Is DCIS cancer?

Should add that by all measurements I was termed "low risk."  Post lumpectomy, I'm now getting rads. and would have certainly needed chemo. had my dr. decided to wait until I "progressed to high risk." What a bunch of bull#$%^.

I can LIVE with overtreatment. I'm not sure I would be ALIVE with undertreatment.

I've had 2 dx of high grade dcis (como type) in the right breast, last dx multifocal. I chose  a simple lumpectomy with watchful waiting. Since I am closely monitored the doctor says that if it is found that it would be stage 0 and easily removed. I realized I am high risk for a recurrence. I am hoping that with supplements, diets and exercise I will not have another recurrence. I am not a worrier type of person. Although being dx is a wakeup call to take better care of myself, and to make sure that I am watchful by getting a yearly mri and mammo. But, the problem with watchful waiting, you never quite feel that it's gone. I don't think about it a lot, but at times you wonder if its still there. It's like your journey isn't quite over.

 I am very interested in what is coming out about dcis ... taking the cancer out of dcis. Like someone said, if dcis is not considered cancer then the insurance doesn't have to pay. I wonder how much of taking the word cancer out of dcis is movtivated by $$$ and if it happens, will it eventually change treatment protocol. High grade cancer cells are disorganized, very aggressive with neurosis. If it looks and acts like cancer, its cancer. When my first final pathology came in (after lumpectomy) the nurse said, congraduations, it's the good cancer. Stage 0 is the curiable cancer. I wondered then if it wasn't invasive then why be concerned. Thanks to Beesie, I've learned a lot since then.

Oh yes, I also have a family history. Interestingly enough my mother's sister died of breast cancer. I think she was first diagnosed when she was about the age I was at first, around 40. I just wish I (she) had known if she had had DCIS first.

When I was in radiation therapy, a fellow patient told me she chose "watch and wait" on the radiation therapy because she had DCIS and had a recurrence within a year.  No thanks.

Hellome, I am also 50.  I was diagnosed for the first time in November.  My left breast was full of DCIS, grade 3.  I had two surgeries, and still couldn't get clean margins.  I was stage 0, as it hadn't become invasive yet.  I, too, researched.  I did not want to take the chance.  My youngest is 12, and I have three kiddos (oldest is a freshman in college).  I opted for a BMX.  I really didn't want to go so extreme, but radiation was not an option for me.  My breasts were too small to take any more breast tissue, so the entire left breast had to go.  I was 90%ER and 60%PR, and I'm premenopausal.  I did NOT want to take tamoxofen.  I had researched that drug and did NOT want to put myself (or my family) through those side effects.  There is a lot of cancer in my family, although not a lot of BC (not many women)....I have gone through genetic counseling/testing (and will be getting my results soon - the counselor called and left a message today asking me to make an appt to discuss the results.) 

I did not want to put my family (or myself, for that matter) through the time, the emotions, or the finances of going through all of this again - which was another reason to go for the BMX.  To me, sitting with DCIS in my breast was like playing Russian Roullette (sp??).  Maybe it would turn invasive, maybe it wouldn't.  Having lost my dad to an aggressive form of lymphoma, watching him take chemo, I did NOT want to have to go through that - so if I could keep myself from going through that and keep my family from watching me go through that, then I would do whatever it took.  And I did.

Of course, that's just MY take on it. 

I think that we're blessed to live in the days and times we are, where the mammograms are so sophisicated where they can see these tiny calcifications, which are the indicators/by-products of the cancer.  Last year (2008), they didn't show up on my annual mammo.  This yea (2009), they did.  Ten years ago, this probably wouldn't have been caught, and I might not have known until I felt a lump....and by then, it could have been invasive....and my battle might have looked totally different.

In a few days, it will be three months since my BMX.  I wish I had never had the DCIS in the first place, but since I did, I'm glad it was caught early, and I'm also glad I've done everything in my power to keep from having a reoccurance.

blessings....robin 

So many interesting posts on this thread. Just wanted to clarify for those that may be taking a watch and wait approach because they only have grade 1 or 2 DCIS, or for those that are feeling regrets because they may have overreacted and had surgery when they just had grade 1 or 2 DCIS, DCIS DOESN'T HAVE TO FIRST BE GRADE 3 BEFORE THERE'S IDC.

My stereo. biopsy resulting after my routine mammo. (at age 44) saw a few small calcs that might be clustered had all the signs of nice innocent DCIS -- good shape, low grade 1 and 2, blah blah blah, everything peachy. I have no family history, genetic testing was negative for BRCA1 and BRCA2, no other warning signs or known risk factors, normal mammo. the year before, I take zero medications, sister and mom never had irregular mammo., etc.

Surgeon didn't take any sentinel nodes during lumpectomy, why should he, odds were it would be just plain old low to medium grade DCIS.

BAM! Lumpectomy pathology lists 1.75 mm microinvasion. Now I'm stage 1. Referred to an oncologist because surgeon thought might need chemo. and have second surgery to check nodes. I am very very thankful that no nodes were involved YET and at < 1 cm, no chemo was prescribed. BUT CHEMO WOULD HAVE BEEN PRESCRIBED HAD I CHOSEN WATCH AND WAIT, BECAUSE 1.75 MM OF INVASIVE DOESN'T TYPICALLY STAY THAT WAY.  

Do not think for a moment that DCIS isn't cancer. Fight it like you'd fight cancer, and have no regrets that you fought it. Later today I will have my 23rd rad. treatment (of 30), with minimal/manageable side effects to date, and I'm VERY glad to irradiate any stray cells that may have eluded the lumpectomy.

CTMOM1234 wrote"...So many interesting posts on this thread. Just wanted to clarify for those that may be taking a watch and wait approach because they only have grade 1 or 2 DCIS, or for those that are feeling regrets because they may have overreacted and had surgery when they just had grade 1 or 2 DCIS, DCIS DOESN'T HAVE TO FIRST BE GRADE 3 BEFORE THERE'S IDC...."

That's all very true, CTMOM - it's definately not just high grade DCIS that becomes IDC. Mine was both IDC and DCIS and both of those components were grade 1 and very non-aggressive (Ki-67 just 5%). My grade 1 DCIS turned invasive sometime during the 7 to 8 year interval between a negative mammogram I had in 1997 and the very next one I had at diagnosis in 2004. 

However, as I was just explaining to someone else in an e-mail earlier today, there's a VERY big difference in the metastatic potential of a low grade IDC as opposed to those that are high grade.  So for example, having a well differentiated, grade 1 DCIS become invasive isn't nearly as big of a concern as having a DCIS that is highly aggressive become invasive. They're two completely different entities.

The word "invasive" scares the hell out of people and in some cases it definately should, but not everyone needs to be absolutely terrified of their DCIS becoming invasive someday. Even if it does, the chances that it will result in metastatic disease (which is the only thing about breast cancer that ever kills anyone) is relatively low. My DCIS became invasive - 60% of my tumor was IDC and the remainding 40% was DCIS at diagnosis - yet I'm alive and well with no problems  6 years later after no treatment at all other than a lumpectomy. I refused all other treatment because I was reasonably sure (and still am) that I didn't really need it  The standards of care, be it breast cancer or anything else, are all designed to treat the most aggressive case scenarios and those standards results in the least worrisome cancers (small and low grade) being overtreated in order to ensure that none of those with the more aggressive and high risk disease slip through the cracks with undertreated. 

To those of you out there with well-differentiated, low grade DCIS, especially older ladies for whom it's more prevalent - don't let your fears dictate treatment that might be unnecessary for you. While I would never advocate the watch and wait approach (i.e. no surgery), not everyone needs radiation and/or anti-hormonal treatment.  First educate yourself and take all the time you need to really think through your treatment options, even if that's many months.  Don't let the medical professionals put a time limit on your decisions because there is absolutely no urgency with low grade DCIS.  A small, invasive cancer that's low grade isn't a disaster in any sense of the word either and it's not something that's very likely to eventually lead to your demise, so don't let your mind wrap itself too solidly around that "invasive" word.  It's just a descriptive word - not a prognosis.

Yes, my path reports (biopsy and surgical) give both the DCIS portion and IDC portion of my tumor a grade. They further call the IDC portion "NOS with tubular features" and grade it I/III which is grade 1 and the DCIS is called "cribriform'' and also graded I/III. Neither report actually says  that 60% of the tumor was IDC, but they do say that 40% was DCIS which would logically leave the remainng 60 % as the IDC since there was no mention of any other type of abnormality or cancer.

If you've had some IDC identified in your pathology, then it should have a grade.  Look it over again and see if it's there somewhere..

CTMOM1234 wrote: Don't really find comfort in the fact that my DCIS is grade 2 -- a lot of good that did, skipped right over grade 3 and into micro-invasive...

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I got the impression in reading the above statement that your understanding of breast cancer grade is that it is a step wise progression from lower to higher grade which eventually results in invasion when it reaches grade 3. And that invasion can be expected only when it reaches stage 3. Neither is true. 

Many years ago, a popular theory was that there is grade progression in breast cancer. More recently however, with the advent of genetic profiling, that theory has essentially been disproven although a few still steadfastly believe in it.  Molecular studies on breast cancer have shown that histological grade is an independent pathological entity and NOT a progression from one grade to another. So to put it simply, there are different subtypes of breast cancer that each have different chromosomal abnormalities which distinguish low grade from high grade. These differences are evident in the very earliest stages of disease - literally, from the moment it first forms. It's all genetically pre-programmed to be what it will be from the very begining.

Low grade breast cancer starts out as low grade breast cancer and continues to be low grade breast cancer as it progresses through the various potential stages of disease - and the same goes for high grade breast cancer. The grade doesn't change or progress - only the stage progresses. The transformation from non-invasive to invasive disease can happen with any grade and at any time,  However, it's more likely to happen sooner with higher grade disease. So your cancer didn't "skip right over grade 3 and into micro-invasive". Your cancer was simply a grade 2 that had become invasive - and if by chance that particular cancer is still present lurking somewhere or reoccurs someday, it will very likely still be a grade 2 when re-discovered.

And something else to be aware of regarding the assignment of a breast cancer to a histological intermediate grade of 2... some research is indicating that technically, there really is no grade 2 breast cancer. They're saying that when examined at the genetic level, almost all grade 2 BC can be divided into either low or high grade and prognostically can be expected to act accordingly.  Which of course, goes a long way in explaining why in just reading the oncotype results posted on this form, we sometimes see such extreme differences in scores for those with same grade tumors and otherwise similar statistics - some get surprisingly low scores while others are much higher. If those researchers are correct (and it appears thus far they are), some people who think they have an intermittent grade 2 tumor, actually have the equivalent of either a grade 1 or a grade 3 - which prognostically, is a major difference.