a question

Dense breasts are the amount of connective tissue you have vs. the amount of fat.  I don't believe it has anything to do with the size of the breast, but I'm not 100% sure on that.   The only way to know is if the radiologist says it in the report - if not, you can call and ask the radiologist for an estimate on how dense your breasts are.  They can tell by looking at your mammograms.  More dense breasts show up as white on mammo's and so do calcifications/tumors - so this is why they are harder to assess for cancer than less dense breasts.  Here is a link that explains it:  http://www.mayoclinic.com/health/mammogram/AN01137.

Here is a link about risk of a new primary cancer (not recurrence, they are two different things) in the contralateral breast.  It lists the risk as 3 or 4 times higher - but I know many women have found it listed as only twice higher, so there must be variation in the results of research studies.  Perhaps someone else has an additional link for the twice higher studies.   Regardless, it is higher, and thus you will want to monitor the other breast more closely as you are planning to do:  http://www.breastcancer.org/risk/factors/personal_history.jsp 

Yes, I do believe when they say original cancer they are referring to a recurrence in the same breast, not a new primary. 

It's definitely confusing when you are learning all of this - it's like cramming for an exam, only with tons more pressure.  Hang in there!   

I haven't researched that question bexy...keeping myself blissfully unaware on that one! LOL! 

bexy, 

Let's see if I can clarify some of this for you.

• A "recurrence" is when the original cancer comes back.  This happens if some of the cancer cells are not removed during surgery and not effectively killed off by post-surgical treatment (radiation and/or Tamoxifen) and at some point these cells start to multiply and spread again (as cancer cells eventually do).  A recurrence after a diagnosis of DCIS can only occur in the same breast as the original cancer.  DCIS cannot recur in the contralateral (other) breast. 
• A "new primary" or "new occurance" is the development of a new breast cancer, completely unconnected to the first breast cancer.  This can happen in either breast.  
• After a mastectomy for DCIS, assuming that you have reasonable margins, your risk of "recurrence" (a return of the original cancer in the breast area of the original breast) generally is thought to be about 1% - 2%.  This risk likely will be higher if margins are narrow.
• After a mastectomy for DCIS, your risk of the development of a "new primary" breast cancer (an unrelated new cancer) in the breast that originally had cancer is also about 1% - 2%.  This is because even after a mastectomy, there is always a small amount of breast tissue left.  
• If you had a single mastectomy and you still have your 'healthy' breast, your risk of development of a "new primary" breast cancer in your remaining breast is thought to be about double the risk of an average woman your age (at least according to my oncologist). You need to consider individual risk factors in this calculation - any individual's risk might be higher or lower than this based on individual factors.  It's best to speak to an oncologist about it. 
• For those who have a lumpectomy for DCIS rather than a mastectomy, the risk of "recurrence" after a lumpectomy can range from as low as about 3% to probably as high as 60% - it all depends on the size of the margins, the pathology of the cancer and what other treatments you have had (radiation and/or Tamoxifen).  For those who have a lumpectomy, the risk of the development of a "new primary" will apply equally to both breasts.

To your question about whether you also have a risk of developing other cancers, well, that depends. Those who are BRCA positive have a known and significant increased risk not just of BC but also of some other cancers.  There are other more rare genetic mutations (Cowden's Syndrome, for example) that also increase the risk fo BC and specific other cancers.  For most of us, who do not have known genetic mutations, because it is not known which factor or combination of factors led to the development of our breast cancer, it's impossible to know if we are also at higher risk for other cancers.  However because some of the factors that cause BC also cause other cancers, it makes sense that overall, among all women diagnosed with BC, there is a greater likelihood that some other type of cancer will also develop at some point in the future.  The following study suggests that on average (all women diagnosed with BC, not any one of us as individuals), there is a higher risk that someone who had BC might develop a new, different primary cancer:

 http://www.medpagetoday.com/HematologyOncology/BreastCancer/2286

BUT... don't let these risk numbers scare you.  As an example, the average women has just under a 2.9% chance of developing endometrial cancer during her lifetime.  A 52% increase takes this risk up by only 1.5 pts, to 4.4% - still very low. Another example: the lifetime risk of developing thyroid cancer is just under 1%.  A 60% increase takes this up to 1.6%. And remember too that these numbers apply to all women who've had breast cancer, not to you individually.  There is simply no way to know if your risk for any other cancer is higher. 

bexy, I understand why you want to know this but I think you are asking for a level of precision that simply doesn't exist.  Either you will develop a new primary breast cancer in your other breast at some point during the rest of your life, or you won't.  For each of us as individuals, the risk is either 0% or 100%.  Until the day that you are diagnosed with a new primary breast cancer or until the day that you die (peacefully in your bed at the age of 97) and it hasn't happened, there is no way to know if your risk was 0% or 100%.

The best anyone can do is estimate your risk based on studies that have been done in the past on other women and based on what are known to be risk factors (this is the information that was provided by the Moderators).

Looking at things about you such as:

- Your age: the risk of BC is greatest when you are older but if you are young when you are first diagnosed, you have more years left within your natural lifetime to be diagnosed again so your overall risk is higher;

- Your family and personal health history: any 1st or 2nd degree relatives with BC?  what age did you start getting your periods? do you have extremely dense breasts? etc. etc.;

- Your life choices and lifestyle and exposure to risk factors & toxins: did you breastfeed?  are you overweight? have you taken HRT? etc. etc.;

it can be estimated that if there were 100 women just like you, X% will develop a new primary breast cancer. That's your risk level and it is calculated based on specific things about you, but it's still based on averages and risk factors and what happened to other women.  It's also not specifically saying what will happen to you - it's saying what will happen to 100 women just like you.  Let's say that the X% is 25%.  This means that there is a 25% chance that you will be diagnosed with a new primary BC at some point in the future. Those are your odds.  But really, it's the odds for the group of 100 women who are all just like you.  1 in 4 of those women will be diagnosed with BC again.  No one can tell you whether, within this group of 100 women, you will be one of the 25 who gets a new primary breast or if you will be one of the 75 who doesn't.  Also if you do turn out to be one of the 25, no one can tell you when you will be diagnosed again; will be it in 2 years or in 22 years or in 42 years? So it's not very precise - even though it's a calculation of your risk level based on specific things about you.  But it's the best anyone can do. 

By the way, you said that "because I am healthy, have no family history and will be undergoing a mastectomy my risk of the other breast getting a new cancer is about double maybe more, but I don't think a lot higher."  To my earlier explanation of the difference between a recurrence and a new primary, keep in mind that having a mastectomy has absolutely no bearing on your risk to develop a new primary breast cancer in your other breast.  

For what it is worth, my mother had stage IV bc that spread to her bones and liver and she died about 6 years after her diagnosis. Her "good" breast was clear to the end and she had invasive, advanced bc in her affected breast.

Aw thanks Bexy. Mom died many years ago but knowing about bc early in my life made me more aware of the warning signs, the importance of having regular exams, etc. I wish you well in your journey, and can see you are researching to make the right choices. You are absolutely right in that many women who have had negative biopsies, no recurrence, etc. do not post here as much so most of the experiences detailed here are from women who have recurrence. I figure there are odds in just plain living and try and take it all in stride.

No matter what a doctor says our recurrence or new cancer risk might be, it's still 0% if you have none, and 100% if you have one. That is why is it so important not to get worried when reading about these studies that provide risk levels. These are normally groups of patients, varying degrees of DCIS or other cancers depending on the study, and cannot hope to take into account how you live your life and family history, etc. When I recently asked about the study that provides the % of recurrence risk for DCIS the doctor said that it included women with DCIS from grades 1 to 3 and all dimensions of affected areas. So how accurate can the % then for a woman with a tiny area at grade 1 compared to a large area and stage 3? 

It's always something, isn't it? I totally agree: life is a balance of moderation and enjoyment.

I consider my DCIS a warning signal to smarten up and take better care of myself. All my life I've drank, ate, smoked, experimented with stuff going around (back in the day), worked hard, didn't get enough sleep, etc. Maybe the crows have come home to roost or maybe I would have developed DCIS anyway, but I refuse to be hard on myself for past choices. The key now is to moderate and make healthier choices going forward.

When I was in the hospital after the birth of my second son, one of the other new moms was a huge advocate of vegetarianism, all organic and alternative practices, etc. She hated having to be in the hospital and chastised us other moms for for being careless with our diets and the horrors of formula we'd chosen for our babies. She monitored every ounce of food she ingested and had a whole host of other guidelines she lived by to ensure the perfect health of her baby. The sad end to this story is that she gave birth to a baby with serious health issues who was immediately rushed to the children's hospital for surgery. I don't know if her baby made it, the odds were not good. After this she refused to leave her room or talk to any of us. The crap shoot of life had completely unhinged her carefully ordered world.

I'm not saying her healthy practices led to her baby's health problems, just that sometimes no matter what you do, there is only so much within your control. Rolling with the punches, trying to make the best informed decisions and helping our bodies be healthier with moderation in diet and life choices seems the most reasonable way to live to me. I'm pretty skeptical of anything radical so I ask a lot of questions and expect doctors to qualify their diagnosis and recommendations. I respect their expertise but don't loose sight of the fact that it's my body and ultimately my call as to what happens with it.

My BS told me risk was 10% after lumpectomy/rads, 2-3% after mastectomy.   I had both IDC and DCIS in same breast.

olivia, while your story of the new mom you met is very sad, it's an excellent illustration of what a "crap shoot" one's health is. My mother was a cigarette smoker and never got lung cancer or had any respiratory problems whatsoever. She got Parkinson's Disease (which, for unknown reasons, relatively few smokers contract) and died in her early 70s.