doctors disagree on path report

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BVGS
BVGS Member Posts: 4
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

I had chemo prior to lumpectomy. Now the doctors disagree about the path report from the surgery. The surgeon told me the path report showed clean margins. When I went to see the radiation oncologist, who is at a different hospital, he told me that he routinely has all path from outside reviewed. His path dept says they found DCIS. & said without added surgery my risk of recurrance would go up 30%.
  Went back to the surgeon. He said he would do an additional surgery if it 'would give me peace of mind' but made it obvious he didn't really think it was necessary.   

  I know that different doctors might have different opinions about the best treatment, but I really thought that whether there are adequate clear margins was a fact not an opinion. So now I am between the proverbial rock and a hard place.  Thinking about a 3rd path report. Obviously I don't "want" more surgery, but I even more don't want to increase my risk of recurrance. When the doctors disagree, how does a patient decide???

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  • kira1234
    kira1234 Member Posts: 3,091
    edited June 2011

    I wonder if the radiation oncologis is one who wants wide margins. I know some Dr.s prefer wider margins than others. I guess if it was me I would get a 3rd opinion. I needed the additional surgery as mine weren't clean. Not what I wanted to hear, but glad I had it done.

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  • nikola
    nikola Member Posts: 466
    edited June 2011

    I think it is always better to be safe than sorry. My BS told me after biopsy showed two cancers it was most likely only one but taken twice from the same spot. I decided to go with double mastectomy and final pathology showed three cancers.

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  • karenuge
    karenuge Member Posts: 5
    edited June 2011

    I had DCIS twice in same breast, (radition and lumpectomy in 2000, recurrance in 2010) and was told mastectomy is recommended. I REALLY did not want to do it. My oncologist said 30-50 percent chance it would become invasive. My breast surgeon, also an oncologist, said more  like 30 percent and they really don't know,. but that she could not do another lumpectomy without taking what was left of that breast---so, really no choice. Five year of Tamoxifen not much good, eh?

    But I am still not sure if any DCIS warrants a mastectomy.

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  • dlb823
    dlb823 Member Posts: 9,430
    edited June 2011

    BVGS ~ IMO, the rad onc should know more about RXing RT than your surgeon, assuming the rad onc deals with a lot of bc.  Do you have a copy of the actual pathology report?  If not, that's something you need to get one.  The difference in opinion may be a difference in what is deemed an acceptable margin between the two.  There actually is some variance in the research re. what is considered safe and acceptable.  

    It sounds like you need more info -- specifically, what are the margins of concern to the rad onc -- then maybe a second opinion from a different rad onc.    

    Good luck getting to the bottom of this, and don't be afraid to ask questions until you have enough information to make an informed decision.    Deanna

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  • cinnamonsmiles
    cinnamonsmiles Member Posts: 779
    edited June 2011

    I am confused, did you have pure DCIS? Or did you have DCIS plus IDC. Chemotherapy is not standard treatment for pure DCIS since it has not broken thru the milk ducts and travelled anywhere else in the body.

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  • SJW1
    SJW1 Member Posts: 244
    edited June 2011

    BVGS,

    When I had a lumpectomy for DCIS in 2007, my pathology report showed positive margins and it seemed as if I would need a mastectomy. However, Dr. Michael Lagios, a world renowned DCIS expert and pathologist, reviewed my pathology and disagreed with the local pathologists. He said that I did get good margins and did not need further surgery. He has a consulting service that anyone can use.

    Pathologists disagree as much as 25 percent of the time. Since all your future treatments are based on your pathology report, you will probably want to get a third opinion from an expert pathologist. Otherwise I would go with the opinon of the more expert of the two pathology reports you have already. 

    Best,

    Sandie

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