Stanford long-term DCIS study

Scrabblelady

Sleuth1:  I'm interested in what treatment you are undertaking with a stage 2, grade 3 bc.  Can you give me the source of your information stating that chemotherapy does not work for bc?  I was initially diagnosed with DCIS, but the core biopsy indicated multifocal ares, high grade and HER+. My paty report from my surgery found areas of microinvasion.  So I am glad that I chose not to wait.  In all the professional literature which I read, no author or study suggested to I wait and watch..

redsox

I would like to invite those who want to discuss chemotherapy to move that discussion to another forum rather than highjacking this thread.  Since this is the DCIS forum it is irrelevant.  For people dealing with a pure DCIS diagnosis chemo is never recommended.

cycle-path

Redsox, I agree. 

xtine

I was curious where sleuth1 quoted from, so I googled it. The copy-paste is from a wikipedia article on chemotherapy, and [20] refers to the following general study:

Morgan G, Ward R, Barton M (December 2004). "The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies". (http://www.ncbi.nlm.nih.gov/pubmed/15630849)

What we seem to have here is a study about whether people are alive in 5 years soley due to chemo. There are many ways of treating breast cancer (chemo, surgery, radiation, herceptin, hormonals...), and for many of us surviving for 5 years is the easy part compared to trying to avoid recurrence and metastasis for the rest of our lives. I'm not an expert (nor have I done chemo), and I can't pull a bunch of studies out about how chemo helps to achieve those goals, but I imagine those studies exist. I am certain that those studies exist about herceptin and hormonals, and I've read a few of them.

Not trying to disregard anyone's choices as to their own treatment, but I too am offended when someone suggests that the treatments so many of us have received are "unnecessary", when there is plenty of evidence to the contrary. 

(editing to agree with the comments above... I really didn't want to discuss chemo either, though I was interested in the original sfgate article.. feel free to continue the chemo discussion on a separate thread!)

redsox

I have read the article in JNCI Vol. 103, Issue 6 | March 16, 2011 entitled:

Long-Term Outcomes of Invasive Ipsilateral Breast Tumor Recurrences After Lumpectomy in NSABP B-17 and B-24 Randomized Clinical Trials for DCIS

Irene L. Wapnir, James J. Dignam, Bernard Fisher, Eleftherios P. Mamounas, Stewart J. Anderson, Thomas B. Julian, Stephanie R. Land, Richard G. Margolese, Sandra M. Swain, Joseph P. Costantino, Norman Wolmark

It reports on extended follow-up for the two NSABP clinical trials B-17 and B-24 which have both been reported earlier and are key studies for DCIS.  B-17 looked at the question of lumpectomy alone vs. lumpectomy + radiation therapy while B-24 looked at the question of lumpectomy + radiation therapy with or without tamoxifen. The primary endpoint reported in this paper is recurrence of invasive breast cancer in the same breast as the original tumor, but it also reports many other endpoints and breaks down the data by other factors.  The follow-up is longer than for earlier reports of these studies, ~15 years (for B-17 median follow-up is 207 months or about 17 years and for B-24 median follow-up is 163 months  or about 13.6 years). 

The results show that in B-17 radiation therapy reduced the risk of invasive same-breast recurrences by 52% while B-24 showed that tamoxifen in combination with radiation therapy showed a 32% reduction in the risk of invasive same-breast recurrences.  (edited to clarify -- the 32% reduction is for tamoxifen.  All patients in this trial had radiation.)  The cumulative incidence of invasive same-breast recurrences at 15 years was 19.4% for lumpectomy alone, 8.9% for lumpectomy + radiation therapy in B-17 and 10% in B-24, and 8.5% for lumpectomy + radiation therapy + tamoxifen. 

The article shows numerous survival curves with four groups displayed on each graph.  I found it a little confusing until I realized that it is not a single trial with 4 study arms but rather two separate trials each with two study arms.  Patients were randomized for the two arms of the first trial and then other patients were randomized for the two arms of the second trial but arms of different trials are not randomized with each other.  The eligibility criteria were looser for the second trial, especially with regards to margin status, presumably because all patients in the second trial received radiation therapy. 

Still, each trial did not include all DCIS cases but tried to define a group likely to have a relatively favorable prognosis.  The criteria for defining a favorable group once again do not work well -- the criteria seem to relate to speed of recurrence at least as much as ultimate rate of recurrence. 

note: If you are interested I will try to summarize more of the results.  This manuscript does not seem to be available in full without a subscription.

vinicaka

Hi Beesie:

 I was diagnosed with  grade 0 DCIS at Jan.  But after MRI and two more biopsy found invasive cell (other than the 1st location) so it turn to grade 1 already.  Waiting for the surgery for mastectomy  and thinking about reconstruction at the same time.   I am worry about the waiting time for the surgery.   Any idea, how long for the waiting time is "reasonable"?   For MX alone, won't wait for long.  However if consider reconstruction, time is unknown!!??

gymnut

hello all,

i'm grateful to everyone brave and caring and open enough to try to share here and give to and learn from each other.  i think that most of us are well-intentioned, or so i would hope.

i would just echo the sentiments of others who suggested that perhaps it makes sense to tread lightly and carefully as we are sharing our questions, opinions, hopes and fears, lest we trample on someone else.

we're all here because we share something in common we all wish none of us or anyone else had to experience (w/ the possible exception of the fact that we are probably also aware that it could be/have been worse & are grateful it isn't or wasn't.) that being said, we each have our own difficult choices to make, costs to way and consequences to live with.  the least we can do for each other is respect each other's right and responsibility for making those choices and hope that we each make the best choices for ourselves, whatever they may be. 

i don't think this is the place to be pushing an agenda, judging other people's choices or proselytizing.  i'm sure everyone here has been through and will have to go through more than enough difficulties w/o negative comments from here adding stress.

as i said, please tread lightly.  and thank you for posting the info on this study which i too find more than a little disturbing.  i guess more info is needed before i decide how upset it makes sense to be.

 take care, all.

mikita5

Hi vinicaka: Sometimes it's a wait for mx with immediate reconstruction because it's hard to get two doctor's schedules with the same 'free time'. I had to wait a couple of months.

sleuth: I was diagnosed with DCIS in ONE breast.. small in size, thru a mammogram. Had a biopsy, had a lumpectomy and SNB. My oncologist spent an hour trying to change my mind about a bilat mx. I knew what I had to do.. But it was JUST a little DCIS area, however, pathology came back with 2 more areas of DCIS. Hmmmm that first lumpectomy may have gotten the FIRST CANCER, but how long would it have been before I was back doing it all again with the two other CANCERS?  By then, would they have been invasive? Treatment IS necessary for DCIS and DCIS high grade, comedo neucrosis. Had mine been low grade and NO comedo...., I'd have chosen the same path...

Cancer is not anything to play with or gamble with. I've lost a Mother, 2 aunts, a grandmother, 3 first cousins from this terrible disease and have several others still fighting it. Waiting and watching is insane. I only hope that no one just joining this 'club' sees your post and takes it to heart!

AlohaGirl

Thanks for the info, Redsox!  The figures are higher than I have seen in the past (from other studies) -- maybe because the study was longer.  I was surprised that tamoxifen seems to only slightly improve the odds -- maybe I will talk to my medical oncologist about that when I have my follow up in a couple of weeks.  Did the study say anything about subsequent DCIS found during the study, or only invasive?  Thanks!

Beesie

sleuth, you might want to consider participating in the Alternate, Complementary and Holistic Forum on this board - you may find people there who share your approach.

For someone who comes to the DCIS forum without a DCIS diagnosis, knowing little about DCIS and with what seems to be the sole purpose of crapping on all of us for our treatment choices, it's strange that you talk about support.  

kittymama

Hi Vinicaka



I noticed that you are from Vancouver. I am located in Toronto, Ontario and have noticed that the process moves a little slower here than in the States, if you want immediate reconstruction.



I was diagnosed with intermediate grade DCIS in late October, had an MRI in late November, which indicated extensive, diffuse DCIS. Decided on a mastectomy with immediate reconstruction. My BS warned me that it might take time to coordinate his schedule with a PS's. Long story, short, my surgery for unilateral mastectomy with immediate reconstruction is scheduled for

March 30, five months post-diagnosis, which in cancer world may not be a long time, but it is a bit stressful to not know the full extent of the disease.



On the other hand, for me at least, the projected benefits of immediate reconstruction seem worth it. I hope I'm right. All the best to you.

Anonymous

Sleuth

I am sorry for the way certain people have treated you here.  This is no excuse for rudeness.

No excuse for someone to say you are "crapping on us" on a support forum.

No one has all of the answers, if we did, there would be a cure for cancer.'

Take care of yourself - I wish you the best

mom3band1g

hahahahah  I was wondering when Erica31 would 'pop' in.  

Beesie - spot on.

redsox

The article reported other endpoints in addition to invasive same-breast recurrence.  Among them were DCIS same-breast recurrence and cancers in the other breast. 

Of all same-breast occurrences 46.3% were noninvasive or DCIS while 53.7% were invasive (the ones I talked about in my previous post).  1.3% had other local, regional, or distant recurrences without documented breast recurrence.  In the B-17 trial lumpectomy + radiation therapy resulted in 47% lower rate of DCIS recurrence compared to lumpectomy alone.

Breast cancer in the other breast was the first event for 7.2% of patients.   In the B-24 trial patients who received lumpectomy + radiation therapy + tamoxifen had a 32% reduction in other breast cancers compared to those who had lumpectomy + radiation therapy with no tamoxifen. 

MarieKelly

Am J Surg. 2008 Oct;196(4):552-5.Invasive local recurrence increased after radiation therapy for ductal carcinoma in situ.Guerra LE, Smith RM, Kaminski A, Lagios MD, Silverstein MJ.Hoag Breast Care Center, One Hoag Dr., Newport Beach, CA 92663, USA. lisaeguerra@gmail.comAbstractBACKGROUND: It is thought that equal numbers of invasive and noninvasive recurrences develop after conservative treatment for ductal carcinoma in situ. We analyzed our data to see if this was true.METHODS: A prospective database of 878 conservatively treated patients with ductal carcinoma in situ was analyzed.RESULTS: Among 551 excision patients, there were 88 recurrences. Thirty-five percent were invasive. Among 327 excision plus radiotherapy patients, there were 59 recurrences. Fifty-three percent were invasive. In an attempt to predict which patients develop invasive recurrences, prolonged time to recurrence was the only statistically significant factor.CONCLUSIONS: The median time to local recurrence for irradiated patients was more than twice as long when compared with nonirradiated patients, during which there is more time for local recurrence to progress to invasion. Irradiated patients had more breast scarring, making diagnosis by palpation and mammography harder. Irradiated patients develop invasive recurrences at a statistically higher rate than nonirradiated patients. Follow-up evaluation with magnetic resonance imaging should be considered.PMID: 18809062 [PubMed - indexed for MEDLINE]http://www.ncbi.nlm.nih.gov/pubmed/18809062 Ductal Carcinoma in Situ: Dilemmaor DenouementTO THE EDITOR: On the basis of multiple randomized trials for ductal carcinoma in situ (DCIS), it has long been claimed that no low-risk subset defined by favorable clinical or pathologic features could be identified and spared irradiation. The report by Hughes et al successfully identified for the first time a low-risk subset in a prospective trial that was spared radiation therapy. Their results were based oncareful mammographic-pathologic correlation and complete sequential tissue processing-methods that are essential to define the size and margin status and to exclude invasion. This type of comprehensive approach has been advocated for some time, and was the consensus recommendation of three consecutive image-detected breast cancer consensus conferences and the recently published College of American Pathologists' guidelines for DCIS. As the accompanying Editorial noted, such methods were not employed by any of the randomized trials. As a result, there were much higher local recurrence rates with or without irradiation and a sizeable number of metastatic first events in B17 and B24, a reflection of unrecognized invasive disease compared with prospective nonrandomized studies. Moreover, this approach was decidedly not part of the prospective study of Wong et al, on which we have  previously commented. In our experience, the two therapeutic interventions for which patients have the greatest dread are radiation therapy and axillary lymph node dissection. Relatively few of our patients seek a bilateral mastectomy for DCIS, and most who initially discuss this will choose alternative breast-conserving treatments when they are properly informed.For the low- to intermediate-grade lesions, 25 mm or smaller with 3mm or more margins, the 7-year rate of IBE was 10.5%, half of which were invasive. In our experience, 10% of patients with invasive recurrences after an initial diagnosis of DCIS die of metastatic breast cancer. That means if 400 patients are not irradiated, we can expect 42 recurrences, 21 of which will be invasive, two of whom will die. If these 400 patients are irradiated, the numbers will be halved to 21 recurrences, 10 of which are invasive, one of whom will die. In other words, we must irradiate 400 patients to save one life. Of the 400 patients, 358 do not benefit from radiation because they would not have recurred. All of them, however, are exposed to the morbidities of radiation therapy. Are we certain that no lives will be shortened because of irradiation? We are not. Long-term data with current techniques do not exist; however, available long-term outcome data of breast irradiation note small increases in mortality related to cardiac disease and smaller risks of lung carcinoma. It hardly seems worth irradiating 400 women to prevent 21 recurrences and one death.Does it not make more sense to carefully follow these patients, re-excise the 42 who recur, and irradiate them at that time, thus sparing 358 the time, expense, and morbidity of breast radiation therapy?http://jco.ascopubs.org/content/28/14/e218.full.pdf 

Jelson

MaryKelly,

your bold type and giant letters are unneccessary and insulting. Posters on the DCIS board are routinely referred to Dr. Lagios for second opinions on their pathology, as well as, to the Van Nuys Prognostic Index. Of course women, as the article states, with low grade DCIS, small tumors and large margins should strongly consider avoiding radiation.

Julie E

Beesie

I'll add that the studies are all over the map on this.  Some show that radiation after a lumpectomy for DCIS equally reduces the risk of both an invasive recurrence or a DCIS recurrence. Others show that radiation more greatly reduces the risk of an invasive recurrence (meaning that more of the recurrences would be DCIS).  And others show that radiation more greatly reduces the risk of a DCIS recurrence (meaning that more of the recurrences would be invasive - as per the article above).  So I don't think any conclusions can be drawn either way.

Here's a good summary of a lot of the DCIS recurrence studies. I know that Wiki isn't particularly reliable but this is the one place where I was able to find a summary of so many studies.  Links to the abstracts are included so it's easy to check the accuracy: 

http://en.wikibooks.org/wiki/Radiation_Oncology/Breast/DCIS 

And I'll agree with Julie's point, which is that I think most of us who hang around in the DCIS forum appreciate that there are cases where radiation may not be necessary after a lumpectomy for DCIS. This is discussed often and many women who have lumpectomies do consider this option.    

Kindergarten

Dear Moderators, Erica31, has just sent me the most disturbing pm. I could not pm backbecause it would not let me. But I would like to put my statement in public for everyone to see. I am truly now leaving this site-BCO. Her pm was somewhat threatening and extremely disturbing. That is all I will say. Kathy

cycle-path

vinicaka:

I think your question got missed, except by kittymama, in all the back-and-forth about other stuff. You said: "I was diagnosed with grade 0 DCIS at Jan. But after MRI and two more biopsy found invasive cell (other than the 1st location) so it turn to grade 1 already. Waiting for the surgery for mastectomy and thinking about reconstruction at the same time. I am worry about the waiting time for the surgery. Any idea, how long for the waiting time is 'reasonable'? For MX alone, won't wait for long. However if consider reconstruction, time is unknown!!??"

First -- you might want to consider looking at the Breast Reconstruction forum here, at http://community.breastcancer.org/forum/44. A couple of times in the past I've posted a query in one forum and gotten no real response, and then I've posted it in a different one and gotten lots of good answers. 

Second -- I don't want to sound critical, but I believe you're using incorrect terminology about your diagnosis. I say this only to help you get the best information for yourself. You say you were diagnosed with grade 0 DCIS, but that a biopsy found invasion so now you are grade 0. I believe what you're talking about is probably STAGE 0 and STAGE 1, which is different from grade 0 and 1. Grade refers, more or less, to how nasty the individual cancer cells look. Stage refers to the size of the tumor and whether or not there has been invasion.

I believe the correct description of your diagnosis is probably DCIS with some stage 1 IDC, though I'm partly guessing about this.

I hope this information is useful to you. Again, think about checking out the Breast Reconstruction forum. Best of luck to you!  

MarieKelly

Jelson wrote:

"MaryKelly,  your bold type and giant letters are unneccessary and insulting."

Sorry, the bold type wasn't intentional. That's just how it copied here. If anyone knows how to prevent it, please tell me and I'll make sure it doesn't happen again.  

baywatcher

I have to say that I pretty much agree with sleuth1. I think DCIS is overtreated. This is MY opinion and it is from someone who has a bi-max. I'm not being judgemental of anyone and don't want to offend anyone.

At the time of my diagnosis, this study was not available.

My DCIS was discovered on a mammogram and the docs scared the crap out of me. I never felt sick and I never felt a lump. The docs convinced me that I needed a mastectomy. At the time, I felt like I traded my breasts for my life. I convinced myself that I was lucky that my cancer was discovered so early. But as time has gone by, the biggest regret in my life is that I ever had a mammogram in the first place.

The mastectomy has affected me in ways that I didn't know existed. I am a different person and I miss the old me. The depression that I have experienced has been severe. I had no idea that I would experience this sadness. In my case I don't believe it was worth it. Of course, hindsight is 20/20.

XmasDx

I am going to hop into this foray at my own risk, just because I do think that some of the points here were sources of very great conflict, confusion, concern, and debate for me when I was first diagnosed with intermediate DCIS. 

I try to stay moderately informed about things, and although I love sugar and weigh 40 lbs too much, and don't exercise as much as I should on the other hand I'm vegetarian, I eliminated parabens and xenoestrogens as much as possible a year ago, I try to eat healthy and organic foods, and do go to the gym occassionally.  So that is to say, I think I'm an average 41 year old woman.  I've listened to Dr. Weil for years, taken supplements, watch Dr. Oz, try to stay open minded, etc...

I had my microcalcifications show up on a mammo, and had never heard of DCIS.  I had a Dr. Oz on my DVR called something like "Are we overdiagnosing breast cancer?"  Now keep in mind, I knew NOTHING about bc, any stage.  Nothing.  So I watch Dr. Laura Esserman on Dr. Oz explaining DCIS, and talking about managing low-grade DCIS with diet and exercise, and how we are basically butchering women in the name of CYA medicine (cover-your-as$$).  Dr. Oz also had a doctor from the Susan G. Komen side of things explaining the more conventional approach, that we just don't know what is safe to leave and what isn't, and she stated that until we know more, better safe than sorry.  Dr. Oz went on to explain how an excisional biopsy gives us more real info than a core biopsy (using red cherry and strawberry pies as an example), and how we just really don't know what we've got until we get in there and get it out and do the pathology.

He gave equal time to both doctors I think, I've rewatched the segment a dozen times but finally deleted it.  Dr. Esserman is from UCSF, not exactly an alternative establishment, as I understand it.  But all her words (and some youtube of her also) stuck in my head so strongly when I did receive my DCIS dx that I just couldn't believe I really needed to treat it aggressively.  My surg onc had a hard time getting through to me that "this is not something you just leave."  My DH heard her though, the odds of recurrence if we do lumpectomy only, or nothing, or no tamoxifen, or no rads...he heard her saying the risks of not treating this thoroughly could eventually be life-threatening.  He wanted it out.

Sorry I'm rambling, but it was pure torture trying to figure out what to do for me.  I had Dr. Esserman in my head, I read some of Suzanne Somer's Knockout which sounds like a lot of the same info in the post above by sleuth saying chemo doesn't work etc etc, and then on top of it bunches of articles like the article in Ladies Home Journal.  I truly felt inundated by news telling me that this DCIS was not cancer in the true sense and that the treatment was worse than leaving it be. 

Dr. Love's book gave me some of the same impressions, she mentioned molecular markers that are being researched that may tell us how likely our DCIS is to turn invasive.  I emailed the author of the study (Karla Kerlikowske) and asked her a few questions, as well as poured over the entire study.  Trying to get an answer for myself, "Do I have something serious, or not?"  It was pure torture, it consumed me from December 13 through mid January. 

Looking through Kerlikowske's study though, I just did not see the pure correlation I was looking for.  I wanted to know that low-grade never turns invasive.  I wanted to know that only high-grade turns invasive.  I wanted to know that only DCIS found as a lump not on a mammogram turns invasive.  None of these things were proven out in the study.  Quite the opposite, there was a randomness to who got IDC down the line that I just did not like at all.  It convinced me, once and for all, that the DCIS had to go, and that if I was being "over-treated" that was a decision I was freely making based on the information available in 2010-2011.  In 2030 will my daughters have more options and more certainty, more information available to them?  Sure they will!  But this isn't 2030.  And I'd like to be around in 2030 to see it! 

Finally after an MRI showed extensive DCIS post-biopsy, I resigned myself that the breast HAD to go, I would hopefully not need radiation, and would not do tamoxifen.  I would save my healthy breast, and have a DIEP by a local ps team.  There, a plan I could live with.   

To the question of how long should you wait between biopsy and surgery?  Well, I waited from Dec. 13 to Feb. 28th.  In that 2 1/2 months it is my belief that my DCIS may have broken out of the inflamed duct from the biopsy, and they found 3mm of low grade IDC in my final (revised) path report post-mx.  Did I have the IDC there all along?  Was it from "seeding" post biopsy?  Who knows.  Did my treatments cause more problems than they cured?   How can I possibly know that?   But I believe the shorter time you wait between biopsy and surgery, the better.  

 I understand the natural route that sleuth and others advocate, and now that my mx is over I do plan to further study what I can do to protect my healthy breast and keep bc away for good.  But I was not some uninformed sheep led to slaughter by a greedy medical system.  I was cynical, suspicious, jaded, questioning, and informed and in the end I made the decision that was best for me that I could live with.  I annoyed the hell out of my ps and my surg onc with my questions, I'm sure.  

The women on this board are like me I see for the most part; questioning, informed, and they weigh their options carefully.  

Choosing to treat DCIS with mx, bmx, lumpectomy, radiation, tamoxifen -- these are things we all weigh heavily, and we're entitled to make our own decisions with our own bodies for our own futures.

But this concept of "over-treatment" is becoming some sort of "conventional wisdom" and I'm sick of the connotation it has that women don't participate in their own healthcare choices.  And all the articles about it scared the heck out of me and made me second guess myself at one of the more difficult times of my life.  

Dr. Esserman is still saying, "If we are catching so many more cancers early with mammography (DCIS), then why aren't the rates of women dying from breast cancer going down?"  I don't know, but it seems to me that the rates of all cancers are sky-rocketing in the past 40-50 years from what I've read... perhaps bc death rates haven't shot through the roof the way they would have if we weren't catching all this DCIS early... I don't know.

xtine

Xmas - exactly. I felt/feel the same.

ddd

Why didn't the study include women who chose bilateral mastectomy and give us an updated recurrence percentage? 

Moderators

Let us all agree to disagree, and try to maintain a respectful tone. I agree with many that it is often HOW it is said, more than WHAT is said that stirs a bad feeling in others. Before posting, think about how you would say what you want to say in a face-to-face interaction, and phrase it as such. Thank you.

Melissa 

mom3band1g

Melissa - thank you!

For those who suggest a 'watch and wait'.....I am genuinly curious how that would work?  How do you watch something that doesn't show on any diagnostic tests?  My other question to those who subscribe to that method, why would you not want to take care of it before chemo is needed and/or your life is truly in danger.  My children are young and just going through 3 surgeries and 6 weeks of rads was hard on them.  I cannot imagine putting them through more because of a wait and watch approach.

redsox

Xmas--

What a great post!   I think you have explained very well the pressure coming from the media telling women that they should not treat a DCIS diagnosis as serious. 

My experience is: I had a diagnosis that looked very favorable in some ways but not so favorable in some of the less obvious details.  I researched thoroughly and consulted experts I knew well and trusted.  I was thrilled that I did not have to consider chemo.  I did not want to have a mastectomy and I did not like the idea of going through all the procedures for reconstruction that I read about.  A lumpectomy seemed reasonable for me and I read thoroughly and questioned my doctors about the papers reporting studies pro and con on radiation therapy and tamoxifen.  I questioned everything and was 100% convinced that radiation was necessary.  I was not as convinced on tamoxifen but decided to take that as well. 

I do think DCIS patients are overtreated in a global sense that a majority of them could have lumpectomy alone and not have a bad outcome -- but that is true of many medical interventions.  The probability of having a recurrence which has some chance of advanced disease is too high for me to risk for a disease that has treatments that can reduce the risk of death to practically zero. When people start dismissing treatment because only 20% or 30% would have a recurrence and only 5% or whatever would die, I am flabbergasted.  Almost no one should die from this.

Attempts to identify a subgroup of DCIS patients who can have lumpectomy alone have been disappointing although I still believe that bio-markers will eventually be found that will identify such a group.  I also suspect that the subgroup will be much smaller than most of us would like to see.  

redsox

ddd-

These two studies were randomized controlled clinical trials. Patients had to be willing to let a random number generator decide what treatment they received. 

In one study the two possibilities were 1) lumpectomy + radiation or 2) lumpectomy with no radiation. 

In the other study the two possibilities were 1) lumpectomy + radiation + tamoxifen or 2) lumpectomy + radiation + placebo.

It would be great to have data from a randomized controlled clinical trial of these options vs. unilateral mastectomy and also bilateral mastectomy, but I doubt if many women would be willing to let random chance make that decision for them. Only if patients are willing to participate can the clinical trial be done.

ddd

It should have been made clear in the original post, that these were randomized controlled clinical trials.

rianne2580

Would all agree a microinvasion of IDC with grade 1 DCIS in one area of the breast and grade 3 DCIS in another area of the breast warrants a mastectomy. I do not know how I'm going to take this mastectomy, feeling like "baywatcher." My BS called me yesterday and talked for quite some time about lymphedema and other problems with surgery. I keep looking at myself in the mirror picturing one less breast. Went to the Mastec Boutiuqe to see what the bras look like, no reconstruction for me, I hate surgery. I am going back and forth about canceling this surgery. Can't a good BS do 2 lumpectomies?