DCIS and microcalcifications

capecodmom-- do a search for posts by beasie- she is very informed about everything to do with DCIS, her posts will amaze you and inform you.  Like Julia said it is a very personal choice.  I was diagnosed at 34 years old.  My mother passed from breast cancer when I was 29.  At the time of diagnosis my children were 6 months and 2 1/2.  Recovery time was the same whether I had a bilateral, or unilateral mastectomy. (I personally never considered lumpectomy.)  If I am having issues at 34 with right breast, what do you think the odds are that it will find a home in the left in the future?  I was looking for survival and to not endure what my mother did.  To not have my children go through the loss of a mother like I did.  I will be honest and say fear fueled my decision.  It's whatever lets you sleep at night.  I will say the BMX was tolerable, easier than thought.  The thought of cancer- not so tolerable.  It still turns my stomach daily.  Good luck to you- it's a personal decision, I was also told lumpectomy and rads are just as effective so you are not wrong.  We just never know.

I had BMX with DCIS because I was 39 when diagnosed, my mom was dying from breast cancer, my grandmother on my mother's side had BC, I was BRAC1 and 2 negative (I attended a young survivor's bc symposium this summer and there was a genetic researcher there who said that there are genetic links for bc that simply haven't been discovered yet), I had very dense breasts which are extremely hard to DX with cancer, my mother was one of the rare ones who developed an aggressive form of endometrial cancer from taking Tamoxifen for five years (but it was still the breast cancer that killed her) ... all of those variables for me, were enough to opt for a BMX. 

The suggested treatment for most DCIS is lumpectomy, radiation, and for most, some kind of hormone treatment, which for me, meant Tamoxifen.  No.

I think the jury is still out on what to do with women who get DCIS who are pre-menopausal.  Most studies on DCIS are done on post-menopausal women.  Because of my history and because DCIS can be a pre-cursor to a more invasive cancer I chose BMX.  Depending on the doctor, some say it is pre-cancer, others say it is cancer.  To me, cancer is cancer.  And she is a bitch I don't want to mess around with.  She took my mom's life and I'm going to do everything I can do so she can't take mine.

capecodmom, you've had some great answers.  Let me try to add a few points that might be important to you.

• Calcifications are very common - about 50% of women get them.  Most calcifications, well over 90%, are benign.  Calcs can however be a sign of the presence of breast cancer.  Calcs become suspicious if they are tiny (i.e. microcalcifications) and if they are either linear or clustered in formation.  If your calcs look that way, you get the BIRADs 4 rating and you're sent for a biopsy.  What's important to know however is that 80% of these suspicious calcs that are biopsied turn out to be regular harmless benign calcs.  So don't assume as this point that you have DCIS.
• If you are in the 20% group that turns out to have calcs that are breast cancer, in most cases the diagnosis will be DCIS, which is Stage 0 breast cancer.  But your surgeon saying that this is the "worst case outcome" is not true.  Sometimes small amounts of invasive cancer are found in with the DCIS.  If the invasive cancer is 1mm in size or smaller, it's called a microinvasion.  I had a microinvasion.  Even with such a small amount of invasive cancer, the diagnosis and staging changes - I'm Stage I because of that 1mm microinvasion.  About 10% - 15% of women initially thought to have DCIS are found to have microinvasions.  An additional 5% or so of women who are initially thought to have DCIS turn out to have more serious invasive cancer, either with a larger tumor and/or with nodal involvement.  So the odds of this for you are very small (5% of 20% = 1%) but it is possible.
• Whether DCIS is or isn't "true cancer" is controversial.  Most experts do consider DCIS to be cancer.  The most accurate definition of DCIS is that it's a pre-invasive cancer.  In it's current state, DCIS cancer cells are confined to the milk ducts of the breast and therefore cannot move into the body. Because of this, DCIS is not life-threatening (and this is why some don't consider DCIS to be a "real" cancer).  But DCIS cancer cells can convert to become invasive cancer at any time; this risk is greatest for those who have more aggressive DCIS. 
• All DCIS is not alike and if you are diagnosed with DCIS, this is very important to understand.  Someone who has a large amount of high grade/aggressive DCIS is at very higher risk of invasive cancer and needs to take more aggressive action than someone who is diagnosed with a small amount of low grade/non-aggressive DCIS.  Those of us who have large amounts of aggressive DCIS really have no choice but to have a mastectomy (that was my situation).  On the other hand, someone who has a small amount of low grade DCIS  might be perfectly fine with a simple excision, possibly without radiation and without Tamoxifen.  So until you are diagnosed and until you know what your diagnosis is, it really is too early to start making assumptions about what your treatment might be.  A diagnosis of 6cm of Grade 3 DCIS with comedonecrosis is a world apart from a diagnosis of 6mm of Grade 1 DCIS.

I hope that helps.  And I hope that your biopsy results are benign so that you don't need to worry about any of this.

Thanks Beesie,

I meet with my radiation oncologist tomorrow and even though I am in medical research I am still beyond confused, I deal with brains not boobies. I had my partial mastectomy on Sept. 28th because they found DCIS in the biopsy. They said it was not cancer but pre cancer and that just confused me, I mean it is CALLED a carcinoma.

Turns out they got it all in the biopsy, but when they did they surgery they had a 3.5x2x.8cm fibrcyctic lesion of Atypical Ductal Hyperplasia, flat epithelial atypia and florid fibrocystic change with microcalcifications.  Anybody got a clue?

I guess they are now more concerned about the hyperplasia then the DCIS but it looks like there are microcalcifications in the hyperplasia?

Is it true they don't want you loosing any weight during radiation?  I am finally on a walking regime and loosing a few pounds a month and really don't want to start gaining again.  I am afraid enough I will be too tired to keep up even though it will be low dose radiation.

Lovelyface, yes, DCIS is "ductal carcinoma in situ".

shirehouse, the "is DCIS cancer?" debate rages on.  Most experts do consider DCIS to be cancer but some call it a pre-cancer.  There have been lots of threads discussing this issue here in the DCIS forum. If you do a search, you can probably find a half dozen.

As for your pathology report, given that you have DCIS, nothing else that you have is particularly concerning, as far as I can tell.  Atypical ductal hyperplasia (ADH) is a high risk condition than can lead to DCIS.  Approx. 20% - 30% of women with ADH eventually develop breast cancer.  ADH does not need to be removed but when ADH is found during a biopsy, normally it is removed just to ensure that nothing more serious (i.e. DCIS) is going on. My stereotactic biopsy showed ADH; when I had my surgical biopsy, more ADH was found, along with DCIS and a microinvasion of IDC. So ADH is concerning only in terms of what it might become or whether it's presence might indicate the presence of something more serious.  As an FYI, the way that cells most often progress from normality to invasive cancer is as follows:

Normal cell ---> Hyperplasia ---> Atypical Hyperplasia ---> DCIS (pre-invasive cancer) ---> IDC (invasive cancer).

I'm not really sure why your docs would be concerned about the presence of ADH.  It's almost a given if you have DCIS.

Bless you, Beesie, for being our resident expert on DCIS - I'm a great researcher, but sometimes it can be confusing.