Article on front page re DCIS, surgery, radiation reoccurance

Thanks for saving me the time reading this article, I'm not interested based on what you've all written.

I made the best decision for me with the information available at the time, no regrets that I had rads after lumpectomy. Alternative presented to me was to have a mx if I didn't want rads (never just lumpectomy) and I didn't want that.

It leaves me wondering if I /we who have opted out of rads with mastectomies are going to have to rethink everything? 

Why?  Were you margins close?  A while back someone posted information on recurrence and the Van Nuys index.  I think the risk of recurrence after mastectomy even for high grade dcis is very low, unless you have a LARGE amount of dcis AND margins under 2 mm AND are very young.  On my prophylactic side, I had scattered dcis (3 quadrants) some high grade and according to the van nuys index my risk with mastectomy is low because all my margins were greater than 2 mm and the dcis was very small (microscopic).  The long term risk from pure dcis is low, even if the dcis is high grade.  I am all for aggressive treatment and even for maximizing treatment, but I like to balance that with a realistic assessment of my actual risk.  I did have radiation (after chemo) to one side after mastectomy more than a year before my prophy mx, and I suspect it was because I had so much dcis along with some small invasive triple negative idc (plus some other stuff, cysts and things), but my mass was 7cm x7cm and I had a close margin by the dcis.  The long term mortality risk for dcis is lower than my general mortality risk (woman in my 40s), so I am monitored closely but I try not to worry about it too much.

I thought when they said surgery only they meant lumpectomy without radiation???

And, the high recurrence rate with lumpectomy and without rads makes some sense since dcis has a tendency to be scattered (at least this is what I heard).  In my prophylactic side, it was like someone sprinkled my breast with dcis (some high grade and some really low grade).  There is no way that a lumpectomy could have removed it effectively once any part of it became detectable through diagnostic screening.   Oddly enough in my other side, outside of the mass the rest of my breast was normal.

A few points about this study, which has NOT been peer viewed yet.

• It was not a clinical trial meaning the women were not randomized to treatment groups. So there could be bias in which women chose their treatment or how the physicians offered treatment or many other factors (race, genetics, etc.) which could influence outcomes.
• The radiation group was followed for a significantly longer period of time (109 months vs. 72 months) and probably were monitored more closely for disease. To me this means that there were differences in follow-up that might account for detection of invasive disease.
• There is nothing in the information provided about the grade of DCIS in the 2 groups. Again because this was not a randomized trial it is possible that the radiation group could have had more advanced disease at diagnosis.
• Other long-term trials that randomized DCIS patients to lumpectomy or lumpectomy + radiation should be looked at for data on invasive cancer (such as the NSABP B-17 trial that randomized 818 women over 20 years ago)
• Nothing here applies to women who had mastectomy for DCIS

Bottom line to those who have had lumpectomy + radiation, I would not regret the decision based on this one study alone. Share it with your physician, but please be aware the study has MANY limitations that must be addressed before reliable conclusions can be made.