Alternatives to Surgery

Beejay123

Hi everyone. New to this board. Have spent the past few nights reading posts on several topics. Still more confused than ever.

Received DCIS diagnosis on 7/5/2011. Consulted with surgeon on 7/13/2011. He recommended what he called partial mastectomy with incisions down middle and under breast to "get best possible result." I am  small breasted so even with care will still look like a chunk of breast tissue is missing. Will need reconstruction to return nipple to original position. If radiation called for will shrink breast further, maybe a cup size difference according to surgeon. But, honestly, even though I opened with this, I'm less concerned with the cosmetics than I am that surgery is necessary at all.

After visiting this forum, I called for a copy of the pathology report and received it yesterday. Thank you all for reminding that I should have that. Here's what it said:

FINAL DIAGNOSIS: Stereotatic core needle biopsy, right breast. Ductal carcinoma in situ. Nuclear grade: Intermediate. Patterns: Cribriform, comedo. Necrosis: Comedo-like. Intratumoral microcalcifications: Present. ASSAY RESULTS: ER+/PR+. COMMENT: Four ductal units are involved in the ductal carcinoma in situ. That was it! Couldn't find any reference to size other than in earlier report to my doctor recommending a biopsy: "Calcifications demonstrate slight variation in size, shape and density. They span a distance of approximately 4 mm. Millimeters!!!! What's more, had an MRI before the surgeon consult and he told me that the microcalcs had been removed in the biopsy!

Although I'm concerned, very concerned, why do I feel that they're trying to use a shotgun to kill a gnat? Why do I need surgery at all? Is "wait and see" a good strategy in my case? Or am I just hiding my head in the sand avoiding the inevitable?

Feeling crazy right now. Thanks so much for any and all insights. Oh, btw, I am 63 years old with no family history of breast cancer

cycle-path

Beejay: first, a disclaimer. I had pure DCIS and a small lumpectomy only. No reconstruction, no chemo. I will probably not have Tamoxifen or other hormone therapy, and the only radiation I had was easy-peasy IORT (http://www.breastcanceriort.org). Therefore, I don't have personal experience with a lot of what others have gone through.

That being said, my impression is that the surgery is the least annoying part of the treatment that will be recommended to you. It will probably be strongly recommended that you have radiation, and there's a good chance an oncologist will want you to take Tamoxifen. Many women complain bitterly about both, though relatively few have a lot of complaints about surgery.

I agree with you about the gnat with a shotgun approach. If you do indeed have pure DCIS with no microinvasion (which, btw, can't be known until biopsy after surgery), radiation and Tamo may seem like an over-reaction. It did to me, and that's why I fought to get IORT and it's one of the reasons I'm unlikely to do Tamo.

I'm about to turn 59 and had the surgery early this year, so our ages are similar. If you could say for certain that your DCIS was not invasive, maybe, maybe, it would be ok to watch and wait. But since you can't know that, I think it's very wise to remove the tumor.

BTW, they can't determine the size of the tumor from a core biopsy, though they sometimes guess at a minimum size based on the sample. The size is determined intially from the mammo and MRI, and finally from the lumpectomy. 

xtine

I agree it is very important to find out the estimated size. If it is really small, I don't see why they couldn't do a lumpectomy. One possible way to better gauge size is by MRI - I had one before any surgery was decided on (the MRI showed the DCIS was slightly larger than estimated). If your surgeon can't give you a straight answer or an MRI, ask for a second opinion?

As for whether you need surgery at all, you should know that surgery is the only treatment that we know can cure breast cancer at this time. There are trials underway for "wait and see" + Tamoxifen approaches with small low-grade DCIS that you can look into (UCSF has one underway). But at this time, nobody can tell you which and when DCIS will turn invasive, and without surgery to remove it all, it's impossible to know if yours hasn't already turned.

kira1234

I wonder how a partial mastectomy differs from a lumpectomy. Mine was 6MM bigger than yours Beejay123, and I had a lumpectomy done with wide margins.

As far as radiation in the DCIS threads there was a lady who had a one time radiation procedure done. I will see if I can find it, and bump it up for you.

It's called side effects of mammasite radiation.

cycle-path

I think partial mastectomy and lumpectomy are two different terms for the same thing. The term "partial mastectomy" is probably used when a larger percentage of the breast is being taken -- which could either be from having small breasts in the first place (as BeeJay says she has) or from having to take out a relatively large chunk, or both.

I'm the person kira is referring to who had the one-time radiation procedure. (http://www.breastcanceriort.org) 

kira1234

cycle-path, Thanks for chiming in on the one time procedure. I really don't see why more Dr's aren't using it.

cinnamonsmiles

I had a BMX with SNB and AND, but I chose that after my lumpectomy/partial mastectomy. I did not have clear margins and my surgeon drew a picture of my atypical ductal hyperplasia and some other kind of precancer and my cancer (DCIS) in my milk ducts and I was covered with it and it seemed to hit different areas as well. I did not want to have mulitple lumpectomies and have any precancerous cells left so that is why I chose the mastectomy. I am happy with the route I chose. It turn out that I had 3 cm of actual cancer in the milk ducts.

Althought many say that with DCIS, there is not necessarily a rush to make decisions, I think it's best to base it on the pathology of our individuals cancers, the type, grade, size, etc. I personally would not want to leave cancer inside me. I did not even want precancerous cells left in me, because I knew I would be waiting for the rest of my life wondering when they would further mutate into more DCIS.

xtine had a very good point, you never know when or if the DCIS would or will turn invasive or grow further. I would think treating it earlier would be better rather than waiting. But, I think I have read of at least one woman on discussion boards that did the wait and see for DCIS and had positive results. For me, like I said, I would rather get it out, treat it early before it would have the chance to get worse.

Had I had clean margins and not been riddled with two types of precancer and DCIS, I would have chosen lumpectomy with radiation. I can not take Tamoxifen, given for hormone positive cancers to stop the body from using hormones so the cancer cells cant use them to grow, because I already have a blood clotting disorder.

My suggestion is to get all the information about YOUR cancer, talk to your surgeon, oncologist, family doctor,etc and then make a decision. Both breastcancer.org and The american cancer society, www.cancer.org have wonderful information about breast cancer, cancer in general, treatments, side effects, etc.

There also is a a discussion board on this site dedicated to people who have chosen a holistic/alternative treament course.

CTMOM1234

Beejay,

I believe that partial mastectomy and lumpectomy are really synonyms. My bs has always termed it a lumpectomy (still does) but one of the admitting people at the hospital before my "lumpectomy" surgery told me I was scheduled for a "partial mastectomy," and I nearly flipped out -- just wanted to make sure that I was scheduled for the right surgery and had no intentions of signing anything saying I was losing the breast and wouldn't go under until I received confirmation.  Please do some more research and do not assume that you will be deformed from either the lump/part.mast or rads. As you can see from my signature, I had both and can assure you that I'm still wearing the same bra. I had much more dcis than you -- over 3 cm -- but am larger (c cup), but I'm still the exact same bra size so it's all relative.

My scar sounds like it is similar to what you'd have: It's vertical from nipple to bottom and then bends into an L, and it is actually not very noticeable from my angle; yes, you can see it in the mirror but there isn't a day that goes by that I'm not so thankful that I still have both breasts, doesn't matter the scar or even slight nipple pointing when you still have full sensation in both.

Oh, and I'm proof that you can't avoid surgery out of any sort of assurance that it's pure dcis. I have zero family history, no lump, just a cluster of micro-calcs. that showed up for the first time ever on a mammo, received confirmation from a stereo. biopsy that it was grade 2 dcis, had an mri that showed nothing unusual, normal surgery to remove dcis . . . and then final report comes back and includes 1.75 mm of idc! Surprise, never expected anything besides pure dcis, but sure am glad I had surgery and then zapped the $#@^ out of any remaining stray cells with rads. I sleep better than I ever would if I'd watched and waited and then wound up needing chemo. 

cycle-path

Ladies, BeeJay's pathology report says that the calcifications "span a distance of approximately 4 mm." My understanding is that the size of the microcalicified area is not necessarily the same size as the tumor. The tumor may be smaller or larger.

Also, BeeJay, just because they got all the calcs doesn't mean they got all the tumor. My calcs were all removed in the biopsy too, but there was still 1 cm of DCIS left when they did the lumpectomy. 

Letlet

Rainbowpony, while xtine had mms of IDC, her DCIS was 10cm! Her decision to choose a mastectomy is not drastic, it may have been her only option.

cycle-path

Rainbowpony, with respect, I don't know why you're saying this. If you had had DCIS, would you not have had a lumpectomy? 

Beesie

Beejay, you are absolutely right that there is no reason to use a shotgun to kill a gnat.  But you do have to find out if it is a gnat.  A stereotactic biopsy only pulls up a few small samples.  Most of the time - about 80% of the time - if a needle biopsy shows DCIS, the final diagnosis is DCIS. But in about 20% of cases the final pathology after surgery shows some invasive cancer, and that changes the diagnosis and could change the treatment and prognosis.  So you have to find out what you are dealing with before you can know what's right for you to do.

I'ts good that you had the MRI. While no screening tool is perfect, MRIs have been shown to be quite effective at finding areas of DCIS, and invasive cancer, that might not show up on a mammogram or ultrasound.  My MRI showed a much larger suspicious area than what showed on my mammo.  The whole area ended up being DCIS.  If sounds as though your MRI came up clean.  That's great news because it confirms that your area of cancer likely is very small.  

By the way, the reason that no size was mentioned on the pathology report from your biopsy is because the biospy only picked up a few core samples - there is nothing done in a biopsy that would indicate the size of an area of cancer. So it's normal to not have a reference to the size of the area of cancer on a core biopsy report. But with the MRI results, in combination with your mammogram, your surgeon should be able to estimate what the size of your tumor is. And that determines the surgical approach. 

A partial mastectomy is, as has been mentioned here by others, exactly the same thing as a lumpectomy.  Some docs use one term, some use the other term.  Sometimes the term they use has to do with filling out insurance forms.  But let's be very clear about it - your doctor is recommending a lumpectomy. It's impossible to know if the surgery that he is planning is larger than it needs to be, based on the expected size of your tumor.  Your surgeon may be planning to remove only a small amount of breast tissue but if the area of cancer is behind your nipple, then that might be reason for the suggested approach.  If you are uncomfortable with his approach, with DCIS you have lots of time to get a second opinion.  That's always a good idea.  And it's a good idea to have the pathology slides reviewed too, to confirm the diagnosis.

One of the things you want to consider is whether you want to try to avoid radiation.  With such a small tumor, that might be very possible - but your doctors will want to ensure that you have clear margins.  And that in effect is why you are going back into surgery.  Even if most of the tumor has been removed there could be rogue cancer cells still left in your breast.  DCIS cancer cells are confined to the milk ducts (and therefore can't travel outside of the breast), but within the ducts they do tend to spread out.  So it's the responsibility of the surgeon to ensure that the full area of cancer really has all been removed.  That's what 'margins' are all about. And of course your surgeon also wants to make sure that there is nothing else - no invasive cancer - hidden in your breast.  If your surgical margins are clear and large enough, you may be able to comfortably and with little risk avoid radiation and all other treatment.  

To net it out, with a small area of DCIS, certainly surgery alone might be sufficient. But to not have surgery at all would mean that you would never know if what you had really was just DCIS, and you would never know if whole area of cancer had been removed.  Once you have those answers, you can choose to have no further treatment.  That might be a be a very reasonable approach but you need more information, which you will only get from your surgery, before you can know that.

rainbowpony, Oh please don't post about subjects that you know absolutely nothing about.  

xtine

Oh come on. I had 10 cm of DCIS. There was no surgical option other than mastectomy. And it turned out my DCIS had turned invasive (not even a micro-invasion - I had 3 mm). If I had opted out of surgery, I would never have known about the invasion, and the cancer would have continued to spread.

I think my situation would be an obvious example of why surgery can be a very wise choice for DCIS.

As for whether I'm recommending a "drastic choice", I was not. I think there are very good reasons to avoid mastectomy for small DCIS, and I could even see someone taking a wait-and-see attitude if the DCIS is very small and low-grade. Which is why I think it would be very wise for Beejay to continue to try to figure out more about her diagnosis before she makes a decision.

So you don't think of DCIS as cancer... doesn't really matter for you as that's not your diagnosis. And your opinion doesn't really matter to the rest of us. I'd rather listen to the medical establishment on that one.

louishenry

Hi Beejay,

My DCIS was similar in size to yours. Radiation was not recommended to me. But, I didn't know that until after my lumpectomy. My biopsy showed Dcis about 4 millimeter, cribriform and micropappillary, with no necrosis. Grade 1-2.

Then I had a lumpectomy. There was nothing there. It turned out that the biopsy had taken everything out, but I would'nt have known that un til after the lumpectomy. My margins were obviously huge. I opted to take tamoxifen. It was optional. This is year 4 for me. I was only 45, so I reacted a little more aggressively. If I were 63, I may not have.

Have the lumpectomy. You may not need rads ;however, you did have some necrosis, so it may be recommended to you. Either way, your dx doesn't sound too bad. My friend is currently in chemo for BC, so I still feel very fortunate.

Rainbowpony,

Not every one considers DCIS a true breast cancer. However, it isn't something to be ignored. Especially someone who has some necrotic cells. From what I've read over the years, DCIS looks like cancer, just doesn't behave like cancer. BUT, it may become invasive cancer in the future. That is what we want to avoid.

Good luck Beejay

hrf

I would be afraid of having something in my body that either might be or could turn into something that is life threatening. Why gamble with your life? I would want the best possible odds and I would want the tumor out and get full pathology. For some women,only surgery is required without follow up treatment. When I had my lumpectomy, there was no real change in my breast at all and no one would have been able to tell unless pointed it out



Some people are saying that it doesn't matter for an older person who is 63. Well I am 63 and don't feel like an "older" person and resent that anyone would think that I don't deserve the same degree of treatment as someone who is 45. My body image and appearance are just as important to me as ever.

SJW1

Hi Beejay,

When I was diagnosed with DCIS in 2007, I was 58 years old with no family history of BC. I didn't want surgery either. If you truly don't want this, you can check with Dr. Shelley Hwang at USC who is doing trials using tamoxifen to try and shrink the DCIS.

http://www.ucsf.edu/news/2009/03/8165/dcis-not-invasive-breast-cancer-and-might-not-require-surgery

I also did not want radiation for a non-invasive cancer. I consulted with Dr. Michael Lagios, who is a world-renowned DCIS expert and pathologist, with a consulting service that anyone can use. After you send your slides to him, he not only sends a pathology review to you, but you get to talk to him for 45 minutes. He reassured me I could take several months to make any decisions. So I waited for 6 months to have my partial mastectomy.

He also used the Van Nuys Prognostic Index to determine my risk recurrence after the surgery was only 4 percent without radiation, so I chose not to have it. I wanted to save RADS in case I ever had an invasive recurrence. Dr. Lagios also explained that DCIS patients with negative margins at best get a 2 percent reduction in risk by taking tamoxifen, so I opted out of that also.

If you want more info about my DCIS journey, you can check out my website at:

https://sites.google.com/site/dciswithoutrads/home

Please also feel free to send me a private message if you have any questions.

Best,

Sandie

AgathaFran

Hi Beejay,

From your posts I take it that only one small area of microcals showed on your mammo and you were told that these microcalcs were all removed following core biopsy. Given my recent experience that would set off alarm bells and before doing anything I would be asking for a re-check on the original biopsy sample. It is highly unlikely that the re-check will find any anomaly but better safe than sorry. 

As Beesie said earlier your surgeon will not be able to determine the area of DCIS involved from your biopsy. Unfortunately the only way you will know for sure is by having further exploration via excisional biopsy/lumpectomy. I believed that I was dealing with mult-focal, extensive low grade DCIS before I had my MX and SNB. My final histopathology showed nothing abnormal except fibrocystic changes in my mx'd breast so I was then told that all the DCIS had been removed with the microcals in my core biopsy.  For my own peace of mind I deeply regret not asking to have my core biopsy tissue sample re-checked.

Had I known before surgery that I had, as was the case, only one small area (still awaiting a copy of my core biopsy path. report for exact measurement) of low grade DCIS I would have jumped at the chance of a lumpectomy without SNB/radiation.That option was never discussed with me however given that my Radiologist and BS assumed that all three areas of microcacls were the same, DCIS. Personally, I would never have considered not having some surgery to ensure clear margins around the biopsy site.

I know from experience that this is a very stressful, confusing time for you but you are doing the right thing by exploring every option until you find the best treatment for you. I hope this helps a little. x

RetiredLibby

I was dx with DCIS </= 1 cm, Grade 3 with comedo necrosis via a stereotactic biopsy in 2007.  I had a lumpectomy and reexcision with >1cm margins that only found 1mm more of DCIS.  I had radiation and took tamoxifen.

In June, I was dx via a stereotactic biopsy with a recurrence in the same breast, same area - DCIS, Grade 2/3 with necrosis.  The area that the radiologist saw was about 3mm, and he speculates he got it all.  An MRI showed a huge area of 5-6 cm from front to back and 2.5 cm from side to side -- but the surgeons and other doctors believe that is the bx track. I am scheduled for a BMX (right prophy) in late August.  I plan a prophy oophorectomy in November or December, as I remain pre-meno at 54.

I do not regret one iota going the aggressive route the first time I was dx.  If I hadn't (and there was some discussion about foregoing rads and doing "watchful waiting"), I believe I would have a healthy case of IDC by now.  This new cancer grew in one year, from one routine mammo to the next, in spite of aggressive rads and tamox.  It was going to grow no matter what.

It is hard to know what to do and I would never, EVER presume to tell anyone what to do or that their cancer wasn't cancer (uh -- the C in DCIS is Carcinoma, meaning cancer!).  However, my philosophy was that I had one chance to get it out and make sure it didn't come back through an aggressive standard of care.  That didn't work, so I'm going over the top with a prophy R mast and ooph.  IMO, that is not overkill for a cancer that should have been killed the first time but refused to die. 

I offer my story merely as another example for folks to consider.

L

Edited to add:  I am very, very fortunate.  50% of the time, when DCIS recurs it recurs as invasive.  I don't know if the tamox played a role in mine returning as DCIS (make no mistake, I am extremely peeved that tamox didn't work), but I do know that I am very, very fortunate. 

1st dx 07/2007, DCIS Gr. 3, Stage 0, 1 cm; lumpectomy, reexcision, rads, tamox. 2nd dx 6/24/2011, DCIS ?? size, Gr. 3, Stage 0; BMX w/ immed. DIEP sched. 8/23/2011.

mom3band1g

why, after a full year does it make me feel sick to my stomach when I read someone saying DCIS isn't cancer.  If you feel that way, please don't comment on the DCIS thread.  I HATE that I had to have a mast and radiation and to read someone say it isn't even cancer makes me feel awful. 

1Athena1

rainbowpony - you don't get to have opinions about whether DCIS is cancer or not. It is cancer and that is a fact - not something to be disputed.

Beejay may decide to watch and wait, or she may decide to have surgery now, but you cannot give her a medical opinion that she does not need the procedure.

It is true that some DCIS will never become invasive cancer and will die if left alone, but so far there is NO way to know what will happen in each individual case. If it were me I would have the DCIS out yesterday. Call me old fashioned, but I do value anxiety-free sleep at night.

IF DCIS turns into IDC, there is no knowing whether it is too late and the train has left the station. The IDC could travel through the bloodstream and not the lymph nodes for distant metastasis. Not to scare you, Beejay, but you should know that some Stage IV patients actually have no cancer in their nodes. Indeed, they may have a 1 or 2 cm IDC in a breast that will not be discovered until an MRI of the back or hip or rib some other body part that is bothering them turns up breast cancer. This is a sneaky disease.

The knowledge that some DCIS will eventually disappear on its own will hopefully serve to expand our understanding of cancer and when and how we should intervene. But not today. We don't know enough.  

Anonymous

Beejay:

I can only say what I would do next, if I were you.  Are you near a University with a Breast Center?  If so, you can request that a board discuss your case and make a recommendation.  I would make sure that these Oncologists are Breast Oncologists.  I would factor this information into what you gather and make your decisions.  When I have had board reviews, the boards have a breast surgeon represented and a pathologist as well.  They should consider your age in their recommendation..

I would not make this decision based on internet information and I would not make it lightly.

baywatcher

BJ-

Very often, no one tells you about the depression that accompanies mastectomies. It seems that about 25% of women experience it but the docs don't tell you about it.

My major regret is that I let myself get talked into a mastectomy for DCIS. I was a very trusting soul at the time.

lassie11

Rainbowponie's cut and paste says, in part: "The plain fact is that most DCIS does not become cancerous" (I unbolded it)

What nonsense!! DCIS is, by definition, cancer. That's what the C in the name stands for, Carcinoma. It is not invasive - that's what the IS stands for (In Situ). It is contained within the milk ducts - that's what the D stands for, Ductal. In total the name DCIS means Ductal Carcinoma In Situ.  If it is DCIS, it really really is a cancer, one that has all the potential of becoming invasive if not treated.

That's not an opinion. That's a fact. No matter what can be found on the internet.

1Athena1

Web definitions of DCIS:

1) The MERCK Manual for professionals:

Carcinoma in situ is proliferation of cancer cells within ducts or lobules and without invasion of stromal tissue. Usually, ductal carcinoma in situ (DCIS) is detected only by mammography and is localized to one area; it may become invasive.

 http://www.merckmanuals.com/professional/print/sec19/ch268/ch268e.html

2) The Mayo Clinic:

Ductal carcinoma in situ (DCIS) is the presence of abnormal cells inside a milk duct in the breast. DCIS is considered the earliest form of breast cancer. DCIS is noninvasive, meaning it hasn't spread out of the milk duct to invade other parts of the breast. 

http://www.mayoclinic.com/health/dcis/DS00983 

3) National Cancer Institute:

A noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive. Also called ductal carcinoma in situ and intraductal carcinoma.

 http://www.cancer.gov/dictionary?expand=D

4) WIKIPEDIA (FWIW) Ductal carcinoma In Situ, DCIS (also known as intraductal carcinoma) is the most common type of noninvasive breast cancer or pre-cancer in women. Ductal carcinoma refers to the development of cancer cells within the milk ducts of the breast. In situ means "in place" and refers to the fact that the cancer has not moved out of the duct and into any surrounding tissue.

 http://en.wikipedia.org/wiki/Ductal_carcinoma_in_situ#Ductal_carcinoma_in_situ_.28intraductal_carcinoma.29

5) OUR OWN BCO: Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means "in its original place."

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

6)  DUCTAL CARCINOMA IN SITU: a non-invasive cancer that stays inside the milk pipes and usually doesn't spread

http://www.doctoresti.com/procedures/breast/medcial-termanology/

  

7) Ductal Carcinoma In Situ (DCIS)
Abnormal cells confined to the breast ducts. These areas often shows micro-calcification on a mammogram. This condition may also be called intraductal carcinoma.

http://www.a-zbreastcancer.com/glossary/glossary-d.htm

covertanjou

Rainbow, why are you telling women on this thread that DCIS is not cancer?  The women here have enough to deal with without you minimizing their dx.  You can believe what you want, but the women here are dealing with their CANCER as best they can. They do not need you, or anyone else, minimizing what they are going through.  You should be ashamed of yourself for coming here and causing them distress.

mollyann

Beejay,

I see two issues. Once you've had a core biopsy, the cells can leak a little so the surgery will clean that up.

Secondly, the comedo cells are tricky. I would want to remove any of them which may have leaked out.

 A partial mastectomy is another word for a lumpectomy. If you get a surgeon that specializes in breast surgery, they usually do a beautiful job on the shape if the breast. You probably wouldn't even know you had surgery except for the scar.

Radiation is being skipped in some parts of the country now for small DCIS such as yours. Radiation has no overall survival value. It just decreases the chance of recurrence in 1 out of ten women.

That being said, you need to take your time and get more information. Don't rush into anything you may regret. Find out exactly what they mean by reconstruction. PM me if you need more info.

HantaYo

Namaste!

Rainbowpony:  You have multiple errors in what you have written.  I am going to just address one in the hope it will help motivate you to not present your opionion as facts and to do a better job of research.  Please know that microcalcifications do not invade the milk ducts as you wrote.  DCIS develops in the milk ducts, IT is the bad guy, not the microcalcifications.  Frequently when cells from the DCIS die calcium will deposit in that area.  When micorcalcifications show up on a mammogram they indicate the possibility of DCIS.  Microcalcifications are the good guys alerting us to a possibility that DCIS is present.

1Athena1

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So BCO takes these things seriously. Patzee/Rainbow, you should not print entire pieces or even extensive segments, and you should provide a link. Otherwise, your posts violate the rules. One or two paragraphs and the link is all that is really allowed. And you knw this because there was a thread on the topic earlier today in which you participated.  

Alpal

"The opposite of intelligent" is posting a lengthy "letter/conversation" written by someone else and failing to attribute it to them.

juliet62

beejay, my first surgery was to determine pathology as a sterotactic could not be done, on the consent it was listed as removal of r breast mass, on the 2nd the to get clean margins it was listed as r partial mastectomy, although he took just enough tissue to get clean margins, tis "just med speak" on the consent, never be afraid to ask questions ecause when you sigh a consent you are saying you understand everything!, i did rads and will start taking tamoxafen next week,

1Athena1

After you - and the numerous copyright violations on your thread.