Is this a recurrace

debbie6122

Just rememberd somthing the other night and it wont go away so thought I would ask maybe a silly question:

about 18 years ago i had a lump in my left breast, i saw a surgoen, they did a lumpectomy and also had calcifacations, they came back benign was told it was dcis and not cancer but to keep an eye on it from all the stories i have been reading dcis is a form of cancer and they know more now than they did years ago, i was in my 30's and never thought another thing about it, even after i was dx with bc and had a mx and chemo this past year i never put it together untill recently, my question is, Is this a reccurance and if so does it make a difference in anything at all, I think im probably being paronoid right now but would like to know

debbie

flash

with such a long time between, I would be inclined to think that you may have a new local.  However, that's just my 2 cents.  I don't think it amkes a big difference in your tx or future.

debbie6122

Thank you flash I didnt really think it would make a difference but I was just curious, so thank you for your answer

debbie

carcharm

DCIS -ductal carcinoma in situ means it is still contained in your duct and has not spread. Was the IDC around the same area you had removed 18 years ago? I think your IDC would be considered a new primary because DCIS is not capable of spreading unless it becomes IDC. After reading posts on this website it seems that if  you have DCIS once it is possible that you are more prone to getting it (not mets-new primaries) again. Ask your onc how often people with DCIS get other areas with DCIS.

barbe1958

From what I've read here DCIS can become invasive if left (thus becoming IDC), so what you have is the result of leavig the DCIS in place.That's why they treat it aggressively now adays. Many pathologies find DCIS when other tumours are removed.

Interesting to note it took 18 years to break through the ducts!

Ezscriiibe

Barbe: I just found out that's true, my pathology report mentioned DCIS, too, (this is the one from the lumpectomy), and I was confused about that. So I asked if that was just part of the IDC tumor that was removed or a totally separate cell mass that was removed. He said it was not part of the IDC tumor. Sort of took me by surprise.

Beesie

Barbe is absolutely right - DCIS cancer cells, if left in the breast, can evolve to become invasive cancer.  With aggressive DCIS, this can happen very quickly but there have been studies that show that with small amounts of less aggressive DCIS, it might be 25 years before the DCIS cancer cells convert to become invasive cancer.  So Debbie, if your IDC was found in the same area as where the DCIS was 18 years ago, then it is very likely that your IDC was in fact the same cancer. 

There is a lot of debate about the percent of DCIS that eventually becomes invasive.  Recently the position of many doctors/scientists is that only about 20% - 30% of DCIS will ever become invasive.  This is based on studies of low grade DCIS; all experts agree that they don't know what percent of high grade DCIS will become invasive but most admit that the percentage is probably a lot higher, possibly 70%, 90% or even more.  This means that the removal and treatment of high grade DCIS is absolutely necessary because when invasive cancer develops from DCIS, it might not be caught until it has progressed. 

With low grade DCIS there is less certainty.  The studies that suggest that only 20% to 30% will become invasive tend to be based on a 5 year or 10 year time frame.  So it's unknown what happens after 20 years, or 25 years. While it's certainly possible that some percentage of low grade DCIS may never become invasive, it's also possible that all DCIS will eventually become invasive, if we wait long enough.

Here's one very interesting study that shows a very high rate of invasive cancer in those who previously had DCIS identified by biopsy but not otherwise removed.  The invasive cancer was in the same area as the DCIS.

Continued local recurrence of carcinoma 15-25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy.  BACKGROUND. The stratification of ductal carcinoma in situ (DCIS) of the human breast into prognostically relevant categories by size and histologic pattern is a current concern. Few studies have been able to follow women after the identification of any type of DCIS when they have had biopsy only. METHODS. This is an extension of a follow-up study of a group of 28 women with small, noncomedo ductal carcinomas in situ that were excised by biopsy only, published in 1982. All these women have now been successfully followed for an average of almost 30 years. RESULTS. The overall risk of development of invasive carcinoma for these women over almost 30 years is nine times that of the general population (95% confidence interval, 4.7-17). This is similar to the 11-fold elevation in relative risk that was determined after about 15 years of follow-up. All invasive carcinomas have developed in the same area in the same breast. There were two women in whom invasive carcinoma developed between 20 and 30 years after initial biopsy. One other woman had an extensive noncomedo DCIS that was identified 25 years after her initial biopsy, but had no evidence of invasive disease. CONCLUSIONS. The natural history of small, noncomedo DCIS can last over at least 2 decades, with invasive carcinoma developing at the same site in which DCIS was previously discovered in a significant percentage of women (broadly, between 25%-50%). This is quite different from the natural history of comedo DCIS or any type of DCIS treated purposefully by surgery alone.   http://www.ncbi.nlm.nih.gov/pubmed/8630897

debbie6122

Wow! This is interresting as barbe and others have said, and beesie, that is such a interresting study, and I think the statistics might be higher because I never mentioned it to my team of dr I have now and Im wondering how many woman had this problem years ago and never thought to bring it up because we were told It was not a cancer, which we are finding out now that DCIS is a cancer.

Cancer does not run in our family at least not untill ,my daughter had it 3 years ago she had a very aggressive cancer and this last year I had it, i asked my onc why would my daughter have it and then all of a sudden I have it when it is not hereditary,he said I problably had it for years and it just manifested... but we both tested with a varible of uncertian significance,What???? They cant tell me what this means or if it even means anything.

But I cant thank you enough for all your opinions, I would like to keep hearing if other woman have had dcis years ago and now have bc in the same breast it scares me because lately Im feeling lumps and bumps and wondering should I be worried,,, hmmmm

debbie

debbie6122

Just want to add that i went to a superbowl pary tongiht and I hope I made sense LOL

NativeMainer

A "variable of uncertain significance" means that the gene being testing does not match the current definition of "normal" but it also doesn't match a known mutation or variation that is linked to cancer.  So no one knows if the "variation" is a mutation or a naturally occuring variation, and so no one knows if the variation is of any significance.  Given that you and your daughter both have the variation  AND a bc diagnosis, it's reasonable to assume that it's genetic, just not BRCA1 or BRCA2.  The 1 and 2 in those names refer to the first and second mutation/variation that are known to link to cancer. 

debbie6122

Thanks native, that is the first time that it was described to me where i actrually understood it.

Ezscriiibe

That makes sense, nativemaine. I was told my my genetic counselor that there are quite a few numbers of genes that can indicate genetic presdisposition for some cancers, not just BRCA1/2, but that the only ones we have a very good "read" for now are the BRCA1/2. She wanted to caution me that, though mine was negative, for THAT mutation, they may find in a few years from now that there were other markers we just can't identify.