SNB for dcis BMX

Judeshome

I recently had a wide excision biopsy which shows DCIS grade 1 in my left breast. My BS recommends a BMX because she says I have multifocal disease in my left breast and she says although nothing in my right showed up on mammo or MRI there is a 90% chance there is DCIS on that side too. The initial tests came back as likely multiple papillomas, confirmed by CNB. My BS who I like, says a Sentinel Node Biopsy isn’t necessary for low grade DCIS but I am wondering why, since no one really knows what is in the rest of either breast! My BMX isn’t until early January and Petrified is an understatement......thank goodness this forum exists....Jude

LisaAlissa

Hi, Judeshome!

I'm so sorry to hear about your news. You're at one of the best places to come to talk about what's going on...and naturally you're feeling petrified. Everything is always a little unknown until after surgery...and two or three months to wonder? No wonder you're feeling that way. There are two separate things I'd like to discuss with you:

1. Info on DCIS & its treatment. Since you've recently been diagnosed with DCIS, you might want to read Beesie's posts on "A layperson's guide to DCIS." As you'll note when you read this, there are lots of variations in a DCIS diagnosis and the treatment approaches you may be asked to consider. For example, many women are asked to choose whether they want a LX, or a MX or a BMX. There may well be reasons that one or more of those choices aren't being offered to you.

Beesie's posts on LX vs. MX vs BMX can be very helpful if you're thinking about surgical options. You can take a look at it "here."

Both are very helpful, as Beesie is one of the best researchers and most articulate writers here.

2. Maybe a second opinion? I was wondering what sort of facility you've been seen at? And if your BS primarily limits her practice to breast cancer surgery? Has she had fellowship training in either oncoplastic surgery or breast surgery? Or (if she was trained before such programs were available, does she go to the conferences/participate in research on breast cancer?)

The advice you've received, based on what you've said about your diagnosis seems a bit odd. Increasingly they are minimizing surgical treatments for low-grade DCIS (grade 1 DCIS is low-grade DCIS). So such a strong suggestion for a BMX seems a bit much (instead of breast conserving surgery as an alternative you can choose). I have to wonder if there is more to your diagnosis that you have told us/or have understood during your consultation with your BS?

If you aren't being seen at an NCIC designated breast cancer center, you might want to consider a second opinion at such a facility. Just for some peace of mind.

HTH,

LisaAlissa

NotHerToo

I was diagnosed with DCIS last fall. Family history, and dense breasts led to my decision for bmx. More DCIS was found, but even more shocking was a 8mm tumor not seen in any imaging. It was a good decision for me, My originial BS recommended lumpectomy, and thought I was over reacting. Glad my second BS agreed with me, as it was HER+. So 12 doses of taxol, and nearing the end of herceptin and grateful it was caught.

MTwoman

Judeshome, I agree with LisaAlissa about the second opinion. If you don't get the SNB prior to mx, then you won't be able to get one later. I believe the NCCN protocols include MX for DCIS both with and without SNB, but it would provide that extra level of certainty for you. I also had multi-focal dcis, 3 locations on the right, so had to have mx. There was never any mention of having bilateral disease, and I got a second opinion on my pathology from a DCIS expert. Not sure where your provider is getting those stats about 90% chance it's also on the other side. I had UMX, and have been NED for 14 almost 15 years.

Judeshome

Thanks for your reply MTWoman, I intend to talk to my surgeon again about SNB, I want the reassurance that there is nothing unexpected in the pathology after the BMX yet am concerned about lymphedema too.. My BS said my breasts are so dense, they can’t really see clearly what is in there, I have multiple papillomas still in my left breast so it seems likely I have more DCIS too. I am 65 and simply want to get back to my life without worrying about tests every 6 months....this is a steep learning curve, I know from my own past experience that the shock will diminish somewhat in time, but I am over emotional at the moment and bursting into tears at the drop of a hat and am sure this is something most women experience under these circumstances. It seems like with DCIS you roll the dice, no way to know if it is aggressive or not there seems to be such a wide range of types. Jude

TrmTab

I didn't have SNB, but I had already had a biopsy and two lumpectomies with only DCIS ...but poor margins, then the MX. There are newer proceedures to mark the sentinal node that allows them to go back for it up to 3-4 days later if pathology warrents. I tend to get all kinds of soft tissue injuries, so thought I was probably a good candidate for LE if I had the SNB and didn't want to do it just because...after a lengthy discussion with my BS he agreed that my LXs made the decision tree different than if I had chosen MX to begin with.

LAstar

There are risks in not taking the nodes, like for my friend whose IDC was only found in her lymph nodes and not found in her breast tissue. This may be less of a risk for Grade 1 DCIS. I had 3 lymph nodes removed and deal with low-level lymphedema regularly. I have to wear a sleeve whenever I exercise, garden, lift things, etc. and have had LE triggered from hangnails, bumps against things, bug bites, and lifting heavy things. I will have to wear my sleeve whenever I fly or do anything strenuous for the rest of my life. My arm gets sore and achy, so it's not the worst thing ever but it's an issue I will always have. If it's true DCIS, there will be no lymph node involvement.

Some surgeons use the dye to locate the sentinel nodes during mastectomy, mark them, and then if anything invasive is found during the mastectomy go back afterward to check them. Then the lymph system is not disrupted unnecessarily. Angelina Jolie's surgeons did this and wrote about it here: https://pinklotus.com/powerup/breastcancer101/prop...