for a collegaue

1Athena1

Hello, fellow BC-ers:

I have a colleague who was recently diagnosed with DCIS (er-, pr-). Apparently it is not a solid tumour but microcalcifications spanning about 7cms - don't know more.

Does anyone have resources in the form of web sites, articles or books they would recommend she read to learn more?

She has not had surgery yet, but it appears that she might have a lumpectomy (she is big- breasted so it is possible even with 7 cms of evil) followed by radiation. I was telling her that radiation may well depend on margins of excisions - that I wasn't sure it was a given that you had to get radiation (assuming no microinvasions are detected, of course).

And re: radiation, I told her there MAY be several protocols, including single dose, but that I would find out, since I know nothing about DCIS or rads.

Any literature on this?

Thanks in advance!!

Edit: sorry for misspelling colleague!!

Beesie

Athena,

Here are some good websites with general information about DCIS: 

http://www.dcis.info/dcis.html

http://www.breastcancer.org/symptoms/types/dcis/

This is a long but excellent article from Dec. 2007 that explains DCIS and talks about treatment options:  http://theoncologist.alphamedpress.org/cgi/reprint/12/11/1276

Another general article which includes some info on recurrence rates with and without radiation: http://cme.medscape.com/viewarticle/447028

The NIH Conference on DCIS - all the articles, including some on radiation (you need to scroll way down the page to get to the links to the articles): http://consensus.nih.gov/2009/dcisabstracts.htm

A couple of other articles that talk about radiation after a lumpectomy for DCIS:

http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional/page4

http://cme.medscape.com/viewarticle/466380

Hope that helps!

1Athena1

Thank you Beesie - you truly are a wonderful source of information.

Hearing about someone else's cancer really brings back those awful feelings of uncertainty, doesn't it? At least I knew I would have a BMX because I specifically asked for one; my colleague DOES want her breasts but may well wake up without one - and with news of a lymph invasion. It makes you shudder all over again. She is scared.

Beesie

Yes, it does bring it all back! 

If you're going to be diagnosed - which of course I wouldn't wish on anyone - DCIS really is the best diagnosis to have.  The problem with DCIS is the uncertainty when you are first diagnosed. With calcifications spanning an area of 7cm, it's just impossible to know what's in there.  Some of the calcs might simply represent ADH and not even be DCIS, but on the other hand the larger the area of calcs the more likely it is that some invasive cancer may be found.  This is the big problem with DCIS - until it's all removed, you really don't know that it is all just DCIS.  Most of the time - about 80% of the time, the diagnosis of DCIS from a needle biopsy doesn't change once the final pathology is in after surgery - but the likelihood that it will change is greatest for those who have more aggressive DCIS (grade 3 with comedonecrosis) or large areas of DCIS, as your friend does.  On the other hand, moving all the way from DCIS in a biopsy to having IDC with nodal involvement only happens a small percent of the time.

Has she joined the board?  If not, send her this way.  There are lots of us who've been through it who'll be happy to hold her hand (figuratively speaking) as she makes her way through the diagnosis and treatment.

1Athena1

No, she hasn't joined it, but I will definitely let her know.

CTMOM1234

Good luck to your friend, Athena. So true, that period of uncertainty is so awful and it pains me when I think of another having to go through that! It was a dark time indeed.

Tell her that even if she's going to have to go rads, it's fine, dealing with the mental worry upfront is the hardest part, not the quick daily treatments. In my case, surgeon gave me only two choices once the stereo biopsy stated grade 2 DCIS: mastectomy or lumpectomy and rads (not lumpectomy and no rads), so I think the option to avoid rads. may also depend upon the protocol that the surgeon follows, regardless of margins and size. As "luck" would have it, final lump.path. report came back with a little bit of IDC, so I assume rads would have been added had they not already been planned.