Anyone from Hamilton Ont, know a good surgeon!!!

You might also touch base with Beesie  she is in Toronto but seems to have a great deal of knowledge about the Canadian Health System..  Best of luck and please know there is a great deal of information on the DCIS site BECAUSE of Beesie (and others) postings... 

paulachiz, I'm sorry to hear that you got the DCIS diagnosis, although going into your biopsy with a BIRADs 5, it was unfortunately the most likely result. I was hoping you'd be one of the 5% with a benign result! I'm glad though that the biopsy has only found DCIS. Hopefully when you have surgery the final diagnosis will remain pure DCIS.

I'm sorry that you ran into a surgeon who doesn't consider DCIS to be breast cancer. Most doctors do consider DCIS to be the earliest stage of breast cancer but there are some doctors who choose to call DCIS a pre-cancer.  As much as I disagree with that, I do understand the logic behind it.  

The issue is in how one defines cancer. The definition of cancer often includes 3 criteria (from the National Cancer Institute: What Is Cancer?):

1) Abnormality of the cells

2) Uncontrolled growth of the cells

3) Invasiveness/the ability to metastasize

DCIS cells are virtually fully formed cancer cells. But DCIS cells are confined to the milk ducts in the breast and do not have the ability to break through the duct or survive/thrive outside of the duct; therefore DCIS is not "invasive" and cannot move beyond the breast.  For those who believe that the definition of cancer includes invasiveness/the ability to metastasize (i.e. the ability of the cancer cells to move to a secondary location in the body away from the main source of the cancer), DCIS does meet that criteria and that's why there are those who say that DCIS is not cancer.  

Here's the big "BUT". Where there is DCIS, there could be invasive cancer. This means that a preliminary diagnosis of DCIS doesn't mean that DCIS is all that is present.  Until all the affected breast tissue is analysed, it can't be known if the diagnosis is pure DCIS or whether some invasive cancer is also present.  In about 20% of cases where DCIS is diagnosed via a needle biopsy, some invasive cancer is later found during the surgery.  Even when this doesn't happen, it only takes one small biological change for a DCIS cell to acquire the ability to break through the milk duct and metastasize. It's the same DCIS cell (with minor biological changes) that moves from the duct into the open breast cancer and becomes an invasive cancer cell. This is why it's important that  every DCIS cell be surgically removed and/or killed off (with rads or hormone therapy).  If any DCIS cells remain in the breast, there can be a recurrence and in 50% of cases, the recurrence is not found until the DCIS has progressed to become IDC (invasive cancer). It's for these reasons that most doctors do consider DCIS to be a pre-invasive cancer, i.e. the earliest stage of breast cancer. 

Regardless of what a doctor calls DCIS, the treatment is the same.  So the MRI and lumpectomy that your surgeon is proposing would be the same whether he calls DCIS a cancer or a pre-cancer.  Still, I can appreciate why you would prefer to see another surgeon. Unfortunately I don't know of any surgeons in Hamilton.  I do recall reading some posts from women who've been treated at the Juravinski Cancer Centre. If you put "Juravinski" in the search box on this site, you'll find some of the women treated there, and you may be able to contact them via PM (if they are still coming to the board). If you are willing to travel a bit, there are lots of women on the board who've gone to Trillium in Mississauga and I'm sure you could get the names of recommended surgeons from them.  I could even recommend a surgeon there too, although he's a surgical oncologist and does not specialize exclusively on breast cancer.  Sorry I can't be more helpful on that. 

Right after I posted and signed off, I thought "Oakville!" I know that there are women on the board who've been treated at Oakville-Trafalgar and that's closer to Paulachiz than Mississauga.  Myleftboob, I'm glad you found this post and chimed in!

I do want to provide one point of clarification about DCIS treatment. If someone with DCIS has a bilateral mastectomy, standard of care guidelines suggest that no further treatment is required. With pure DCIS, there should be no risk of distant metastasis (unless there was a misdiagnosis or an occult invasion) and there is usually only about a 1% - 2% risk of a local recurrence (assuming adequate margins from the mastectomy). Most oncologists, and all treatment guidelines that I've ever seen, say that such a low risk does not warrant any further treatment. But that doesn't mean that anyone who goes this route can stop being diligent. If there is a local recurrence, and if it's not found while it's still DCIS, that changes the whole diagnosis and prognosis. And that's how someone with DCIS could end up with mets. It's rare - most studies put the the long term survival rate for those diagnosed with pure DCIS at 98% - 99% - but it can happen. 

My bc was Nicole Hodgson who is an Oncological Surgeon. She works out of juravinsky cancer centre. I loved her.

Joanne

Myleftboob, Tamoxifen normally would not be recommended after a BMX for DCIS even if someone is ER+. In fact I was ER+ and I had a UMX for DCIS-Mi and my oncologist recommended against Tamoxifen for me, although he would have prescribed it if I'd asked. He explained that the benefit would have been protection of my remaining breast rather than any meaningful recurrence risk reduction because after a BMX for DCIS, recurrence risk is already so low. 

I'm wondering if the person you are referring to had invasive cancer in addition to DCIS. That's usually the case if additional treatments are recommended after a BMX. If the diagnosis included invasive cancer, that can completely change the risk/benefit equation for Tamoxifen and make Tamoxifen very worthwhile. And with invasive cancer, there is of course a risk of mets, which someone with pure DCIS would not face. 

Whatever the original diagnosis, I share your hope that she does remain stable now. 

Paulachiz, get your family doc to get you in ASAP with Dr. Hodgson. She works from the cancer centre. She is wonderful and very knowledgable of breast cancer. She will do your surgery. Get your questions ready for her. I would wait until you could get in to see her and let her send you for more tests.

Paulachiz,

Rdrunner on the Canadian thread has Dr. Hodgson too so you could send her a PM. I am sure you will be happy.

I agree with the prior posting about getting the MRI prior to surgery. That is what my doctors did before the surgical procedure.

Myleftboob, DCIS can be ER+/PR+/HER2+. It often is. But the treatment protocol for DCIS is different than the treatment protocal for invasive cancer, even if they are both ER+/PR+/HER2+.  Herceptin, as one example, is not even approved for women with DCIS.  AIs are not approved yet either.  Tamoxifen is, but after a BMX for DCIS, Tamox is not generally considered to be necessary because there is usually only a 1%-2% risk of local recurrence and no risk of mets. DCIS, no matter how aggressive the pathology, cannot metastasize. So DCIS has a different risk profile than invasive cancer. That's why the treatment protocol is different and that's why usually no additional treatment is recommended if someone with DCIS has a BMX. 

Bessie is correct dcis is cancer.breast cancer.