dcis comedo type

tvirgo05, I missed seeing your post yesterday; sorry that no one has replied until now.

With DCIS the most important thing is to remove it.  Because DCIS is confined to the milk ducts, it can't travel into the nodes and from there, into the body.  So after DCIS is removed from the breast, you don't need to worry about a distant (i.e. beyond the breast) recurrence.  The only concern is a local recurrence, i.e. in the breast area. Normally for those who have a BMX for DCIS, no other treatment is prescribed.  This is because after a BMX for DCIS, the risk of recurrence is usually only about 1% - 2%.  Similarly, the risk of developing a new breast cancer some time in the future is also only about 1% - 2%.  But that's where margins come in.  There have been a couple of small studies over the past few years that have shown that the recurrence rate can be higher for those who have close margins after a mastectomy for DCIS.  This is relatively new news and as a result, the question of whether or not radiation is sometimes required after a mastectomy for DCIS is now a hot topic.  Back when I was diagnosed 6 years ago, radiation was virtually never given to someone who had a MX for DCIS.  But these days we are seeing more and more women who are getting radiation.

The problem is that there is no consistency on this.  Some docs say that radiation should be given if the post-MX margins are close, even if it's just DCIS that is near the margins, and other docs say that radiation isn't necessary.  So your doctors - with half saying "yes" and half saying "no" - are pretty much right where all doctors are on this. In other words, they are confused. As the patient, that doesn't help you much.

I think you have to decide how worried you are and make your decision from there.  And it is your decision.  

Here are a couple of discussion threads from this forum where this issue has been discussed.  You might find the discussions helpful. 

Chest Wall Margin 0.1mm after Mastectomy - radiation decision 

DCIS, BMX/MX, and radiation ladies 

tvirgo05 - I saw 3 different ROs before I was convinced (and accepted) that I had to have radition.  I had minimal SEs from radiation during the process however I've noted changes on my radiated side (and TE).   I don't regret the radiation but still wish I didn't have to have gone through it.  Good luck in your decisions!

Juls