found your cancer while it was DCIS.

MaryDee

The problem with watch & wait as I see it is that all of the current imaging techniques we have are not sensitive enough to detect the point at which DCIS stops being contained by the duct and breaks through as 'microinvasion'.  As soon as that occurs, the disease can spread - and possibly advance quite quickly to other organs which then becomes a) harder to treat and b) life-threatening.  

Often, a definitive diagnosis of DCIS is not confirmed until AFTER the initial surgery when the pathology is returned.  I have read time and time again of women thinking they were having DCIS or LCIS removed only to discover there was invasive disease in there as well.  Would any of them have preferred to wait while their invasive disease advanced?  I don't think so.  Of course that's speculation...but as a person who had "real" cancer alongside my "pre-cancer", I still believe it's better to "overtreat" than to risk the tragedy of women slipping through "undertreated" and paying for it with their lives.

Beesie

I think they got it backwards. 

If and when medical science is able to determine, based on a comprehensive understanding of the clinical, pathologic, and biologic factors associated with DCIS, which cases of DCIS may be managed with less therapeutic intervention and which cases require immediate intervention due to the high risk of invasive cancer, then perhaps it might be appropriate to reclassify only those non-threatening forms of DCIS as non-cancers.  Until then, it would be foolhardy to do so. 

I understand the concern within that medical community that some women who are very low risk for developing invasive cancer from their DCIS may be "overtreating" their condition.  I get that, and frankly, I agree.  But until we can identify with precision who those women are, if the medical community downplays the seriousness and potential risk of DCIS, women who do need the more drastic treatments might not seek or agree to those treatments, and that will result in more cases of invasive cancer, and more deaths from breast cancer. 

And if in the future doctors are able to distinguish between those cases of DCIS that are non-threatening and those that are more serious, why would they remove the word "carcinoma" from all DCIS, rather than just those cases that are non-threatening?  We all know that all cases of DCIS are not the same.  There is a very significant difference in risk level between someone diagnosed with a very small amount of non-aggressive DCIS, vs. someone diagnosed with a large amount of aggressive DCIS.  There are no doubt other pathologic and biologic factors that also distinguish riskier cases of DCIS from those that are low risk.  So once medical science figures this all out, why not split DCIS into two different conditions, one that is DCIS (and requires the attention and treatment that we get today) and one that is a low risk pre-cancer, similar to ADH?

From everything I've read, there are two reasons why this has surfaced, the idea of taking the word "carcinoma" out of DCIS.  First, there is concern among the medical community about the anxiety that women feel when they are diagnosed with DCIS, not understanding that it is not a life-threatening (at this point) breast cancer.  Second, there is concern that some women with DCIS overtreat their disease, opting for mastectomies when they are not medically necessary (although sometimes with DCIS they are medically necessary) and even bilateral mastectomies.

Well, anxiety is bad, yes, but won't the anxiety be a lot worse - and totally legitimate - if the DCIS (or whatever they decide to call it) is not treated, evolves to become invasive and moves into the nodes?  Won't the anxiety be a lot worse if by the time the patient treats the cancer, chemo is necessary (chemo of course is never necessary for pure DCIS)?  Rather than change the name to alleviate anxiety, I think a more reasonable approach would be to educate doctors so that they immediately explain to their patients diagnosed with DCIS that is it not life-threatening (in it's current state). 

As for over-treatment, if DCIS is properly explained (as it so often itsn't), if the risks are properly explained (no, DCIS cannot recur in your other breast!), I'm sure that will eliminate some of the over-treatment.  The medical community also has to consider that many of the decisions that women make to have mastectomies and bilateral mastectomies are based not on medical need but are based on emotional and psychological need. These can be very legimate reasons to have a bilateral and in those cases, the mastectomy or bilateral should not be considered "over-treatment" if the decision is well thought out and the risks are well understood.  Lastly, which is worse, over-treatment, or under-treatment that eventually leads to a more serious diagnosis and the need for treatments with more serious side effects?

Back to what I said at the start, I think they have this backwards. 

CrunchyPoodleMama

I think it's about time the medical world decided to find out whether DCIS will lead to invasive cancer or not.

I agree with this completely. Of all the millions poured into cancer research, why is this not a research focus? (or is it, but it's top-secret or something??) 

I personally don't believe in "watching and waiting" if that doesn't include a very aggressively anti-cancer diet and lifetstyle (read: If I get diagnosed with DCIS and choose no treatment, but keep right on eating my microwaved heat-up carcinogen dinners and fast food, I shouldn't be shocked when it develops into invasive cancer). But the watch-wait-while-living-an-aggressively-anti-cancer-lifestyle approach is what I would be doing now if I didn't have babies in my future. Since I do hope to have a baby, I'm not going to take that risk... I personally have a very high risk tolerance, but I guess I am a "risk wimp" when it comes to my future children.

Beesie

Coolbreeze, you say that "Assuming my cancer started as DCIS, and I would have caught it at that stage, I would have chosen watchful waiting."  When you say that, you are making certain assumptions about what a diagnosis of DCIS means.  But all diagnoses of DCIS are not alike and broad statements such as yours, and discussions by doctors and scientists about removing the word "carcinoma" from DCIS, unfortunately don't take that into consideration.

By the time my DCIS was caught, I already had a microinvasion of IDC.  But maybe if it had been caught 6 months earlier, the microinvasion would not have been here.  Still, my diagnosis would have been 6cm+ of high grade DCIS with comedonecrosis in two locations of my breast.  Would you have chosen watchful waiting with that type of DCIS diagnosis? Would anyone? Like you, I'm not a worrier. I'm also really good at living with risk and uncertainty (I've been dealing just fine with breast issues since my first biopsy at the age of 16).  Yet I know with 100% certainty that I wouldn't have taken a watchful waiting approach with a diagnosis like mine (assuming the microinvasion wasn't yet there).  In fact, since I'm small breasted, I doubt that there is a doctor in the world who would not have advised that I have a mastectomy.  So here's another problem with the idea of taking the word "carcinoma" out of DCIS:  As confused and frustrated as I was that I needed to have a mastectomy, I would have been many times more confused, and much madder - flaming, raging mad - if I'd been told that I had to have a mastectomy for something that was not even considered to be cancer. 

On the other hand, if my diagnosis had been 0.4cm of low grade DCIS, it's quite possible that I too would take the watchful waiting approach.  So it's not that the approach is wrong all of the time but everyone needs to understand that not all DCIS is alike and many diagnoses of DCIS do need to be treated aggressively, just like a similar early Stage 1 breast cancer.  For some of us with DCIS, a mastectomy was not a choice but a necessity.  In fact, because of how DCIS spreads through the ducts, and because the option of shrinking the tumor with chemo isn't available for those who have DCIS, mastectomies are considered to be medically necessary more often for those who have DCIS than for those who have invasive cancer.  Big general statements saying that watchful waiting is a reasonable approach to DCIS and suggesting that DCIS should be renamed to remove the word "carcinoma", are inconsiderate of and hurtful to those of us who faced this type of serious DCIS diagnosis, and there are a lot of us out there.

Julia, have your read the thread about "DCIS to Invasive Statistics"?  What is known with 100% certainty is that DCIS evolves to become to invasive cancer.  It's also known that most IDC starts as DCIS.  What is speculated/assumed is that not all DCIS will evolve to become invasive.  Medical science has a lot of knowledge about which cases of DCIS are higher risk and which are lower risk, but we're not at the point yet where any one case can be assessed with certainty.  They continue to search for other factors that might help with this understanding. http://community.breastcancer.org/forum/68/topic/719826?page=1 

robinlbe

test

3monstmama

It would be great if medical science could determine whose DCIS will turn "rogue" and whose will do nothing until the day the woman dies. 

But which of us wants to volunteer for the experiment? 

Not me.

Robby

What is under attack is not just semantics, but also screening.   Younger and younger men and women are being diagnosed with early stage cancer -- PSA leading to biopsy and discovery of early stage prostate contained malignancy -- maybe that shouldn't be called cancer either after all it's confined to the prostate (till it gets out), digital mammograms leading to biopsy and discovery of DCIS.  In both cases  people (wise objective scientists) are "blaming" the screening for causing anxiety and false alarms since if the cancer doesn't get out -- it won't cause much in the way of problems. They think its stupid of us to want to get treated and want to save us from our stupidity.  In both cases many of the detected cases will not become invasive but it isn't clear which are these cases. The odds are in favor of doing nothing if you want to play that game. In both cases once the cancer cells get out of their confined space --- treatment is a lot worse then when they are still contained. The smart money says -- don't worry about it, it's only a minority. By the way, the term I see in use more and more is not "watchful waiting" but "active surveillance" meaning short intervals between tests, ongoing biopsies, and continual reevaluation to avoid invasion.  So no matter what the statistics say -- many of , e.g. my husband and myself, prefer to avoid playing Russian Roulette with our lives if we can. What are the odds -- would you play Russian Roulette if there was one bullet in 6 chambers? 1 in 10, 1 in 20? So far, thank God, so good.  Both our cancers seem to be gone and good riddance.  And thank God that early screening was able to detect early stage cancer before it had a chance to spread. 

monaelena

I have dcis

it is the size of a period

classified as stage 0

I am waiting and watching

lvtwoqlt

I was diagnosed with ADH in Feb 2005 left breast, because of family history of breast and ovarian cancer we started the watch/wait survelance. 18 months later diagnosis of ADH in my right breast (Aug 2006), doctor suggested I think about preventative bilat mast and let him know on my next appointment. April 2007 third time abnormal mammo, third time biopsy (right side), showed DCIS. I was tired of the watch/wait game had Bilat June 2007.  Final path report showed additional ADH in right breast not seen on mammo and Hyperplaysic ductal cells in my left breast again not seen on mammo. Was I crazy to not continue the watch/wait survelance, for me, I stopped the beast before it became invasive.

Sheila

MaryDee

Beesie wrote: 

So here's another problem with the idea of taking the word "carcinoma" out of DCIS:  As confused and frustrated as I was that I needed to have a mastectomy, I would have been many times more confused, and much madder - flaming, raging mad - if I'd been told that I had to have a mastectomy for something that was not even considered to be cancer. 

I couldn't agree with you more.  As it was I had to deal with the weirdest moment of my life, the day the surgeon rang me to say "The good news is it's not invasive, so technically not cancerous, but we are recommending you have a mastectomy"  (with explanation, of course - he's a very good dr).  It took quite a lot to get my head around that. 

Jan1

Beesie,  You are a wonderful compassionate, well educated woman    The information you posted was so helpful to me now and in the past .     My multi centric DCIS dx came with microinvasion, grade 3 and  I was so frustrated that maybe my mastectomy wasn't really necessary.   Thank you for the reminder that we make the best health care choices that we can at the time we make them.  Thank you for the confirmation that not all DCIS diagnosis can be classified as a one size, one treatment fits all. 

Jan

kiffc

I was diagnosed with DCIS on my right side in May 2008. I chose to have a masectomy with immediate reconstruction a month later. It is a very personal choice on how you want to treat or not treat. I did not reach my decision lightly. I have to say I'm in Beesie's and Robby's camp and did not want to wait and see. I think each of us who go through this must self-educate, determine the right care providers and then select the best course of action.

My first symptom was discharge from only my right nipple. At the time I had been exercising a lot and thought I had just chaffed it. Being a mom and working full time, I discounted it for a few months but luckily not too long. When I called my OB/GYN, I was told to get a mammo immediately as I was overdue. In my case, I had done my mammos about every 1-1/2 to 2 years prior to that point so I had 2 sets of "normal" mammos which I had to compare to the mammo which highlighted my DCIS. For me personally, it was very obvious that my right breast was very messed up. I like data and data trending; when you have normal mammos and then have one that's not, it's very apparent -- at least it was with mine. My normal mammos were primarily dark -- like the opposite of an xray. The newest mammo showed a white spaghetti bowl in my right breast.

However, I tried to remain calm wanting to get some more data as you tend to be in disbelief that it's happening to you. Next was a breast MRI. That sealed the deal for me -- it was a rainbow colored spaghetti bowl. One thing I learned was not all hospitals have MRIs equipped for breast scans. I live in a major metropolitan area and was surprised that there weren't that many hospitals even in my area. I went to the hospital closest to my house and decided to work with the care providers there as I figured the hospital was "invested" in the treatment of women's health.

The radiologist and surgeon advised that, based on the size of my breast, to do a lumpectomy would still wipe out a sizable amount of tissue and I would have to do radiation. Since I'm a mom and work full time, I wanted to avoid radiation if possible. I also had looked at several pictures of real people (neck down) at my plastic surgeon's office to see the reality of radiation treatment and various reconstruction results -- some photos were patients who had come to her to fix a previous reconstruction. Again, for me, the choice was a masectomy with immediate reconstruction.

I was amazed and still am with the extraordinary outcome given my fear of a masectomy. It is different but I kept the "shell" of my breast and then my back tissue and blood vessels were used to fill in followed by an implant. As I tell my kids, my "stuffing" was removed and new stuffing was put in its place. It wasn't like the "radical" mastecomies of years past. My plastic surgeon was not a "chop shot" -- she had worked with burn patients during her residency which is how she got into plastic surgery. I had ready access to the surgeon and asked as many questions as I needed -- he was very good about returning calls, listening and providing answers as was my plastic surgeon.

The point in sharing some of this background is to provide some context. I had the benefit of two baseline mammos. My third mammo convinced me that something was grossly wrong on my right side. The breast MRI punctuated that fact. Had I not had the original mammos, it may not have been so obvious to me. Therefore, I do believe baseline mammos are extremely important because it provides at the initial phase something to compare to. I also think working with a hospital that's vested in women's health and having the right care provider team is critical. Although you can't ignore the fact that it's an emotional journey, if you focus on the data -- your personal data -- against the available info. and you feel confident in your care providers -- you make the most informed decision that is right for you. What I did find out, based on the biopsies from my surgery (I also had a pre-biopsy), is that my margins were at the last stage before being invasive so it definitely was the right decision for me. All in all I had three surgeries over 1-1/2 years and some in-office tatoo procedures.

Lesson learned: Do those annual mammos. It helps provide objectivity when you have some personal data to leverage when faced with this diagnosis. I also think doing a breast MRI is extremely helpful.

kmccraw423

I had a bleeding left nipple - elected bilateral mastectomy.  First, my grandmother had breast cancer, my mother died of pancreatic cancer and her brother had colon cancer.  I was NOT taking any chances!  Upon pathologic exam there was DCIS in the "healthy" breast.  The oncologist I saw thought I was making an "emotional" decision so he had further pathologic tests to discover there was DCIS in the so-called healthy breast.  The DCIS was NOT seen on mammo or ultra sound.  It took a MRI to find it and it was large - the breast surgeon could not assure me that she would get clean edges.  If it was large a lumptectomy would probably require surgery or it would be misshapened.  The other breast would need surgery to match.  Both breasts would have to be surgically altered and I would still have breast tissue; hence, still worried about breast cancer.

I was NOT making an "emotional" decision.  I wanted the cancer out and ALL breast tissue gone so that this would be a non-issue in my life.  I don't want to "wait and see" for anything that could remotely turn into something life-threatening.  Also, had I waited, I would be that much older and more of a surgical risk (I was 61 at diagnosis).

As far as I am concerned, if it can turn life threatening, its cancer.  Call it whatever you want.

sweatyspice

Nah, it's not cancer.  I just had a boob job that insurance paid for. 

j/k

Deirdre1

sweatyspice wrote:  "Nah, it not cancer.  I just had a boob job that insurance paid for"

<chuckling>...  and not a good boob job at that!

I can chuckle now but it was no laughing matter when I too had to make the decision to go bi-lateral!   And once again I say it is the doc's who need to be more educated, changing the name only saves insurance companies money and we all know the lobbyist are heavy into the insurance business.  So what's a few lives worth to them!  The idea of changing the name infuriates me to no end!  If they had some new information/research (not paid for or endorsed by insurance or medicine - but a real actual scientific study) that showed it was not dangerous I'd be singing a different tune.. but they don't - they would be changing the name only to stop the charges that insurance companies are having to pay for so many tests and potentially mastectomy's and after care.. It is so clear what is happening with the "change of name" platform!!!  Business and money first, blame the patient and if the patient has to take the hit (death) well the numbers will be small right???  <nodding head in disbelief>

mollie07

In the eyes of your insurance company yes it is. Iam a breast cancer patient with breast removals and the diagnosis was DCIS. Speaking personally, I have had physicians tell me don't ever let anyone tell you that you had cancer as your diagnosis was DCIS. But also speaking from experience, in the eyes of the insurance companies you have had cancer.

allvirgo71

after a wide excision biopsy my original BS said "If Im going to have cancer, its the 'best' kind to get"

Then I met my original oncologist who told me I didnt have cancer at all, (DCIS) but that my non cancer should be treated with radiation and tamoxifen. I was so angry with the onco and I told my huz in the car " so what? I have cancer? I dont have cancer? Is my cancer kinda like prisoners in gitmo? Theyre called terrorists ONLY IF they escape?" We laughed about it and began to do the foot work.

What a confusing time! Id JUST turned 38 and decided to do my homework based on the knowledge available. Based on the options available for me I chose bilateral mx with immediate reconstruction. Would I suggest this for everyone? No. Individual choices for every person have to be made based on what applies to their particular situation. No one can say with 100 percent certainty what they would do in anyone elses situation-for the simple fact that any judgement calls based on an event that isnt happening causes subjection and partiality based on what IS happening. 

In one way or another we are in this together-or this would be the womenwhoarebored.org website. 

speech529

I sent the entire article that Robby quoted to my father, a retired surgeon.  He graduated from medical school in 1963.  He told me that "watchful waiting" was what they were taught in medical school over 40 years ago and he does not agree with it.  This is part of his reply to me:

Regarding the word hysteria about cancer diagnosis is not hysteria but a normal healthy reaction to a major threat to one's well being. Regarding the quote "We should be demanding change". From good to uncertain? Regarding "minimal risk lesions" should not be called cancer, no wait until these abnormal cells become invasive, then treat.

If this is implemented it will be a long term study with all the risk born by the patient. Will the stats say wait and see is good, or will they say we should have been treating that in-situ "lesion"? Ask authors what to do if it's them or child or mom or sister or dad or brother or aunt or etc?

I don't know the extent of my DCIS....I will not know until I get my path report (tomorrow), see the breast surgeon (in 6 days), get surgical treatment and the path report after that.  I will not wait and see!

I am scared, worried and hate the waiting. But I plan to do what I need to do to take care of myself.  I don't see any of this as "overtreatment".  

 

iHEARTu

Why is it that someone with 10+cm grade 3 is diagnosed with DCIS and another with 4cm Grade 3 with IDC? 'They' don't know? We can only do what information is given to us today. Researchers/Doctors at this very point in time treat DCIS as CANCER. Next year it may be proven a mastectomy for DCIS is overkill? I certainly was not going to wait.

CTMOM1234

Sure am glad I had routine mammogram even though i'm < 50 and no risk factors, sure am glad my dr. didn't take the watch and wait approach when my biopsy came back as grade 2 DCIS, sure didn't expect that final pathology report said that lumpectomy contained 1.7 mm of invasive -- Surprise!

I'm obviously so very thankful that it was caught early. No insurance company's going to convince me otherwise.

CTMOM1234

Should add that by all measurements I was termed "low risk."  Post lumpectomy, I'm now getting rads. and would have certainly needed chemo. had my dr. decided to wait until I "progressed to high risk." What a bunch of bull#$%^.

I can LIVE with overtreatment. I'm not sure I would be ALIVE with undertreatment.