Why do I need radiation?

Hey! thats my question too!

Like you I have DCIS only I think my patch is smaller.  I have NEVER liked the idea of radiation--seems too much like an elephant gun on a gnat.  What if godforbid, I get some other type of cancer down the road that can only be treated by radiation only I can't have radiation because I will have already had it.  I get that DCIS can be something else but I don't see that the radiation guarantees that it won't.  Plus as I understand it, radiation can be worse on the left over your heart which is EXACTLY where I will have to be treated.

By the way June2268, on the reconstruction part, I was told that it was much tricker to reconstruct a radiated breast.  2 PSs told me implants would be out though they gave me some other different options.......

I have been thinking the exact thing.  If I have a clear margin and the ONE node infected was removed, why radiation?  Mine is my left breast as well, so I have the worry of it effected my heart and I currently have a breast implant ans was told it MAY harden.  Only other option is mastectomy, but I am dead against it.

Without a doubt, a serious talk with a doctor is in order.  The infernal CAT scan turned up a spot on my lungs that may be scarring from pneumonia but maybe something else as well.  I am suspecting that the reason radiation et all hasn't been fully discussed is that the surgeons are too focused on getting me into surgery.  Of course, if I come back with an infected node its probably a non-issue for me though then again, isn't that an issue for other types of chemo?

But my question is more if there is nothing but the DCIS---isn't tamoxifen a form of chemo?  Isn't it supposed to stop future DCIS from growing in the other breast?  Why wouldn't it have the same impact on the breast that already had DCIS excised?  And if I am taking something that will stop DCIS from growing, then why radiation as well?

Of course, if they can't get good margins and the lumpectomy is going to be too scarring so that I end up with a mastectomy then I guess the whole thing is resolved by itself, isn't it?

sigh.

There can still be microscopic cancer left behind after surgery.  Especially if it traveled to the lymph node.  They do not remove the whole lymph sinus with surgery.  Most likely there are still cells left and radiation kills them.  Chemo also does not always kill all cancer cells.It can happen but it is not a given.  Clear margins are great but does not mean all cells are gone.

I have the very same question!

I am TN, multi-focal IDC (largest of three was 2cm), high grade, had a Bilateral mx (12/2), they got clear margins, and only one node (the sentinal node) was affected out of the the 11 they removed.  I started chemo 1/6.  The dr's seem torn on my need for Rads -- matter of fact, we are having trouble getting stats for TN folks and rads out of the Dr's.  The Rad Dr. says I should get the rads (of course), my Oncologist seems to be in the middle.  I even think the Rad Dr. said that there are not many stats on TN folks and rads and if it improves outcome (?) -- really?  I doubt that.

I have no problem taking the rads if they can tell me that they can reduce reoccurence by a certain percentage ... but I am not up for just taking Rads because it is jsut part of a protocol, and has nothing positive to add to my diagnosis and outcome, you know? 

 Anyone have any imput on this?

Dear Patty, thank you for posting the link to the report. I am 4 weeks done with the RT and my left has a square area of sun burn. Both me and my DH are freaking out. We once again asking ourselves whether we made the right decision...

Mei

 Hope,

Considering the kind of cancer you had (small, grade 1, node negative), refusing radiation would certainly be a reasonable decision - and in my opinion, a very intelligent decision too.  There are most definately risks associated with radiation - many of which will not become evident until a decade or more has passed. After all, we're talking here about standard of care treatment that has some significant potential aftereffects both short and longterm.

For some with an aggressive form of breast cancer, a local recurrence of that cancer would offer yet another opportunity for metastatic disease to develop. When it's aggressive breast cancer, that additional opportunity needs to be avoided at all costs. And so for those people, the potential benefits of local control by radiation after lumpectomy makes sense because the potential benefits outweigh the potential risks. Just stop and think for a moment - if someone has an aggressive breast cancer which has a high probability of eventually causing their demise if it becomes metastatic, that person may not even be alive a decade or more later. Which then of course, makes the potential long term consequences of radiation essentially a moot point. 

On the other hand, for those with non-aggressive breast cancer, and especially those with small tumors that were very likely to have been sugically cured, the prospect of still being alive in a decade or more to suffer the possible consequences of treatment are very, very high. In these situations, the ratio of potential benefit vs potential risk is far less favorable to the patient. If someone was cured of the breast cancer by it's surgical removal (and many are) then it becomes all risk and no benefit whatsoever for that person. If someone with a non-aggressive breast cancer has a local breast reoccurence because some bit of the original cancer was left behind, it's likely going to be the very same non-aggressive cancer the 2nd time around.  Unlike high grade breast cancer which sometimes can become distantly metastatic when the tumor itself is very tiny or even microscopic, grade 1 breast cancer is very unlikely to become metastatic until it's much larger in size, if at all. The potential risk from grade 1 breast reoccurence is miniscule in comparison to that from a high grade reoccurence.

So yes, in my opinion, keeping a close watch on things would be much more preferably to assuming the risks of radiation - assuming of course, you've got wide, clean margins. You'll be hard pressed to find an oncologist to agree that it's a reasonable decision. They prescibe treatment according the care standards and unfortunately, the current standards call for everyone with invasive cancer to undergo post lumpectomy radiation irregardless of their individual circumstances. So if you stand firm in that decison, be prepared to make stand alone with it.

As you can see from my bio line below, I too had a small grade 1 tumor of which about 60% was IDC and the other 40% DCIS. My surgeon got very wide margins (the specimen removed was something like 7.5 by 3.5 cm) and he even removed the biopsy track along with it. It's now been over 6 years since my lumpectomy WITHOUT radiation and without any hormonal therapy either. My most recent mammogram last month was again completely negative. Having a heart valve problem and being a lifelong smoker would have put me at even greater (much, much greater!) risk for consequences of left breast radiation, but I would have been given it anyway by the radiation oncologist I consulted with -  and without even so much as a second thought about it from him, had I not known enough to refuse it.

Good luck to you in making your final decision, but again - don't expect the medical professionals to support you. It would be a rare one who does. You won't get very much support for it here either, because most people wouldn't dare act contrary to what they're being told to do by a medical professional even if their gut was telling them otherwise. Just human nature, I guess.. 

My theory to this radiation is: if you want it get it or if you don't don't. I had 2 lumpetomies, got clear margins, had radiation and am on tamoxifen. I figured I was darn lucky the first time it being caught early and non-aggresive. I was going to do everything I possibly could to keep it away. If I have to stay on these pills the rest of my life (I'm 53) I will. The decision is your's to do what you want to do. I didn't want to say later on, I wish I would have ..........

Good Luck on whatever you girls do and I wish you the best.

I did not want radiation on my left breast either. I was advised my someone on this site to get a second opinion from a world famous expert and pathologist who has a consulting practice. It was the best thing I ever did! This man has spoken all over the world on DCIS. He will order your films and slides from your hospital and surgeon, and then re-write your pathology. He will tell you exactly where you stand as far as whether or not you actually need radiation. You will get a written report plus an hour long phone consultation where you can ask him all your questions which pertain to YOUR case. Everyone is different, and there is a big group of women that are being needlessly radiated. (There is a new article on WebMD about this issue.) He, along with another famous doctor in CA, participated in inventing the Van Nuys Prognostic Index. It looks at all the characteristics of YOUR DCIS and gives you a ratng, which he will explain in detail. Without knowing where you stand and what YOUR risk is, how can you make an informed decision? Even weeks after the consult was over and I was having some issues with my choice, he immediately answered my questions and came to the rescue! I didn't think my insurance would cover it, but I was reimbursed for the majority of the cost! I don't think I'm supposed to mention a doctor's name on here, but if anyone wants more info, email me at lauren@mancini.ws. I would be glad to help. 

I also asked him about Tamoxifen since I was reading so many conflicting things. He told me there are two new reports out showing Tamoxifen has a .077% benefit for DCIS patients. I asked, then why is my surgeon pushing it so hard? His reply was...tradition. I have since found out that I am estrogen dominant, so in my case, I am taking bio-identical progesterone to balance out the little bit of estrogen I have, rather than shut it down. (Unopposed estrogen is dangerous because it makes cells multiply...cancer.) Also...check your vitamin D levels. I was totally lacking!

Good luck and God bless!

Texastoots: I don't think its anger - it might be fear for your health... everyone is entitled to their opinion and reasons for doing certain things... in your case, it seems in the middle of the road and you have choices to make.. I don't have DCIS so I'm not sure about your cancer.. I know I had one node that had micromatasteses...I didn't have chemo and the RO didn't trust being they only took that one node that it would be safe to say I was clear...so I had rads... mine wasn't insitu either... I know that my sister who just found out she has BC also was told she didn't need either chemo or rads but suggested AI's for her.