RADS for small size, high grade DCIS?

The pathology after my lumpectomy and reexcision was 7 mm focal DCIS, Grade 2, ER+,PR+, BRCA- with good margins and a VNPI score of 6 at 50 years old.  Before the surgeries, it WAS my intent to forgoe radiation treatments if there were no surprises in either pathology.   After the surgeries, it was still my plan.  Then came the consultation with my medical oncologist, a doctor that I knew and trusted, about Tamoxifin.  While I'm still on the fence about the Tamoxifin, he really convinced me to reconsider whole breast radiation to reduce the chance of recurrence.  So......fast forward to today.  20 radiation treatments down and 13 to go and no looking back.  I'm comfortable with all of my decisions thus far.  It is truly a personal decision that only you can make. 

I had BMX so my situation does not compare, but data from a clinical trial published this year showed a decreased risk of developing invasive cancer with lumpectomy + rads. (Tamoxifen adds some additional benefit depending on hormonal status, but one has to balance risks and benefits)



Sorry that I can't link the latest clinical trial from my iPad. But, the 15-year risk of invasive cancer occurring in the originally treated breast was: 19.4% lumpectomy alone, 8.9% lumpectomy + whole breast radiation, 8.5% adding Tamoxifen to radiation.
Edited to add a non-clickable link to the abstract http://www.ncbi.nlm.nih.gov/pubmed/21398619

I had a diagnosis of DCIS in July '08.  The only thing I had done was the surgical excisional biopsy/lumpectomy which completely removed the tiny area of DCIS (1.6 mm -- less than 1/8th of an inch - which was listed as Intermediate grade) and I had clear margins (although one was 'close').  At follow up appt. a week after the biopsy, a medical oncologist spoke with me and told me that my tumor was sooo tiny he thought there was a miniscule chance it would cause me problems down the road and he did not recommend radiation therapy or hormonal therapy with their associated risks and side effects for my particular situation.  He actually told me I was not to lose sleep over this or worry about it and he never expected to see me again.   I also met with a radiation oncologist who wavered a bit on his recommendation (seems I was also in "gray" area due to my age at the time - 46 and the one margin that was 'close'), but ultimately told me after we had a long discussion, that he said I got a pass on this and that with my particular circumstances that if I were his wife, he would NOT treat me with radiation.  Therefore, I decided against doing anything more except for close monitoring with mammograms and MRI's as needed.

However, my decision MIGHT have been different if it had not been pure DCIS, had I NOT had clear margins, had my DCIS not been sooo tiny, had the path report showed there was sign of necrosis or it was the more aggressive comedo cell type, OR if MRI had showed any other type of concern.    (Since you have family history and comedo necrosis with grading of 3, our situations are not exactly the 'same')

Just this past July of 2011 I had another 'scare' where they found a 'grouping' of microcalc's in that same left breast.  I again underwent an excisional biopsy (I am too small for sterotactic procedure) and this time the results of biopsy were all benign conditions (which was a huge relief).  The breast surgeon told me to just go back to annual mammogram screening which I will set up again for Summer of 2012.