DCIS, Lumpectomy no clean margins & two microinvasions

There is a discussion topic on here called Micro-Invasive DCIS that is Her2 positive. Even though you don't know if you are Her2 positive, you could try posting over there,too. 

flopsy, DCIS usually does show up on imaging.  Not always, of course, and not always all of it, but most DCIS is screen detected.  Mammograms are generally quite good at showing the calcifications that are a sign of DCIS.  And high grade DCIS often shows up even better on an MRI than on a mammogram.  

The two main problems with detection of DCIS is that the entire area of DCIS is not always visible on the films, as you said, although MRIs are pretty good at showing the entire area, and if there are small microinvasions hidden in with the DCIS, these may not be detected by any screening method.  

suzegirl, I can't tell you what you should do. The decision between lumpectomy and mastectomy is such a personal decision, and so life-impacting, that it's one that only you can make.  Only you can know how often you want to try re-excisions to see if you can get clear margins.  With DD breasts, you do have enough breast tissue to work with to try another one or two re-excisions, if you prefer the lumpectomy option to having a mastectomy. 

One thing that's important that you understand is that with the microinvasions, your diagnosis is no longer pure DCIS, and it is no longer Stage 0.  Assuming that none of the microinvasions are larger than 1mm, your diagnosis is now DCIS-Mi, which is the earliest Stage I breast cancer. If any of the microinvasions are more than 1mm, then your diagnosis is IDC, Stage I. I notice that your signature line says that you are HER2+.  Having HER2+ invasive cancer, and with more than one invasion, you really need to see an oncologist to talk about whether this impacts your treatment.  It might, particularly if any of the invasions are larger than 1mm.  If you have a more extensive/difficult treatment plan, this might impact whether or not you want to go through a masectomy. 

Have your sister and mother also been BRCA tested?  This could be very important to understanding your future risk, if you turn out to be BRCA negative.  If one or both of them are positive, your being negative would be very significant.  But if everyone is negative, then it's what's called an "uninformed negative" which means that there could be a genetic component to the breast cancer in your family but it just not the current strains of BRCA that are being tested for.  If your result is positive, that of course means that you do have a significant future risk.  That could certainly impact your decision to have a mastectomy rather than a lumpectomy. 

Since you are unsure about what to do with the surgery, you may want proceed on the current path at least until the BRCA results are in and you've talked to an oncologist. Finding out if you have positive nodes is also very important, since this too will impact your treatment plan.  Once you have more information and you better understand your complete treatment plan, it may be easier to decide if you want to opt for a mastectomy or if you'd prefer to continue to try to get clear margins.

Bessie is the expert here but me, I did have 3 lumpies to get clear margins. BS thought she had it all but the RO pulled a mamo prior to rads and it showed more junk

I hesitated and debated by all three docs....BS, RO and my MO all said go for the lumpie#3

I did, am 4 years out and feel I made the right choice for me

it is a huge choice 

NSJ2, I don't want to divert this thread away from suzegirl's situation and concerns.  You can find the information about the relevance (lack of revelance) of HER2+ status on DCIS in the main post here:  A layperson's guide To DCIS

It's also discussed here:  HER2 testing