Lumpectomy Only-Treatment for DCIS,

I was dx'd with 4mm DCIS with clean margins. My BS thought maybe lumpectomy with Tamoxifen would be all I need due to the small size and wide margins. He referred me to the MO to make the decision. The MO told me without a doubt I'd need radation. (Grade 3 with comedonecrosis). When I questioned him about the need for rads, he kept circling the word comedonecrosis on the path report and said "this is not good, you need radiation." He also said my age (47) and strong family was a factor as well. I agree with redsox, you should get a second opinion. I did not only because my insurance would not pay for me to go anywhere else and based on my own research, I felt that it was the right decision for me.

Flag,

 A couple of things that you also need to take into consideration are the size of the margins and your age.  You say "clean" margins but clean 1 mm margins are different than clean 1 cm margins.  The older you are, the safer it is to go w/out rads.

Have you looked at the Van Nuys scale?  If not, do a search and figure out what your score is.  There are two versions, the newer version uses your age to help determine treatment so make sure you are looking at that one.

Necrosis usually calls for a more aggressive treatement.  I would definitely talk to the oncologist as far as what route to go.  My bs made suggestions to me but he said that is all he can do and told me I needed to talk with an oncologist to make firm plans. 

My breast surgeon was pretty clear that I needed radiation from the beginning, but when pushed on the details, he said, "I'm a surgical oncologist.  You need to ask a radiation oncologist these questions."

When I asked the RO about tamoxifen, he said, "I'm a radiation oncologist.  You need to ask the medical oncologist these questions."

My point is that the surgeon has his/her specialties and radiation isn't one of them.  I'd definitely make an appointment with an RO for a consultation.  I think you're right to question your surgeon's wisdom on this one.  If the RO tells you you're good, then I'd be more likely to believe it.

Steph 

It's really a matter of your level of comfort. Radiation cuts your risk of recurrence and so does Tamoxifen. (I believe each cuts the risk by half.) If you're comfortable with that risk -- and many women are -- then be thankful your BS is not pushing rads and Tamox. If you're not comfortable with it -- which is what you're indicating -- then it's not really even a case of a second opinion, IMO, it's a case of finding a doc who shares your feelings about risk.

Many women woth DCIS would be dancing in the street if their BS had said rads and Tamox weren't necessary. It sounds like you're not one of them, and that's ok too.

Surgeons cut out cancer, oncologists make sure it doesn't come back. 

Go find an Oncologist and see what they tell you.  It may be that you have the recommendation you have because of the grade and size of your DCIS but the best way to feel comfortable is to go get another opinion.  In this case, since the question is post-surgical treatment,  I would be finding TWO oncologists and seeing what they say.

 good luck!

Flag, I'm not real clear on your margins - if they are .4 cm or less than .1 cm.  But either way is not real optimal.  Generally speaking doctors want them to be over 1 cm to avoid rads.  And less than .1 cm usually calls for a re-excision.  Between the margins and the necrosis I'm really surprised that your bs is suggesting you skip rads. 

Surgeons and oncologists have to work together as a team to help your do what you can to bring your recurrence risk down to as low as your are comfortable.  You need both on your team.  I'd stick with having the surgeon do the surgey and the oncologists (medical and radiation) advising you as to what you should do next.  Is the an oncologist in your area who specializes in bc?

Me.  I have a lot of experience at Stanford.  Who is  your surgeon? 

Please see an oncologist for a consultation about the added benefit for YOU for rads +/- tamoxifen.

I would go to a medical oncologist for another opinoin. Surgeons do the surgery to remove the suspicious area, but they are not the specialist in treating cancer, the oncologist is.

anne 

Keep at it.  Many of the docs have regular days for specific types of appointments, e.g. patients under treatment, patients on follow-up, new patients, simulations, etc.  The kind of appointment you need, new patient consult, should be scheduled for a long slot and they only do a few in one day. 

Flag,   I have found hat persistence in geting appts pays off.  Be nice but call the office everyday or every other to see if they have any cancellations.   I usually call around 9:00 am because a lot of times they know by then.  

I do not think your BS got good margins if your info you posted is correct.  I would point blank ask her about that and if not satisfied would get another opinion by unbiased DR.   Sometimes it can be hard to find another Dr that will do that but I would certainly try.   I work with BC patients and am a survivor myself and can tell you that you have to educate yourself and be insistent to get what you need!!!!!

Hugs to you andI hope all gets settled and goes well!!!!!

Hi Flag, 2 yrs ago I had DCIS on the left breast, 9mm, grade 3 with comedo necrosis, I had a lumpectomy (with good margins) and rads, but I met with a MO and RO to determine that. They said because of the high grade and necrosis the radiation was my best bet, in my case lumpectomy and radation would give me a survival rate similar to mx. Now I have just been diagnoses on the other breast with DCIS, this time  4mm, grade 2 with necrosis. Have not had treatment yet, but the BS said that if I chose lumpectomy they would want me to have rads, I believe that is because of the necrosis. She also offered me mx with reconstruction and I have met with 2 plastic surgeons to discuss reconstruction options, but have pretty much decided that for me the lumpectomy is going to be the way to go. Waiting to talk to the BS again today and will definitely want to talk to the MO and RO before deciding if rads are needed this time. Last time I really didn't want to have the rads, but the MO asked me to at least meet the the RO before making a decision. You definitely want to talk with an RO before deciding.