DCIS - No surgery?

Oktogo9

Hi there!

I'd really like to hear from women who have been diagnosed with DCIS but have questioned their proposed treatment. As my breast care nurse said, they don't have a lot of statistics on what happens when DCIS is left untreated, as most women have treatment. Have you considered monitoring rather than lumpectomy or mastectomy? How is it going?

Thanks.

SpecialK

I would no sooner "watch and wait" than fly to the moon, but that is just me.  Annual mammograms and ultrasound failed to detect my DCIS, 2cm of IDC and two positive nodes.  Look at the surgeries and systemic treatment in my signature line and think about whether things might have been easier if I could have removed this when it was just DCIS.

I have included a link for you since I see that this is your first post.  Please carefully read the intro section of this thread, it outlines much about DCIS and IDC.  Pay particular attention to the sections concerning when DCIS may become IDC, that often there is invasive cancer within the DCIS, and the section concerning the importance of post-operative pathology reports and whether there is truly pure DCIS, or an invasive component, which cannot be known unless and until the area of DCIS is removed surgically.

http://community.breastcancer.org/forum/68/topic/790992?page=2#idx_51

exbrnxgrl

What would you be monitoring for? More DCIS? Signs that it has become invasive? This question has been asked before and I'm not sure you'd get many who have done what you're considering. This is, after all, a forum where most have already been dx with breast cancer.

Caryn

Oktogo9

Thank you for your responses, but it appears you didn't read my post. There are lots of posts and discussions for those that have had their treatment. Each time there is even a hint of someone having a thought about another possibility, it seems to be hijacked by some angry at the prospect! I know that BC is scary, believe me. With respect, this is a forum, and as such, all subjects should be open for discussion. Personally, I would like come to a decision on MY body based on ALL the information. Not just the loud voice of the many, but also the quiet voice of the few. If you are afraid to discuss this openly and incur the wrath of those who have made different choices, feel free to message me privately. Though I do believe it would be more helpful to discuss this freely.

Leah_S

Oktogo, it appears that you are seriously considering monitoring for DCIS. Therefore, I will ask the same question Caryn asked - for what are you monitoring? There is no imaging technique available now that can tell when/if DCIS becomes invasive. It's true what the nurse said - there just aren't a lot of statistics available about that option.

I don't know a lot about DCIS, though I do know that the pathology on your biopsy will tell you how aggressive it is. That should also help guide your decision.

Best of luck.

Leah

exbrnxgrl

Oktogo9,

I did read your post. I am not at all angry at the prospect of what you are considering. You may be reading a bit more into it than was intended. But I think asking what you are waiting for is a legitimate question you need to evaluate if you take this approach. You are right that it is your body and you want to have as much information as possible before making a decision. You are also correct in saying that all subjects should be open to discussion. There is no wrath to be incurred. The reality is that few have chosen to forgo any type of surgery if they have a definite DCIS diagnosis. No hijacking at all, just the reality of a bc diagnosis.I hope that someone who has chosen no surgery responds to you soon.

Caryn, the single voice of one

Oktogo9

As I've read on this site, " 80% - 90% of IDC is believed to have evolved from DCIS." Believed? But not proven?? I've been told that 20%-50% of women with high grade DCIS develop an invasive cancer. Which means 50-80% don't! I can fully understand that women fearful of even the slightest chance would want to act upon it. I'm not one of those. I would like the full story from all sides. I have low grade DCIS 6cm with no invasive cancer. I was initially told the only treatment was mastectomy. Against their wishes, I've put it off in order to do my own research. No one is amputating a part of my body without me being in no doubt that it's the right thing to do. This morning I received a letter from the radiologist saying my case was unusual and on review with the surgeon, they are now proposing a breast-conserving procedure with cosmetic surgery to the other breast. Initially I was told this wasn't possible.

So, in answer to your question, yes, monitoring for changes that may never occur! My mother died last year with untreated breast cancer. She was 88. She actually died of lung cancer as she was a heavy smoker. She had one radiation treatment on her lung and refused any more. She had had a heart attack at 60. Also a few mini strokes. But she was feisty to the end.

A mastectomy won't guarantee me a long life, it just removes one of the many possible ways I might die. I have a large gallstone and a fibroid that should both have been removed. They don't bother me. Something else could kill me before breast cancer does. All I know for sure is that I will die, we're not promised tomorrow.

Whatever I do, surgery or not, I will make that decision based on ALL the arguments and information. I have a wealth of it from the 'for' camp. I really only want to hear from the 'against' or at least 'not so sure' camp!

Thanks.

Oktogo9

Thanks for your comments.

@ Leah, my DCIS is low grade . The title of the topic is a question and I 'm hoping to find others who are in the midst of asking similar questions, rather than those that have already had surgery.



@Caryn, I wasn't referring to you personally. Other posts I've read on a similar vein seem to have degenerated into all out fights! I thought I'd start a new topic rather than sift through it all. In a way, I can understand. I would hate to lose my breast then find out afterwards there might have been a stone left unturned! I somehow doubt I'll find an ally. They all seem to have been scared off!

Good health to you all.

CTMOM1234

No hijack attempt here. My DCIS wasn't high grade, it was middle -- Grade 2. Showed up on my second ever annual mammogram at age 43 as some micro-calcs, which I'd never even heard of before. No one in my family including older sibling and mom had ever had an irregular mammogram, no one has had bc, and I guess I just thought all I was getting myself in for was a routine mammogram. So came out of the "blue" and I really wanted to just leave it alone. 

I underwent genetic testing for the BRCA1/2 gene and did additional testing, including an mri, ultrasound, and more mammograms -- Nothing more showed up than the suspected DCIS, and I underwent a lumpectomy.

1.75 mm of IDC was detected in my final pathology report, again no signs before that whatsoever. I am glad I had this taken care of at this time, it didn't change my course of treatment (no chemo), and there had been absolutely no reason to suspect the IDC was even there.

Wishing you good inner peace with whatever decision(s) you make, they are yours alone to make.

exbrnxgrl

Your proposed course of action is very uncommon. Very few make that choice and that is probably why you've had no responses. It's not a matter of allies. The only enemy is bc.

BLinthedesert

As I posted on the other thread where you asked this question, there are not many studies that describe the "natural history" of small, low grade, DCIS that is left untreated.  There are few doctors, or patients, who want to risk death from a completely treatable disease.  However, I will point out data from the paper(s) I linked from that thread.  This is one of the few long-term follow-up studies of women who were mis-diagnosed (therefore had no treatment other than biopsies) with benign disease when they in fact had low-grade, small, DCIS.  It is important to keep in mind that these papers are actually written by a group of researchers who do believe that there ARE some DCIS patients for whom wide excision alone will be curative - but they are definitely not for no treatment at all.

There is an "alternative treatment" thread available on this site, and you might find more discussion there about treatment options that differ from the more traditional therapies that are being discussed in these treatment specific threads. 

 "Small, low-grade, noncomedo DCIS is the pivotal lesion in understanding the borderline between malignancy and nonmalignancy in the female breast. Noncomedo DCIS is a nonobligate precursor that involves a very long clinical evolution to invasive carcinoma in approximately 50% of women. Therefore, over time, any residual DCIS either remains dormant after biopsy alone, expands extensively as in situ disease, or progresses to invasive carcinoma with metastatic and death-dealing capacity. These invasive carcinomas, with few exceptions, arise in the same quadrant of the same breast as the original biopsy.

The current series and the series reported by Betsill et al.8 provide important biologic validation of the diagnostic criteria currently used to delimit small noncomedo DCIS lesions. They indicate a striking dividing point biologically and histopathologically between low-grade DCIS lesions and the cytologically similar but lesser lesions of ADH.3, 9 ADH indicates a small, generalized, increased risk of breast carcinoma in both breasts that is approximately one half that of low-grade DCIS lesions, and these cancers may occur at any site rather than in a local region.3, 4 Recognition of ADH as a lesion limited in size, as well as completeness or purity of its cell population, has refined and confined the definition of DCIS. Distinction of small examples of DCIS from ADH is one of the most critical intersections of histopathology and clinical management today. The practical difference between these diagnoses is that DCIS, left without further treatment, predicts for a regional risk and will eventuate in invasive carcinoma in the same site in the same breast in 30% of patients within 15 years. 

A major barrier to achieving a greater level of understanding among clinicians and patients regarding the diagnosis and therapy of DCIS is the erroneous idea that DCIS is one disease. Evidence now overwhelmingly demonstrates that DCIS is a spectrum of disease ranging from extensive, high-grade lesions, most likely requiring mastectomy for eradication, to small, low-grade lesions, which can be cured effectively by excision alone. It is also clear that there is a middle ground in which excision plus radiation therapy is valid. This requires separation and stratification of different forms of DCIS based on a combination of their natural history and the extent of mammary involvement to guide rational therapeutics.10 Precise case definitions are of critical importance to these considerations. "

Oktogo9

Some of the very best choices I've made in my life have been those that few would have made. I know the risk and I'm not afraid of risk. Breast cancer is not my enemy, it is a fact of my life. If there is an enemy, it's the lack of information and clarity on what the facts truly are, rather than estimated statistics and percentages. It's very moving to hear other people's experiences but what I'm simply asking to communicate with people who, like me, are trying to make a decision and aren't comfortable with what's on offer. I'm very pleased you were comfortable with it and it worked out well for you. As I suspected, the questioning voice gets drowned out. Fortunately, I do know some, but I was hoping to find more, especially those further down the line.

Oktogo9

Thanks for the info BLinthe desert.

" DCIS, left without further treatment, predicts for a regional risk and will eventuate in invasive carcinoma in the same site in the same breast in 30% of patients within 15 years. " Yes, I've read that. So for 70% it takes longer or doesn't at all..?

BLinthedesert

Yes ... and in those 30% that DO end up with invasive cancer ~45% will die of a completely treatable disease -- not a disease that has no cure (like cystic fibrosis, Parkinsons, etc.) - but a completely treatable disease.  It is all about what risk you are personally willing to live with.  Personally, I am not interested in convincing anyone about what treatment they should consider.  I am solely pointing out the data that is currently available that helps people make decisions.

I also would like to point out that I am not sure to whom your comment "I am glad your decisions worked out for you" was directed to -- if it was me, yes, I am glad as well, I feel incredibly lucky and happy with my decisions.  If it was any of the other women who have responded to this thread I will point out two wonderful women who have responded that have stage IV breast cancer, unlike me, they currently have no options that will allow them to be "cured" (though I hope, and with others, support, any and all research that might change this). I am sure either of them would trade places with you in a milisecond, and would not give a relatively minor surgery that would cure them a second thought.

Good luck to you. 

Oktogo9

It also means that 70% would have had unnecessary treatment in order to save less than 15%...?

BLinthedesert

I am done with this thread.  We all agree that you can do whatever you wish with any information that has been presented to you.  I am not asking you to change your mind, I am not going to debate my decisions with you.  I was faced with decisions, I evaluated the data and made my decisions based on those data and the amount of risk I was willing to live with.  You can do the same.  Just as you would prefer not to be judged for your decisions, I would prefer not to be judged for mine.

 Best of luck to you, and I am very  happy that you recognize your risk and are at peace with your decisions, it is all we all can hope and wish for. 

Oktogo9

@BLinthedesert, I wasn't aware that I was questioning your decision, I'm sorry you thought so. I was trying to discuss points in the study. "Evidence now overwhelmingly demonstrates that DCIS is a spectrum of disease ", my case is not the same as yours. As, I've said, I was hoping to be in touch with women who haven't decided on their proposed path of treatment. I hope that when I make my decision, I'll be confident with it too. Thanks for your input.

1Athena1

oktogo9:

I recommend that before you get too far along on the active surveillance issue, you first double check that you really do only have pure DCIS. Surgery - even if just exploratory-- may be the only way to know for sure. Imaging studies can't be relied on.

Many people get told they have DCIS at initial dx - then surgery will often uncover the presence of invasive cancer. There is no way of knowing for sure whether this is the case with you or not.

Oktogo9

Thanks Kayb. I'm interested in finding others precisely because of the lack of scientific evidence. The answers from my doctors is as you suggest. They don't know!

I have a friend who was recently diagnosed with prostate cancer and was told he would have to have his prostate removed. He did his own research and found a treatment called HIFU and told his surgeon. He managed to save his prostate and his sex life! Like him, I just want to know what all my options are. If I had an invasive cancer, that choice would be clearer. The argument is that my life is at risk. But, by the little data I've seen, that risk is 13.5%. And 70% would have been treated that didn't need it.

I'm just asking questions. And yes, I've had stereotactic biopsies.

JamieB86

"It also means that 70% would have had unnecessary treatment in order to save less than 15%...?"

You have the right to  make what ever choice you want.  It's good to research all of the options.  There is no definitive proof at this point as to which DCIS becomes invasive.  I chose to take action so I wouldn't be in the less than 15%.  I hope you don't end up in that group.

1Athena1

A stereo-tactic biopsy would not necessarily detect invasive components - it is a very imprecise instrument for that and never relied on for a final description of a tumor.

An option would be exploratory surgery where several samples can be extracted and analyzed under a microscope. The procedure would not alter your breast the way a full excision might, but it will be the only way you can know for sure that there isn't an invasive component.

It is common for women to have tumors with varying characteristics. I had both DCIS and IDC, grade 2 and grade 3 components. Some women have various types of tumor. It is crucial that you have something more reliable than a stereotactic  biopsy done since you have said that for IDC you would feel differently. The research is fairly clear on that point. No ambiguities or "ifs" there.

CTMOM1234

Original Poster:  "If I had an invasive cancer, that choice would be clearer."

Really? How do you know that you ONLY have DCIS? You seem well versed and educated, and you did, I assume, read my post. I had NO thought that I had anything more than a few cms of DCIS, and my size was smaller than yours. I did every test possible prior to surgery, and nothing suggested anything besides DCIS. My bs even did a preliminary biopsy at the start of my lumpectomy and nothing suggested anything beyond Grade 2 dcis.

Final pathology report was the only time that anyone knew -- or could know -- that I did in fact have a small amount of idc. 

I do not just go with the flow, I definitely appreciate that you want to consider all options. Please reread my post.  Then make the best educated decision for yourself.

Deirdre1

Many of these responses feels like a harsh reaction to a simple and maybe necessary question...  When faced with my own DX of DCIS G2/3 I initially decised on a "watch & wait" protocol... because my doc's were giving me different signals and that allowed me to understand that they truly did not know how to proceed to treat DCIS... The literature is clear that it is or can be an option with DCIS G/1 - and there is a sense of over-treatment in the newest literature...  I totally get why you are asking yourself (and others) this question and it should be asked...  Can we answer it - NO!  We are not quallified to suggest that we may know better than the doc's you are working with..  I would suggest that you go to Beesies DCIS question thread though and look at all the research there - it is or can be very enlightening... I hope that if you do choose "watch & wait" that you never have another bout with DCIS and or invasive cancer again...  Please add an MRI to your "watch & wait" protocol, have the genetic BRCA testing and counseling in addition to your mamo's and also a therapist so that you can continue to hear your own voice when other's might drowned your out.. Please know that their opinions are being offered out of love (usually) and so your own voice may become weaker...  Best of luck and I hope you live a very very long life and die (because we all do) from something you were never even worried about!!!  Sincerely,  Deirdre

Beesie

Oktogo9, I understand why you are asking the questions and raising these issues. There's a lot of discussion within the medical community about what the appropriate treatment is for DCIS so I think that asking these questions is a good and responsible approach. 

One point of clarification with regard to the previous discussion. The statement "...DCIS, left without further treatment, predicts for a regional risk and will eventuate in invasive carcinoma in the same site in the same breast in 30% of patients within 15 years." refers specifically to small amounts of low grade DCIS.  The only studies that are available that measure the progression of DCIS left in the breast involve patients who had small amounts of low grade DCIS.  Most experts believe that high grade DCIS, or comedo-type DCIS, will progress to IDC at least 75% of the time, and maybe 100% of the time.  Time frame will be much less than 15 years. The problem is that there is simply no way to know this for sure since very few women have ever passed on surgery if they've had this type of DCIS. 

I bring that up to make the point that DCIS is not a single disease (as BLinthedesert pointed out). Someone who has a small amount (let's say <1cm) of grade 1 DCIS is probably taking a relatively low risk if she chooses to leave the DCIS in the breast and monitor with mammos and MRIs.  But someone with a larger amount of DCIS or a small but high grade DCIS (and particularly, comedo-type DCIS) is taking a considerably higher risk if she decides against surgical removal.

It seems to me that your diagnosis falls in the middle. You have grade 1 DCIS, but it appears that you have a lot of it.  6cm is a lot, so this means that your DCIS, even though it's low grade, is doing what cancer cells do - multiplying and expanding and spreading.  It's simply because these cancer cells are currently DCIS and are stuck in the milk duct that the spreading is taking place within the ductal system of your breast.

The fact that your DCIS is so widespread does present a red flag.  Large amounts of DCIS - whatever the grade - are more likely to be found to be hiding invasive cancer.  And that's the thing. Just from a needle biopsy and films, there is no way to know what your actual diagnosis is.  My mammo films showed two areas of calcifications that were mildly but not overly suspicious.  My stereotactic biopsy result was ADH - a high risk but non-cancerous condition. My surgeon urged me to have an excisional / surgical biopsy (not what I wanted but I agreed).  The excisional biopsy pathology showed over 3cm of high grade DCIS with comedonecrosis, a 1mm microinvasion of IDC, and yes, more ADH.  And after all that, I didn't have any clear margins. A follow-up MRI showed that my breast was still full of "stuff" so I had a mastectomy (again, not something that I wanted) and another 4cm of DCIS was found, most of it high grade with comedonecrosis but a small amount was grade 2.  And there was more ADH found too. All that is to say that at this point, your diagnosis is preliminary.  Without surgery, you don't know for sure what you have, and unfortunately, none of the screening tools available today are precise enough to see a small area of invasive cancer in with all that DCIS.  And none will be able to spot the development of a small area of IDC in middle of the DCIS, if you choose to go with monitoring.

There is a small study that does look at the results of the "watchful waiting" approach for DCIS; I'll see if I can find it and post the link here.  I'll also look for the reports I've read that show the risk of finding invasive cancer hidden in with even low grade DCIS.  

Edited for typos only (My proof-reading skills are crap!) 

Dianarose

From what I have read all cancers start out microscopic, so if you think about it they all start out as insitu. They don't start out as an invasive cancer. Some stay put while others decide to travel. Why would anyone want to wait for that journey??? Not removing it from your body and sitting around while they do their so call monitoring is crazy. I had DCIS and LCIS almost 8 yrs ago, now I am stage IIIc and going thru chemo. I did have a lumpectomy and rads, but they were doing their so called monitoring after the fact and missed my cancer in the other breast for 7 yrs and look where I am now. This is just my opinion.

Specialk- I am with you. I would fly to the moon before I play the monitor game. 

Beesie

Oktogo9, here is the information I referenced in my earlier post:

Outcome of long term active surveillance for estrogen receptor-positive ductal carcinoma in situ 

Abstract
INTRODUCTION: An option for active surveillance is not currently offered to patients with ductal carcinoma in situ (DCIS); however a small number of women decline standard surgical treatment for noninvasive cancer. The purpose of this study was to assess outcomes in a cohort of 14 well-informed women who elected non-surgical active surveillance with endocrine treatment alone for estrogen receptor-positive DCIS.
METHODS: Retrospective review of 14 women, 12 of whom were enrolled in an IRB-approved single-arm study of 3 months of neoadjuvant endocrine therapy prior to definitive surgical management. The patients in this report withdrew from the parent study opting instead for active surveillance with endocrine treatment and imaging.
RESULTS:  8 women had surgery at a median follow up of 28.3 months (range 10.1-70 months), 5 had stage I IDC at surgical excision, and 3 had DCIS alone. 6 women remain on surveillance without evidence of invasive disease for a median of 31.8 months (range 11.8-80.8 months).

CONCLUSION:  Long-term active surveillance for DCIS is feasible in a well-informed patient population, but is associated with risk of invasive cancer at surgical excision. 

.

Predictors of invasive breast cancer in patients with an initial diagnosis of ductal carcinoma in situ 

STUDY DESIGN: The records of 398 consecutive patients from our prospective database with an initial diagnosis of DCIS, treated between July 1999 and December 2002, were analyzed. Associations between clinical and pathologic factors and patient selection for SLNB and outcomes were analyzed for significance using univariate and multivariate analyses.
RESULTS: Of the 398 patients, 80 (20%) were found to have invasive disease on final pathology. Multivariate analysis revealed 4 independent predictors of invasive cancer on final pathology: 55 years of age or younger (odds ratio [OR], 2.19; p = 0.024), diagnosis by core-needle biopsy (OR, 3.76; p = 0.006), mammographic DCIS size of at least 4 cm (OR, 2.92; p = 0.001), and high-grade DCIS (OR, 3.06; p = 0.002).  

cinnamonsmiles

My decision for treatment was very easy. I, too, had a large amount of DCIS low grade and a lot of ADH. It seemed like my breast was a breeding ground for ADH and Cancer.I never really saw "statistics" until I started using this website regularly, and me treatment was over.

When I read about "statistics" about DCIS, I always wonder, how in the world would I know which percentage I would fall into? And would I want to take a chance?Did I want to essentially roll the dice and take a chance? My answer was no. To me, treating DCIS is a lot more appealing than treating IDC with rads and possibly chemo and/or  Her2 positive drugs and/or hormone therapy drugs for 5 years.

 I wouldn't say your thread has been hijacked by angry responses. I would say they are passionate and don't understand why you would want to take the chance of getting IDC when treating DCIS would be so much "easier" than a higher stage cancer.

itsjustme10

If you haven't had surgery, how do you know that your 6 cm DCIS, (which by the way is huge) has no invasive portion?

Obviously, it's your life, and your risk.  Some women may try and talk to you, out of caring, out of being unable to understand how someone could allow themselves such a risk. There's no way to determine the moment that DCIS becomes invasive - or ideally the moment before it becomes invasive, so you can have it removed at the last second.  There's no way, by looking at it, to know if a biopsy didn't hit an invasive portion, so you actually do have IDC as well right now, as we speak. 

But, it's your choice, and having seen the direction of enough of these same threads, I'll just wish you good luck - I hope you're one of the lucky ones.

armywife199

oktogo9,  I pray you are still well.   I also questioned anything regarding surgery at the time of my diagnosis.  However, I was in school and wished to have my treatment done and over with that I could finish my studies.  School became the crux of my problem.  Deep inside I had problems with the Dr. wanting to go in with what I felt was a Navy Seal team after something I thought a simple rifle team could take care of.  Since my lump was so close to the nipple, and I was not yet aware of seeking out an nipple sparing surgeon I submitted to the mastectomy w/o radiation since I was even more determined to avoid chemo/radiation as I was surgery.  I applaude your waiting.  I wanted fast and finished and so lost sight of details of voicing rejecting of more than 1 node removal for DCIS, there is NO reason for more than 1 node removal for DCIS and will see that never again will I submit to that should DCIS arrive in other side.  Studies backing that have been published over and over.  Take your time, research, find what you are comfortable with.  Then when the stars line up and you feel armed, do what you know to be right for you.  And what ever the pathology reports go from there to finish or to continue on in the joy of your life.    Thank you for your courage.  Can you imagine how the Surgeon was treated that was the first to remove breast tissue around tumor but not muscles from the chest wall?  He also was very frowned upon and laughed at by other Dr.'s with Navy Seal teams ready to go.  It is just NOT necessary in the case of such light tissue involvement.  Now, they use skin sparing, muscle sparing, nipple sparing surgeries and one day they'll even diagnose DCIS w/o the Seal team at the ready!  Nothing but the best of wishes and prayers for your safe future!

Beesie

I hope that Oktogo9 hasn't been driven away.

I have to admit that when I read this thread yesterday, I was surprised at the vehemence of some of the answers to Oktogo9's very legitimate questions. There is a very judgemental tone to many of the responses. It's probably because these questions have been asked before and these issues have been discussed before, but someone who's newly diagnosed and here for the first time would not have seen any of those discussions. 

The simple fact is that DCIS treatment - particularly grade 1 DCIS - is becoming more and more controversial. Every couple of months there is a new stream of articles in the press saying that DCIS is being over-diagnosed and over-treated.  So why shouldn't someone who is newly diagnosed with DCIS ask these questions?  As Oktogo9 said, she just wants to make the decision on her body based on ALL the information available. Seems reasonable to me.

Oktogo9, I hope that you are still with us. I agree with you that it would be beneficial - not just for you but for everyone - to discuss this freely and without passing judgement. Within the DCIS forum, those who ask about what might be considered to be over-treatment are applauded and praised, whereas those who question the need for standard-of-care treatment are vilified.  And yet the direction of the medical community is towards the latter. Personally I think that a open-minded discussion on all these issues might just lead to more women choosing the most appropriate treatment for their diagnosis and their risk profile, and that's what I think we all should be aiming for. 

BLinthedesert

I agree, and am sorry if I sounded defensive (which I know I did).  I realize that these threads may be legitimate, and I hope they are, it is just there have been so many that disintegrated into what appeared to be troll attempts.  One of them even went as far as to discuss how excited they were to see how many posts the thread generated (not in a nice way - but more as a way to insult all the people that had gotten emotionally entangled in the discussion).   I really hate to say it, but it really looked to me like many of these threads (three that I can think of) are actually the same person.  But, on the off chance that they are not, I should either be more polite, or not post on them at all.

So, again, I apologize to Oktogo. 

I agree with you, Beesie, we need to be more helpful, and less judgemental.  But, the three threads that have decided on no surgical removal at all, are really not discussing treatment - and are flying in face of even minimal standard-of-care (surgical removal) - and therefore, they are actually more appropriate threads for the "alternative treatments" section.