chemo for DCIS?

shrink · November 2008

My sister was recently diagnosed with DCIS. She is triple pos with no node involvement. Her onc. has recommended 4 rounds of chemo. She's already had a lumpectomy and will also have radiation. Anyone else with DCIS treated with chemo?

roseg · November 2008

It's a certainty that your sister has DCIS AND an invasive cancer!

It isn't unusual for women to have DCIS plus something else and it's often confusing when they get the pathology. DCIS is an easy to remember acronym, plus it's the lessor diagnosis so that's often what sticks in women's minds as to "what they have."

Good luck to your sister!

Beesie · November 2008

I agree with Rose. Chemo is never required for just DCIS. By definition, DCIS is non-invasive, which means that DCIS cancer cells cannot move outside of the breast. So while all the cancer must be removed from the breast (either a lumpectomy or mastectomy), with DCIS there is no need for any systemic (beyond the breast) treatment. Chemo is a systemic treatment. The specific reason why chemo is given is to attack & kill any cancer cells that may have moved outside of the breast and into other parts of the body. Chemo is not required if the cancer cells have not moved beyond the breast.

It's not unusual to find women who believe that their diagnosis is DCIS and who have had chemo. But as Rose said, the term "ductal carcinoma in situ" or the acronym "DCIS" tend to stick out in a pathology report, whereas the terms used to describe invasive cancer might not be so clear. Over the time I've been on this board I've seen quite a few situations where someone thought that they had DCIS but in looking at the detail of their pathology report, they've discovered that they did in fact have invasive cancer, and that's why the chemo was given.

shrink · November 2008

Thanks, Ladies. When I asked her about the reason for chemo, she said it was because of her HER2 status. It didn't make sense to me but you're probably right that she didn't want to hear anything more threatening.

Beesie · November 2008

Ah, it could be the HER2 status that's driving the chemo recommendation but I still think that there has to be more to the diagnosis than just DCIS. HER2 status with DCIS is considered meaningless. The reason is that there hasn't been a enough research done to know what HER2+ means for DCIS - some studies suggest that just like with IDC, HER2+ means that the DCIS is more aggressive. But at least one other study has shown exactly the opposite. And none of the studies have been large enough to be conclusive. So for now, there are no differences in treatment for DCIS women who are HER2- versus those who are HER2+.

This changes however if someone has a microinvasion of invasive cancer, or perhaps a bit more than a microinvasion. Technically, a microinvasion is no more than 1mm but sometimes the term is used for small amounts of IDC up to about 4mm. If your sister primarily has DCIS but also has a small amount of IDC - maybe 3mm or 4mm - and if that IDC is HER2+, then chemo might be given. Such a small amount of IDC would not usually warrant chemo, but if it is strongly HER2+, then it might. And if someone has a large amount of DCIS but only a small amount of IDC, it's easy to think that the chemo is being given for the DCIS, not the IDC. So that might be the explanation.

sam408 · November 2008

I have to agree with Beesie. I had HER2+ DCIS and was not given any treatment for it. My onc said it didn't mean anything more than raising the aggressiveness of my DCIS.

Some of these drugs can have serious side effects, so I hope your sister clarifies her diagnosis before starting any chemo. Perhaps a second oncs opinion would be in order.

Good luck to her.

apfuentes · November 2008

I'm sorry to steal this thread with my own question, but it is related. I am new to this board. I was originally diagnosed with IDC (ER/PR +), had a bilateral mastectomy on 10/21 with negative nodes (2 removed), but the mastectomy tissue pathology report indicated all they were seeing was DCIS. This apparently is very rare and everything was sent off for an expert opinion. The final pathology report came back as 95% DCIS with small (less than 3mm) of scattered IDC, which my original biopsy happened to pick up. My onc has sent off for the Oncotype test and I meet with her again on 11/21 for treatment plans. I just can't wait that long...for 95% DCIS, what is your opinion on chemo treatment? There seems to be a lot of knowledgeable ladies on this board and I would love to hear your input. Thanks!!

Emily2008 · November 2008

Sorry you had to join us, but you're right that there are a bunch of knowledgeable ladies here to help. Don't know if I'm one of them, LOL, but I'll give you my thoughts, FWIW. I think the Oncotype score will determine a lot, as will your age. If you score is low, your stage and grade are low and given that there was such a small amount of IDC, you should be able to skip chemo. OTOH, if for some reason your oncotype score is in the intermediate or higher range, and you happen to be pre-menopausal, you may have a recommendation to go through several rounds.

In my case, I had 2 areas of IDC, one 8 mm and one 5 mm, as well as 8 mm of DCIS. Had a lumpectomy at first, but had bad margins,so ended up with a mast and recon. Just finished my 4th and last round of chemo. My oncotype was in the lower range (14), but I was also just 35 years old at diagnosis. With all this info, I sought the advice of 2 different oncos, one in private practice and one at a research hospital. They both recommended the chemo for my treatment. A major factor for me was that I had multi-focal, muti-centric tumors and was approx 15 years from natural menopause, according to my family history. They also recommended BRCA testing, which I had done last week.

All this to say that each situation is so different and there are many influential factors that come into play. Wait for your oncotype score (I know---waiting is the worst), then talk to your onco, and even get another opinion if it helps you rest in your decision. I would be inclined to skip chemo in your case, but wouldn't make the decision til I had all my facts.

HTH!

apfuentes · November 2008

First off, shrink - Good luck to your sister. I apologize for being so selfish and stealing your thread. I hope your sister has found a good support group to get her through this horrible journey. I find message boards like this to be very helpful. I will keep her in my prayers.

Emily2008 - Thank you so much for your opinion. I think I have already convinced myself that I won't be doing chemo, so I hope I'm not setting myself up for disappointment. Unfortunately, I am young (34) and pre-menopausal, so I hope that doesn't change things for me. I did test negative for the BRCA genes and I'm praying for low onco scores. I am very hopeful and will definitely be getting a second opinion, as you suggest, just to have more than one opinion.

PRW · January 2013

Hi Ladie, I just found this thread and joined

because you all seem to have some good info. I was diagnosed with DCIS on Jan 2nd and had a lumpectomy last Thurs. I am to get my path report back tomorrow. Do they ever recommend anything other than radiation for this kind of cancer? I think the doctor was waiting on the path report to make sure there wasn't anything else. We did an MRI and they didn't see anything What should I expect to hear?

Annette47 · January 2013

If it is "pure" DCIS, meaning nothing else was found, then the typical recommendation would be lumpectomy with radiation and possibly tamoxifen (or an aromatase inhibitor depending on whether you are pre or post menopausal) depending on the hormone status of the DCIS.

Good luck!

chemo for DCIS?

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