Correct treatment?

Excision alone is often an acceptable treatment for DCIS.  However, from the information you've provided, it's impossible to know if your situation is one in which excision alone might be okay.

First of all, did you have a lumpectomy or a mastectomy?  Excision alone is more likely to be the recommended treatment for those who have a mastectomy.  For those who have a lumpectomy, it's all a question of the pathology.  Specifically: 

• What was the size and grade of your DCIS?  Was it small & lower grade or large & higher grade?  Radiation is less likely to be recommended for those who have only a small amount of low grade DCIS. 
• How large were the margins after surgery?  "Ideal" margins are 10mm or greater, on all sides.  With 10mm margins, radiation often is not considered necessary after a lumpectomy for DCIS.  But with smaller margins, radiation is more likely to be required. 

Do you have a copy of the pathology report?  Information about the margins - which is the most important factor in this decision - should be included in the pathology report.

Ellenida,

I am sorry you have to go through all the confusion about what to do next. I tend to agree another opinion unrelated might be best.  I had a mx three weeks ago and margins are 1mm - noone is happy with that and so I have an appt in a few weeks with the oncologist to discuss my next step options.  

Olivia 

From what I've read, ideal margins are usually considered to be 1cm, good margins are 2mm. 

There have been lots of studies that show that with 10mm margins the recurrence risk after a lumpectomy will be very low, whatever the original diagnosis (grade, size of tumor, etc.).  So it's pretty much agreed that 10mm (or 1cm - same thing) is an "ideal" margin. 

The inconsistencies relate to the definition of what is a "minimally acceptable margin".  Some doctors say that even a few cells is okay.  Others go with 1mm.  Most prefer 2mm or 3mm as the minimum.  There isn't agreement on minimum margin size simply because medical science isn't precise and the results aren't always the same when studies are done.  Often a 1mm margin will be perfectly fine and there won't be a recurrence but sometimes even those who have much larger margins end up having a recurrence.  It's not black and white and there is no clear answer.  Because of that, doctors use their judgement in this area, as they do in so many other areas of our treatment.  If a doctor has good experiences with small margins, he might say that 1mm is okay.  If another doctor has recently had a few patients who've had recurrences, he might err on the conservative side and suggest a re-excision for any margin that is less than 3mm. 

Here is information about DCIS recurrence rates and margin size (and other pathological factors):

http://www.breastdiseases.com/dcispath.htm

http://theoncologist.alphamedpress.org/cgi/content/full/3/2/94/T2

Beesie,

Thank you for the web links, they are informative. My appt is next week to find out next steps. It has been a nice break for me to have some time to heal before I found out if more surgery is necessary.  Radiation is not possible because I have lupus.  

My bc surgeon said that wide margins are not always a guarantee against a recurrence. DCIS can jump around. After my first lumpectomy, I had very safe wide margins...one year later, another dx.