How much to worry about close margins after MX?

Maybe_Maeby

Hi everyone—have been soaking up everything here for a few weeks now but finally posting a question of my own now that I have a full diagnosis. My final pathology report showed I had less than a 1mm clear margin after my UMX and don’t know what that means, if anything.Surgeon told me it was an area (superior margin) that has absolutely no breast tissue left in it so there should be no concern but I don’t know how to feel about it considering this was an MX instead of an LX—meaning, there’s not exactly going to be a reexcision or whatever. I see the oncologist in a few days but mulling this over in the meantime. Has anyone had a similar situation? Should I be requesting something further? Thanks all!

Nursepatient35

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yes, I had the same kind of pathology report. My margins were less than 0.3 mm from the skin and I thought they normally want a wider margin than that. My plastic surgeon seemed concerned with this but my breast surgeon said it was fine. I ended up going to an oncologist to get his insight. He said close margins like that are concerning if it's invasive cancer but since dcis is contained and hasn't spread the close margins no longer matter. I know every doctor may say something a little different but hopefully that helps you a little. I see you just had the same type of surgery I did. Hope you're feeling better each day.

TB90

Maybe: I had the exact experience five years ago. I researched this extensively. A close or positive margin can increase your chances of recurrence. Even with DCIS. I went from a one to two percent to a thirteen percent. Radiation cut that by half, but comes with additional risks. I found equal amounts of studies supporting no radiation as radiation. My decision was based upon my personality. Had to do everything. I was so afraid. After five years and much calmer, I do not regret my decision but do not feel as convicted. Most surgeons will not re excision after mx for DCIS. There are many studies that will support your excellent prognosis even with close margins an no further treatment. Take your time to research your particular situation and post here for further support. Take care

Maybe_Maeby

Thank you both! I imagined a thousand scenarios after this extensive a procedure but this wasn’t one of them. I appreciate you taking the time to let me know your experiences!!

wanjiru73

Hey TB90,

Am just starting on this journey with my 1st Post-DCIS diagnosis for next month. Can you kindly expound on the Radiation after Lumpectomy? Is this the savage kind like for other Cancer treatment that leaves one sicker than they really were with a gazillion side effects of is this different for DCIS treatment? And what if one forwent the Radiation and stuck with Lumpectomy and Hormonal treatment?

Congrats! You are doing so well!

SuQu31

I had a somewhat similar situation and wanted to post in hopes it might help someone else. I had no idea that I could end up with the possibility of re-excision after mastectomy. (I totally blame myself, although I do think it is uncommon). My less than 1mm margin was anterior, or close to the skin, and my cancer was at one o'clock. My BS said I could have radiation or she could remove a wedge of tissue to get a better margin. I chose the re-excision, which was done 10 days after my bilateral mastectomy. The tissue removed was benign, so no radiation was necessary. However, I have quite a scar running from my breast to my armpit, which my BS was completely up front about in our discussion. The scar was not a concern for me. Re-excision was the best option for me and my situation.

Mudstick

Hi Maybe - I'm in a somewhat similar situation as well and empathize with your concerns. I had a UMX and DIEP recon for DCIS/IDC in October 2018 and the pathology came back with a positive anterior margin (close to skin) for the DCIS. All the IDC margins were clean (multi-focal with 6 invasive tumors) Rads were not recommended, nor any further surgery. My MO said not to worry about the positive margin because he DCIS is "wimpy cancer" and with a mastectomy there is very little risk of anything being left behind. Well - regardless of their opinion, I worry about a recurrence. A lot. I am really trying to move on, live my life and forget about it and not obsess, but with it all being so recent, I'm not there yet....the fear of recurrence is sitting like a fairly heavy black cloud over my head right now :-(

I do love hearing/reading about all the positive stories on this forum, they are wonderful and really help with understanding that this fear will lessen over time

I wish you peace of mind and health throughout your journey!!

TB90

So sorry you are dealing with this too. But the bottom line is that a mx is really an effective treatment for DCIS even with close or a positive margin. I researched this extensively five years ago and there is a 50 - 50 split in the literature. To have radiation or not:

NOT: Saves the use of radiation for later use if necessary (hopefully not) and even more importantly, saves your body from unnecessary radiation (hopefully again . . . that it was not necessary, I mean) and

HAVING RADIATION: Does reduce your chances of a recurrence, but at the expense of having radiation and using up a treatment that could be saved for later if required.

Studies both support and disagree with radiation following mx with positive margins equally, as the chance of complete response to treatment without radiation is still so high. As my RO put it, it depends upon your personality type. He agreed that my A type personality would not relax without doing everything upfront. Radiation has risks, but I could for some reason, accept that. Five years later I am facing a similar situation with my thyroid and just want to say, "someone make this less difficult please!" But I also feel very lucky to have to face two cancers that have such high rates of treatment. NOW, did the radiation lead to my highly likely thyroid cancer that they cannot confirm without removing it first. Studies support and contradict that theory too. So now, should I monitor it further or have it removed? Coming out later this month. And on we go.

But ladies, regardless, rest assured that you have had treatment considered very effective in treating your DCIS. Studies now state that we over estimate the risk that DCIS presents. It does get easier, but DCIS is not free from risk. Take care and try to enjoy each day without giving it away to fear. Wish I had.

Mudstick

TB90 - Thank you so much for sharing your research and wisdom having gone through the trenches and come out the other side! I look forward to having the fear lessen with time and I know its eventually going to happen. I'm being a little impatient maybe? :-)

I'm sorry to hear that you are dealing with issues related to your thyroid - I wish you luck, quick healing and benign results with your upcoming surgery.