Lightning (DCIS) strikes twice.

So very very sorry for the news, Cat.  Is this new finding in your left breast?  I also didn't know that ALH and LCIS was actually considered "DCIS".

She had 2 biopsies, the first ultrasound guided one showed LCIS, the excisional biopsy showed DCIS.



Is this on the other breast? The non mx side?

kelmo2013 I had a BMX for high grade DCIS on August 31. I did not have to have any chemo or rads and all the cancer was stage 0. Just wanted to give you a little bit of hope that it will be okay. I had TE's placed after surgery and my reconstruction will be sometime next month. Never for a second do I or will I ever regret having a BMX, even thought the cancer was only on the left side. I'm a 37 year old stay at home mommy with a 3 year old and a 7 year old and I have no regrets. Best wishes.

Mammograms are the technology that defines breast density (sometimes MRI, but not always) - pathology only examines the cells - not the overall breast tissue, so the pathology report would not have this information.

Breast density is usually measured during regular screening mammogram and there are 4 levels:

1) Entirely fat

2) Scattered fibrogladular densities

3) Heterogeneously dense

4) Extremely dense 

Im very sorry to hear of the new dx Cat, really sucks you have to go through all this again so soon. I am curious though, have you been on tamoxifen or arimidex? If so is the new dcis the same er & pr+ or has it changed to negative?

Did you go to the same place for your Mammo and MRI both times, back in 2011 and 2012? Just wondering. If not, perhaps one has newer technology then the other.

If you did go to the same place. Did you ask them why the 2011 baseline on your first mammo and MRI didn't show the DCIS in your left breast back then?  And how did they respond?

It is important to note that breast imaging does not see everything, particularly in dense breasts.  I had an annual mammo going back many years and my 2cm IDC was not seen at any point.  It was not seen until ultrasound, which was done thankfully right after the mammo.  I went back to the radiologist after dx to thank him for referring me for a biopsy, and he looked at my mammo film again with me since I now had a definitive dx.  He still saw absolutely nothing that even indicated a lump.  The pre-surgical MRI did not see the ADH and ALH in the "prophy" breast.  That was not discovered until post-op pathology.

nsj2 - I believe that MRI, like mammo, sometimes sees it and sometimes does not.  There does not seem to be a wealth of info regarding non-invasive detection.  It appears to often be an incidental finding at biopsy/lumpectomy/mastectomy.

My MRI did 'pick-up' my benign stuff (ADH) too.  

Although mammogram isn't what found my DCIS (ultrasound did) - it found the microcalcifications that seemed to be hovering around the ADH - I guess I will get my yearly mammograms more faithfully now.  My last mammogram, before this year, was 2007 (when I was 45) and before that when I was 40 (baseline).  I did not go frequently because I got these letters in the mail that said, "your mammogram did not pick up any abnormalities, but because your breasts are heterogeneously dense with 50-75% dense tissue we can't see anything anyway" (ok, I paraphrased that last part ).  

I have a follow-up MRI this month only because they found something in my opposite breast and wanted a 6 month follow-up.  After this comes out clear (which I am assuming it will) -- I don't plan on any more breast MRIs -- that is *my* plan anyway 

Cat - best of luck to you with your surgery.  I am so sorry that you have to go through this, and I am hopeful that this will be the last of it for you!! 

I have a question: can DCIS still show up in the opposite breast during the 5 years of tamoxifen?



This may have been mentioned above...I didn't read all of the posts.

I see...so it prevents new cancer from forming, not eliminate cancer that is already there.

"so it prevents new cancer from forming, not eliminate cancer that is already there."

Actually, Tamoxifen does both.  It can prevent the development of a new cancer, but it can also kill off cancer cells that are already in the breast.  

Tamoxifen is given as a preventative to stop the development of a new breast cancer in either the same breast or the contralateral breast.  And Tamoxifen is also given to reduce recurrence risk after the surgical removal of DCIS.  By definition, a recurrence is what happens when the original cancer flares up again. A local (in the breast area) recurrence develops when a few rogue cells from the original cancer remain in the breast after surgery and these cells have the opportunity to take hold and start to grow again.  The role of Tamoxifen is to starve these cells of their estrogen supply so that these cells die off.  As a result, someone who might have had a recurrence doesn't have one.

Tamoxifen is a systemic treatment (i.e. it enters into and works in the whole body) and therefore it also works against distant recurrence, which can happen when cancer cells traveled out of the breast and moved into the body prior to surgery (i.e. before the cancer was removed from the breast). Just as Tamoxifen starves those rogue cells left behind in the breast, Tamoxifen will starve these rogue cells that have moved into the body.  Of course this is only relevant to women who've had invasive cancer, and who therefore have a risk of mets; this is not a concern for those who've had pure DCIS. 

Those are the 3 benefits of Tamoxifen. It can prevent the development of a new BC.  It can prevent the development of a local recurrence.  It can prevent the development of a distant recurrence. But Tamoxifen, like any drug or treatment, including surgery, is not 100% effective.  On average Tamoxifen tends to reduce the risk of recurrence or the development of a new BC by about 45% - 50%.  For some women it's completely effective.  For other women it may kill off some of the rogue or existing cancer cells but not all of them, and a recurrence or new BC may therefore develop despite being on Tamoxifen.  

By the way, there are now clinical trials underway on women who have DCIS who want to try to delay or possibly even completely avoid surgery.  What is being investigated is whether Tamoxifen (for pre-menopausal women) or Femara (for post-menopausal women), taken at the time that DCIS is discovered but prior to surgery, can stop the DCIS from any further development or shrink/eliminate the DCIS that's already there.  So clearly Tamoxifen does have the ability to eliminate a cancer that is already there.  It just doesn't do it every time.

Tamoxifen or Letrozole in Treating Women With Ductal Carcinoma in Situ