DCIS in biopsy but not lumpectomy-- should I get radiation?

elizafizz

From a single excisional biopsy, I was diagnosed with high grade (3) DCIS, ER+ and PR+.  I have to find out how large the mass was, but the biopsy removed all of the cancer-- my lumpectomy at Sloan-Kettering showed no DCIS whatsoever.  Is there any point in getting radiation if there's no cancer found in the lumpectomy?

p.s. I tested negative for both BRCA1 and BRCA2.

rn4babies

Eliza......the first time I was diagnosed I was in the same situation as you. No DCIS was found in the lumpectomy. I was told it was because it was so small the biopsy removed all of it.. It was still strongly recommended that I get radiation to kill any stray cells.

ballet12

Hi Eliza,

I just sent you a private message.  I am also being treated at MSKCC. 

Good luck!

ej01

I had the same situation as you, and I struggled with the radiation decision. I thought that 5-6 weeks of radiation seemed like overkill for my situation and had pretty much decided against it, but went into the RO appointment with an open mind to hear what he had to say.  He recommended partial breast radiation for me.  It was a 5 day external beam radiation (2x per day) that targetted the area immediately around my where my cancer had been, because that is where stray cells are most likely to be found.  This is the option that I chose.  

Beesie

Should you get radiation?  ONLY YOU can correctly answer that question.  I (or anyone here) could offer an opinion, or tell you what we might do in your situation, and that can be helpful as you evaluate the different options.  But every situation is different, and each of us views risk differently.  So in the end, what anyone else might do in your situation is not necessarily what's right for you to do.  

To get to your answer, to figure out what's right for you, you need to know what your recurrence risk is if you don't have rads.  Your doctors should be able to give you an estimate of this, based on the pathology of your DCIS, the size of your DCIS, and the size of the surgical margins. Since no cancer was found during surgery, technically you don't have any surgical margins, so what's important instead is the size of the area of breast tissue removed during surgery.  Your recurrence risk likely would be quite different if the amount of breast tissue removed during surgery was small (let's say a circular area about 1cm in size) vs. large (let's say a circular area about 3cm in size). 

The fact that your DCIS was grade 3 is significant, since grade 3 DCIS is more aggressive and is more likely to be multi-focal.  This is why the amount of breast tissue removed during surgery is significant.  If no cancer was found in a fairly large area of removed breast tissue, then the likelihood that you will have any rogue cancer cells remaining in your breast is probably very small.  But if the amount of tissue removed was small, then the risk increases that a few rogue cells might still be in your breast. 

Rads on average reduces recurrence risk by ~50%.  So once you get an estimate from your doctors of what your recurrence risk is, then you can decide if rads is worth it for you.   A 50% reduction of an already low recurrence risk, let's say only 4%, would only be 2% and that might not be enough of a benefit to warrant rads... or maybe for you it would be.  If your risk starts out higher - let's say 10% - then a 50% reduction would be a 5% benefit, and that might be enough for you to say that rads is worthwhile... or maybe for you it wouldn't be.  

As you can see, the benefit from rads is different for everyone, based on our diagnosis and pathology, and each of us has a different assessment of what risk level is low enough to pass on rads and what risk level is high enough to warrant rads. 

Talk to your doctors to get the information about your estimated recurrence risk level.  And good luck with your decision. 

elizafizz

Thank you to all responders!  Very helpful.

Sloper

I was in a similar situation, as virtually all of my DCIS was removed in the biopsy; less than 1 mm was removed during the lumpectomy, which meant that I had very wide, clear margins.  My surgeon (also at Memorial Sloan Kettering) thought at first that I might not need radiation, but the radiation oncologist thought otherwise, given the various other risk factors (high grade DCIS, my age at onset etc.)  They have a predictive tool, similar to Van Nuys, that calculated my risk of recurrence at somewhere around 20% without rads.  If I recall correctly, rads reduced the risk to around 5%.  I am now mid-way through my course of treatment and it's going okay so far.  My next big decision will be whether to do tamoxifen....  Good luck with whatever you decide to do!

Annette47

New here, but wanted to respond as I was in a similar situation, although one difference was that although my DCIS was grade 2 (with some comedo necrosis), I also have a suspected microinvasion.   All of it was removed through the stereotactic core biopsy though - the lumpectomy found nothing and the SLN biopsy was negative.

I went in last week for my radiation consult and they were pretty definitive I should have radiation.    Part of that is most likely from the microinvasion, but they also mentioned my age (45) and the comedo necrosis as factors to consider. 

I would say that if you haven't already, you should at least have a consult with the radiation oncologist even if you eventually end up deciding against it.

Janet456

Only speaking from my experience where my DCIS was picked up as an incidental finding.

Due to mine being an incidental finding, and only 9mm with clear margins my RO was happy for me to skip rads.  However, he did say that if it was high grade that we would be having a totally different conversation.

I am in the UK and treated under the NHS system so we might get less options, however I am confident that I was treated very well and was left it no doubt that if mine had been high grade I wouldn't have had a choice about rads, it would just have been a done deal. x

lbcchicago

Im new to all of this as well and agree whole heartily with what bessie said...i have opted out of radiation....now i did still met with the RO to discuss this decision which i found helpful especially when i have days that i question if i made the right one and recall all we talked about and my risk numbers etc so i would encourage you do that...i was dx in nov with a small area of DCIS-3mm, clear margins grade 1 and am suppose to be taking tamoxifen but cant bring myself to start it!!  even last night i held the pill in my hand and just couldn't do it...fear i suppose, if its the right thing to start taking and if im going to struggle with the S/E like so many women do...some days i feel like im a time bomb just waiting to feel the lump....

  

OldOakTree

Elizafizz - I'm wondering if you've come to any kind of decision yet.  For what it's worth, I was diagnosed 9 1/2 years ago with a small area of DCIS, medium grade, good margins and was told I can forego rads.  That area is good all these years later but I am facing a possible problem in the other breast which would be there I assume, whether or not I had rads.  As far as tamoxifen I decided not to take it based on what my oncologist told me.  She said the risks outweigh the benefits in my case. 

kat526

I am with you.... I will be going to the oncologist tomorrow and the radiologist next week, and I know the drill they will want me to do.... I don't want to take tamoxifen either, said no 14 years ago.... I know I am very sensitive and if there are any side effects, I know it would affect me, that is just my make up... I would be more worried about taking the pill than recurrance, where I"ve know women who have taken it and cancer came back anyway. Its a crap shoot.

kat526

my diagnosis very similar to yours.

Beesie

kat, there's been a lot of discussion recently about whether or not rads is necessary after a diagnosis of DCIS.  From everything I've seen, it seems to me that the answer is "Sometimes yes, sometimes no.".  So the most important point that I can make is that every situation is different and each case needs to be assessed individually.

Here are some of the other recent threads on this topic:

Topic: No radiation?

Topic: Refusing radiation treatments?

Topic: DCIS lumpectomy without radiation?

Topic: anyone with low grade dcis not having radiation

Alternative to Radiation for DCIS

PatriciaCarol

Have you had any side effects from the Rimadyl?

Moderators

PatriciaCarol, just wanted to welcome you to BCO but also suggest you start a new topic with your question, as this is a somewhat old thread.

PatriciaCarol

How do I do that?

LisaAlissa

Hi PatriciaCarol!

Not a mod, but go to the top of the page, and on the left, you'll find a blue bar that says "All Topics."

Open that, then read down the list until you find one that seems to fit. (I'm not sure what "Rimadyl" is, but if it a anti-hormonal agent, you might want it under "Hormonal Therapy--Before, During and After." Or if it's a chemotherapy agent, under "Chemotherapy--Before, During and After." (Both of those are under the "Tests, Treatments & Side Effects" categories. Or you might choose to start it under an appropriate category in the "Connecting with others who have a similar diagnosis."

In any event, once you find the category you want, open it, and you'll see a maroon link near the top of the page that says "Start a New Topic." Click that link while you're in the category you'd like your new thread to be in and there you go!

HTH,

LisaAlissa

Jelson

Rimadyl is a veterinary drug for dogs suffering from arthritis. check the spelling of the drug you are asking about.

http://www.fda.gov/downloads/AnimalVeterinary/Prod...