time between your last mammogram and your DCIS diagnosis?

Lilyluv

I was just wondering if your DCIS was diagnosed between your regular yearly screenings?  Were there any areas in your breast that they were monitoring and doing a wait and see before it showed up?    I had skipped almost 2.5 yr. of screenings and it was high grade 2.5-3cm with necrosis.

Does DCIS go from a progression gradually from low to high grade?  Or can DCIS just jump directly to high grade bypassing the lower grades? 

  

Annette47

I skipped about 3 years worth of mammograms until my mother was diagnosed which prompted me to go in.   I had gone at 40 and 41 and then not again until 45.   They found a very small amount of grade  2 (but with necrosis) DCIS as well as an even smaller amount of IDC.     No idea if it would have been picked up had I gone in a year prior, but I tend to doubt it as it was so small.    I'm just glad I went in when I did as I might have waited a few more years had my mom not been diagnosed since they had recently changed the recommendation to not needing annual ones until age 50.

annajo

found at my first screening, at 41

Beesie

Research on the development of DCIS suggests that DCIS does not usually progress from low grade to intermediate to high grade.  DCIS can develop directly as high grade. 

ballet12

I had an astute radiologist in 2012  who looked back to the mammo screenings going back to 2009 and found a progression in the development of the calcifications.  The radiologists in the previous years did not really look as carefully as she did.  My breast surgeon said that they should have been looking more carefully, because of a history of ADH/ALH, but I wasn't really been seen in a high risk clinic, and wasn't on any particular high risk screening program that many people are on. All of the ADH diagnoses I received said "severe" atypia, so I suspect it went from severe atypia directly to high grade DCIS. 

AZ85048

LilyLuv - They suspected they saw microcalcifications during my annual mammogram which is part of my physical for work.  Got called back for a second mammogram for verification, then stereotactic biopsy (when they diagnosed the multifocal DCIS, grade 3), which led to an excisional biopsy (where they discovered LCIS and ALH), and then I opted for a BMX.  There was no indication of anything on the mammogram from the prior year.

Ariom

I have always been regular with my screening, but moved to a new area just as my Mammo was due. The new facility has the newest Digital Machine, and my DCIS was picked up straight away. The Analogue picture from my previous Mammo was beside the new picture and although they said the DCIS was likely there, it couldn't be seen.

I had a mix of grade 2 and 3, but they apparently got all the grade 2 out during the Stereotactic Biopsy.

I do thank my lucky stars that I moved here and had the new machine do my Mammo. I don't like to think what may have been, if I had returned to the old facility with the Analogue machine, who knows what another 2 years would have meant.

Mayanne

I've always wondered about this, too.

Microcalcifications were seen on my annual mammogram in October 2012 and the nurse called my home and told me about them, said to not worry, but they wanted me to have a follow up on my left breast in April 2013 with magnifications.  I had that and no one was concerned.  The nurse called again and said that I should then go back to my yearly mammograms of both breasts in October of 2013.   Now, that's when all of this began, because the very next day, my PCP called, very concerned, and said that the microcalcs were now clustering in a pattern and MUST be biopsies.  Her attitude, of course, worried me, but I also wondered how something could go from April with magnifications and no real concern to October with (what I believe was probably Birad 4) and become cancerous.  

I had the biopsy reluctantly - still believing they were over-reacting, possibly because of my high risk status with my mother having had BC in 1978 and my sister on her second bout.  I didn't get totally stressed out until I hadnt heard for a week and called the office and was told to come to talk to doctor the next morning at 8. The doctor was very serious and concerned and told me that the biopsy had found DCIS, high grade with necrosis.  I was still more optimistic than she, saying "Well it's early stage, and treatable, right?"  I still could not wrap my head around it having developed within those 6 months.

Being high grade, this is probably how and why it became so apparent in October when it was not in April.  I've asked several doctors since if it was not there in April or if the radiologist in April just made the wrong call.  Of course, no one can tell me.  I've also wondered how the DCIS itself pops up.  Does it begin as one of the pre pre cancers?  When you see the high grade pictures, with the duct stuffed with cells and the holes in it, does it look six months previously (maybe before it throws off the microcalcs) as a partially filled version of it's later-stage self?   Or does it transform quickly into what it becomes?  Pathologists, when examining tissue must see - either only high grade DCIS as we know and see it or partial-looking high grade DCIS.  These may be rhetorical questions!

But I would say to answer your question, that since my DCIS was being watched closely (with magnifications) a mere 6 months earlier, that it was active during those six months and hadn't been lurking around for much longer than a year or so.  

rusty4

My mammogram in Nov 2012 was clear. My mammogram in Jan 2014 showed clumps of calcifications. I am now having a mastectomy of my right breast. It did come on fast and no one can explain it. I had two biopsies done after my Jan mammogram. One is DCIS the other is slight invasive.

Beesie

Just because a mammogram is clear doesn't mean that the DCIS didn't started to develop much earlier.  The calcifications are not the DCIS - the calcs are formed from the dead DCIS cells.  Here's how breastcancer.org explain it:

DCIS is usually found by mammography. As old cancer cells die off and
pile up, tiny specks of calcium (called "calcifications" or
"microcalcifications") form within the broken-down cells. The mammogram
will show the cancer cells inside the ducts as a cluster of these
microcalcifications, which appear either as white specks or as a shadow. Diagnosis of DCIS

Breast cancer normally starts as just a few cells, which might multiply quickly, or might multiply slowly or might remain dormant for a while. With DCIS (or any cancer), it could be years before enough cancer cells have died and formed calcifications that are large enough to be visible on a mammogram.  Consider that autopsy studies have found that on average, ~9% of women who die have undetected DCIS - and interestingly, "Prevalences were higher among women likely to have been screened (that is, women 40 to 70 years of age)."  So these women had DCIS that didn't show up on their mammograms.  They never knew they had DCIS and they passed away of some other condition.  Would some or most of these cases of DCIS eventually have been found?  Probably but who knows how many years it might take before those first calcifications finally showed up on a mammogram. 

Using Autopsy Series To Estimate the Disease “Reservoir” for Ductal Carcinoma in Situ of the Breast: How Much More Breast Cancer Can We Find?

Mayanne

 Beesie, does anyone know how DCIS - high grade - develops?  If one could look at the same duct that eventually would be filled with the DCIS cells, would it be sparsely filled with the same cells or would the cells be a different type.  I guess what I mean is whether anyone knows if the DCIS just appears quickly and presents itself immediately as the pictures we are familiar with OR does it add a few cells at a time? I would think that pathologists looking at a lot of DCIS in, say an autopsy would see either DCIS foci all looking the same or as ducts with some high grade cells trying to get a foothold (or cell hold).  I imagine that in the future, women won't have to wait until the microcalcs are seen - the DCIS will be discovered in its infancy (if it has an infancy).

Beesie

I believe like all cancers, DCIS forms one cell at a time. Each cell splits, and then splits again and that's how eventually DCIS can completely fill a duct and/or be quite spread out within the ductal system.

AZ85048

Beesie - Do you have any idea how much we've all learned from you and how very much we appreciate your expertise?  Well, if not, now you do.  Thank you sincerely for all that I've learned from you and your posts over these past months...

ballet12

Hi Mayanne, I hope you are doing well.  I don't have the scientific answer, but I did have the pre-pre cancer cells next to the DCIS.  I had atypical ductal hyperplasia, and it was categorized as "severe", so I believe that the DCIS evolves from that previous stage, and the severely atypical ductal hyperplasia can lead to high grade DCIS, which I had.  At the same time, I will state that 17 years earlier, they also found severe atypia (atypical ductal and lobular hyperplasia), and despite several intervening biopsies (all surgical), the DCIS wasn't found until much later.  It's quite possible that the first batch of atypical cells did not contribute to the later diagnosis at all, and given that the biopsy was surgical, they could have been removed at that time.  Then, the body produced more of those cells, but now I'm older, and the older one gets, the more chance that the cells will progress.  My view of this is that my body (immune system, etc.) has actually prevented the cells from progressing further.  As a result, I had a fairly large amount of multifocal high grade DCIS (probably close to 6 cm), but it was all pure DCIS.  I will say that the mammo only showed a very small portion of the calcifications and the pathology that was ultimately found.

Mayanne

Thank you, Beesie.  I am also so appreciative of your sharing your knowledge with us!

Hi Ballet!  I am doing well, going through radiation now.  Thank you, also, for sharing what you know and have experienced with your DCIS.  So, possibly, your high grade grade DCIS began in a previous evolutionary step as severe atypical hyperplasia?  That makes sense, especially knowing that those cells were found along with your DCIS.   And then when it becomes DCIS, the cells begin splitting and filling the duct as high grade?  I've just been trying to "picture" how it began and when.  Interesting that it was also found 17 years ago.  I totally believe that our immune systems help to overcome it until the "guards" fail at their job, whether to do with environmental exposure, stress, age or whatever.  In my case, I would imagine that extreme stress I'd been experiencing a few years ago distracted and depleted my immune system. 

ballet12

Mayanne, good luck with the radiation treatments, and I hope it isn't too too difficult to get there daily, given the challenging winter we've been having (way worse up there, I know).

Mayanne

I have lucked out so far with the timing of the storms and my appointments, Laurie.  But I've done only six with twenty seven to go, so who knows what will happen.  The doctor and techs are lenient - their philosophy is that "you shouldn't risk your life to save your life".  So if a big storm happens and driving the usually nice 30 minute drive through the countryside - becomes dangerous - I will opt out and not mind that one extra day is added to the end!

Lilyluv

Thanks for the information Beesie - you sure know a heck of a lot about DCIS!   And thanks to you all for sharing your experiences.   Very interesting to see how many different paths we all came down to have this found. 

percy4

My girlfriend had the wire placement 15 years ago and it hurt a lot.  When I had it recently, they told me a lot has been learned about it.  They said that it used to be thought it didn't hurt inside, but they were wrong, and now they anestisize the whole breast, because they now know it can hurt inside.  My wire placement, 2 months ago, was almost painless.