Re-excision or radiation

NorthSalem-

I had a similar situation - high grade with the smallest margin 1.5mm margin on the skin side - at the areole. The surgeon was looking for a 2mm margin. If I had a re-excision, I would have lost part of the areole/nipple. Instead, my radiation plan - included boosts to the area of the incision.  Talk with the Radiation Oncologist - who may or may not be comfortable with radiation without the re-excision. I had an MRI after surgery but before radiation - mainly to check the othe breast. I had the impression that the area around the incision was difficult to read due to the scarring/healing going on, but others might chime in on that - I am not sure it would tell you definitively what you want to know. I would go with your gut feeling, what you would feel most comfortable with. It sounds like your surgeon wants to spare you the re-excision, but the decision should be yours.  

Take care 

Julie E

Hi, I had what may have been a similar situation.  My closest margin was .5mm and I was sure from reading that I would have to have a re-excision.  But when I saw the BS he said I didn't need it.  I was so surprised that I didn't take in everything he said.  But a few days later I had an appointment with the medical oncologist and he said the same thing: that I did not need a re-excision. At this point, I had myself together enough to ask why and  he said it all had to do with how the specimen was handled.  I had shaved margins (which I never really understood) which makes it even harder to understand.  He was completely adamant that I didn't need a re-excision.  He said it was likely I had scattered DCIS cells elsewhere in my breast, and then I asked  him if I should have a mastectomy and he said no, same statistics.  He said that's what radiation is meant for.  He said the person with the last word, though, would be the radiation oncologist, whom I saw a few days later.  The rad onc said that she didn't think I needed a re-excision, but that she had taken my case to the tumor board of the multidisciplinary cancer center at the med school (she used to chair of the radiaition oncology department) and they agreed that I did not need a re-excision. She said I didn't have extensive DCIS and that the close margins were away from the clusters of calcifications (which is what had started the whole thing).  As close as I can understand it, it is not unusual for women to have residual DCIS.  What they worry about, though, is that original tumor is out.  She said with radiation but without a boost my (personal) risk of recurrence was about 6% and with a boost about 4% (I had a small area of intermediate grade DCIS). 

 Your situation is not the same as mine, so your doctors might recommend other strategies.  But as much as I actually wanted the re-excision, in the end I just couldn't push it any further:  3 highly trained specialists and a tumor board had to know more than I did.

 I did a lot of reading about margins.  I am not a scientist but I can make my way through a research article.  In the end I decided I couldn't really understand the intricacies of the literature.  And there are so many variables in the research.  There's no consistency in how the pathology is handled or what counts as "close" margin.  I think you should try to understand as much as you can and ask your doctors as many questions as possible.  But in the end, I think one should understand that this is all very complicated and that general guidelines don't work in every case.

For me, negotiating the margin stuff was the most stressful part of the whole experience.  PM if you want to talk more.

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