RADS for small size, high grade DCIS?

rn4babies

I just had my post- op lumpectomy appt with my surgeon.  He said my needs for RADS is "fuzzy" at this point. I had a 4mm lesion, Grade 3 with comedo necrosis, solid and cribriform. I had good margins with no signs of microinvasion and all of the DCIS was removed with the core biopsy. I did have ADH in both pathology reports. I fall in the middle of the Van Nuys Index. Has anyone had similar stats to mine that can tell me whether or not they still had RADS? He still wants me to meet with a medical oncologist for his opinion. I have a VERY strong family hx. and I'm 47 years old. Thanks for your input!

ej01

I have my lumpectomy tomorrow, and based on what i understand from the initial pathology report from the needle biopsy, I am expecting (hoping) to be in the 'fuzzy' area...similar to you.   I am 49, with no family history of BC.  (~3mm, Grade 3, ER+).   If so, I doubt that I will go ahead with radiation.    I guess I can't say for sure until I get my final results.

kittylee

The pathology after my lumpectomy and reexcision was 7 mm focal DCIS, Grade 2, ER+,PR+, BRCA- with good margins and a VNPI score of 6 at 50 years old.  Before the surgeries, it WAS my intent to forgoe radiation treatments if there were no surprises in either pathology.   After the surgeries, it was still my plan.  Then came the consultation with my medical oncologist, a doctor that I knew and trusted, about Tamoxifin.  While I'm still on the fence about the Tamoxifin, he really convinced me to reconsider whole breast radiation to reduce the chance of recurrence.  So......fast forward to today.  20 radiation treatments down and 13 to go and no looking back.  I'm comfortable with all of my decisions thus far.  It is truly a personal decision that only you can make. 

rn4babies

ej......Good luck tomorrow. Please keep me updated on your status. I've learned soooo much from this website and everyone's advice and experiences are so valuable to me.  kittylee.....I'm on the fence about Tamoxifen as well. I was told it definitely will be recommended but I'm not sure if I want to take it. I wish the onco's office would call me with the appt already. I just want to move forward and put all this behind me someday.

jyg

I had BMX so my situation does not compare, but data from a clinical trial published this year showed a decreased risk of developing invasive cancer with lumpectomy + rads. (Tamoxifen adds some additional benefit depending on hormonal status, but one has to balance risks and benefits)



Sorry that I can't link the latest clinical trial from my iPad. But, the 15-year risk of invasive cancer occurring in the originally treated breast was: 19.4% lumpectomy alone, 8.9% lumpectomy + whole breast radiation, 8.5% adding Tamoxifen to radiation.
Edited to add a non-clickable link to the abstract http://www.ncbi.nlm.nih.gov/pubmed/21398619

Natters

I guess my stats are similar to yours, although my tumor was bigger (8mm removed during lumpectomy).  But I'm in my 40s and my DCIS was grade 3 (solid, crib, comedo, etc). How wide were your margins? My most narrow one was 5mm, so they were decent. I do NOT have family history, so that is another difference between us - maybe one that evens us out on the tumor size? I dunno.

But in any case, everyone I've talked to (surgeons, rad oncs, med oncs) has insisted that I do rads on the full breast. No fuzzy greay area, no questions. So I was really surprised to hear that someone with what sounds like a fairly similar case might get a pass? I am curious to hear what your new MO says. My MO prescribed Tamox but said that radiation was what was really going to cut my risk of recurrence! And my own reading turned up studies like that one posted by jyg, too.

momzr

I had a diagnosis of DCIS in July '08.  The only thing I had done was the surgical excisional biopsy/lumpectomy which completely removed the tiny area of DCIS (1.6 mm -- less than 1/8th of an inch - which was listed as Intermediate grade) and I had clear margins (although one was 'close').  At follow up appt. a week after the biopsy, a medical oncologist spoke with me and told me that my tumor was sooo tiny he thought there was a miniscule chance it would cause me problems down the road and he did not recommend radiation therapy or hormonal therapy with their associated risks and side effects for my particular situation.  He actually told me I was not to lose sleep over this or worry about it and he never expected to see me again.   I also met with a radiation oncologist who wavered a bit on his recommendation (seems I was also in "gray" area due to my age at the time - 46 and the one margin that was 'close'), but ultimately told me after we had a long discussion, that he said I got a pass on this and that with my particular circumstances that if I were his wife, he would NOT treat me with radiation.  Therefore, I decided against doing anything more except for close monitoring with mammograms and MRI's as needed.

However, my decision MIGHT have been different if it had not been pure DCIS, had I NOT had clear margins, had my DCIS not been sooo tiny, had the path report showed there was sign of necrosis or it was the more aggressive comedo cell type, OR if MRI had showed any other type of concern.    (Since you have family history and comedo necrosis with grading of 3, our situations are not exactly the 'same')

Just this past July of 2011 I had another 'scare' where they found a 'grouping' of microcalc's in that same left breast.  I again underwent an excisional biopsy (I am too small for sterotactic procedure) and this time the results of biopsy were all benign conditions (which was a huge relief).  The breast surgeon told me to just go back to annual mammogram screening which I will set up again for Summer of 2012. 

CTMOM1234

I think this is one of those times that it is going to depend on the conventions of your dr. My bs suggests rads to all women under 50 with dcis -- regardless of grade or size ... either that, he says, or mastectomy. I was in my early 40s with no family history when dcis was diagnosed and didn't want a mx, so selected the "lesser of two evils" which was lump+rads. Really didn't want to have rads. but was willing to do them. As it turned out, 1.75 mm of idc was found among the dcis, so then I was glad to zap the heck out any stray cells. 

Good luck and whatever you decide, may you have no regrets.  

rn4babies

I have my appointment with the MO on Friday. I am very anxious to see what his recommendation is. I still think Tamoxifen is in my cards though.  I appreciate everyone's input and will let you know what his suggested plan of treatment is for me.