DCIS & Mammography

Hi GL:

Not sure why they would be certain about DCIS without examining actual cells. Can't know until after the biopsy.....you could just have microcalcifications which would be benign. Personally, I've not heard of a diagnosis being made without the biopsy.

Even if it is DCIS, it is not "benign" but very treatable and curable.  Keep us posted!

I'm sure other women will be addressing your question as well, with even better info. You've come to the right place!

Jan 

GL,

You cannot be diagnosed without a biopsy.  While a mammogram or ultrasound might show what appears to be cancerous calcifications, there is absolutely no way to know if these calcifications are cancerous until a biopsy is done. 

Calcifications are very common and well over 95% are benign and harmless.  If the calcs form a particular pattern, as yours do, then there is a possiblity that these calcs might represent either a pre-cancerous condition (atypical cells) or breast cancer (DCIS or invasive cancer).  In those cases a biopsy will be done but even for those who have suspicious calcifications, 80% biopsies result in benign findings.

If your mammo was highly suspicious, it would have been rated BIRADs 5 - that would indicate a 95% chance that cancer will be found.  But even some BIRADs 5 cases turn out to be benign.  With BIRADs 4, the majority of biospy results are benign.

If it turns out that your calcs are cancer, then in all likelihood they would be DCIS but there is no guarantee of this; it is possible that some invasive cancer (a more serious condition) could be found in the area with calcifications.  DCIS is a pre-invasive cancer; with DCIS, the cancer cells are contained within the milk ducts of the breast.  This means that the cancer is fully contained within the breast and cannot move to the lymph nodes.  For this reason, some docs consider DCIS to be a pre-cancer, but most docs and experts do identify DCIS as the earliest stage of breast cancer.  DCIS, if properly treated so that there is no recurrence, is 100% survivable.

The net of this is that since you have not had a biopsy yet, there is no way that either the radiologist or your doctor can know that you have DCIS.  They can suspect that you do, but they could be wrong  - in over 4 years here, I have seen many cases come through this site where radiologists and doctors were "sure" it was cancer but turned out to be wrong. 

Good luck with the biopsy.  Hopefully your doctors are wrong and your calcs turn out to be benign.

Hi goldenlotus,

DCIS means ductal cancer in situ, these are cancer cells which are not capable of breaking out of the breast milk ducts - which happen to be where most breast cancers start.There is a controversy over whether DCIS has been/is being treated too aggressively because there is a strong and growing belief that not all DCIS will ever become capable of breaking out of the ducts and spreading/invading other breast tissue/getting into the lymph or blood system. But since they don't know how to tell which DCIS will progress to invasive cancer and which won't - it is usually treated with surgery and then perhaps radiation and if Estrogen Receptive, a 5 year regimen of tamoxifen. I am not sure about the use of the word "benign" in relation to DCIS, I would say on a relative scale of good/benign to bad/invasive cancer, then yes DCIS is relatively benign. Because of this issue of not knowing whether it will progress and when, there are some medical professionals who feel that it shouldn't even be called cancer at all and there are some that think it should be called a pre-cancer. At this point, I believe most of the women on this board say GET IT OUT, and the question is whether lumpectomy or mastectomy. With DCIS you have time to sort it all through, to research and to get second opinions so that you can make the right decision for YOU. 

mammography can reveal the microcalcification clusters which are contained in the ducts and which can, but not always, characterize DCIS. Perhaps yours, on mammography, looks like a "textbook case" .  A stereotactic biopsy is however, really the "gold standard" way to diagnose DCIS - so while your doctors are very suspicious, they don't know for sure. The biopsy will result in samples being taken of the cells from probably several points in the area of suspicion. I am not sure what the "faint soft tissue density" indicates. I know that the size of the DCIS can be larger or smaller than the area indicated by mammography. You are at the beginning of this journey - Depending on your biopsy results, It may turn out that eventhough it looked like DCIS, it wasn't!  But if it is, we  will see you through.

Good luck, Julie E

GL, it's normal to be scared.  But here's the thing to remember, even if it turns out that you do have DCIS:  DCIS is 100% survivable. 

The only "if" related to that statement is that DCIS is 100% survivable if there is no subsequent recurrence that is not found until after the DCIS has evolved to become invasive cancer.  So, should it turn out that you do have DCIS, the key will be to ensure that you get the treatments you need to minimize your risk of recurrence.  Depending on the size and pathology of the DCIS, for some women, all they need is surgery, a lumpectomy.  Others may require a lumpectomy plus additional treatments such as radiation and/or Tamoxifen (an anti-hormone drug).  Others who have a larger area of DCIS may require a mastectomy.  With any of these treatments it is possible to get recurrence risk down to the single digits - less than 10% and sometimes as low as 2%.  That's lower than the risk that an average woman faces of getting breast cancer - lower than your risk before you knew anything about all of this and before you starting worrying about it.

As for the radiologist, what she told you was completely inappropriate. I think that doctors who tell patients things like this are cruel; these are doctors who obviously think too highly of themselves, believing that they know something that simply cannot be known with certainty.  Breast cancer cannot be diagnosed without a biopsy - there are no exceptions to this.  A radiologist or breast surgeon might look at a mammogram and tell a patient that the film appears "highly suspicious" and that there is a "good likelihood" that cancer will be found - that would be an appropriate warning - but no radiologist or doctor should ever tell a patient that she has breast cancer based only on what was seen on the films. As I mentioned in my first post, even those who are BIRADs 5 turn out to have benign results 5% of the time.  With BIRADs 4, the definition is that "These are lesions that do not have the characteristic morphologies of breast cancer but have a definite probability of being malignant. The radiologist has sufficient concern to urge a biopsy."  http://www.birads.at/kategorien.html  On average, approx. 25% - 30% of BIRADs 4 biopsies turn out to be malignant, meaning that 70% - 75% are benign. 

I hope this is the reassurance you need!  It doesn't mean that your situation is sure to be benign but even if it is DCIS, it's not the end of the world, I promise!

Hi, goldenlotus,

I had a needle biopsy on 11/23--DCIS.  Surgery on 12/15--lumpectomy--margins clear and sentinel node clear.  I had mammosite radiation which consisted of 5 days of radiation twice a day.  Then I was finished before Xmas.  I will see a medical oncologist to go over the results of my oncotype test in order to determine if I will need additional treatment.  

My films looked much like you described--that is why my radiologist recommended a needle biospy. I went from a suspicious mammo early in November to a cancer diagnosis on the 23rd based on the biopsy.Good luck to you.

I too was scaredbut now that surgery is finished as is the radiation, I feel very hopeful, 

Hi monaelena,

I had a lumpectomy followed by 5 day mammosite radiation.  My tumor was small, less than 1 cm, margins and nodes were clear.  I also had the oncotype dx test run and scored a 16.  I am going on hormone therapy--no chemo--as a follow-up.

read your pathologist's report.  Mammosite radiation depends on  several factors--how large the tumor, how far from the rib cage and skin. 

 good luck--I am thinking about you and sending positive thoughts.

has anyone had laser rather than lumpectomy?