Cancer? Me? No way....

Hi Laurie,

Best of luck with the MRI and the surgery.  I have had multiple surgeries on one breast, so I've had a fair amount of experience with this process.  I had four excisional (surgical) biopsies, which is the term used when a diagnosis hasn't been made yet, although it is essentially the same as a lumpectomy (one in this last go around) and two additional lumpectomies to get clean margins.  I have always recovered quickly, even being able to take my ballet class in less than a week after surgery, which does involve raising the arms overhead (surgery on Friday, back in class with modification on Wednesday).  Although everyone is different and every surgery is different, it is very helpful to wear a compression kind of bra to support the breast. Usually they recommend sports bras.  You will also need to ice the area (even bags of frozen peas work well).  You may well find that you will recover earlier than four weeks, enough to get back to even your kind of work, which of course does involve raising the arms a lot. 

Hi Laurie,

Most oncologists will not let DCIS patients have HRT, primarily because of the Women's Health Initiative study that showed an increase in breast cancer in women who were using synthetic HRTs like the ones you were on. However, you can probably find a hormone doctor who will at least prescribe bio-identical progesterone and estriol for you. Bio-identicals, unlike synthetics have the same molecular structure as the hormones your body makes naturally. Studies show both bio-identical progesterone and estriol are safe to use and may even be preventative.

After reading Dr. John Lee's What Your Doctor May Not Tell You About Breast Cancer when I was diagnosed with DCIS in 2007, I started using bio-identical progesterone cream and later found a doctor to prescribe bio-identical oral progesterone (Prometrium). At the time, a blood test showed I was extremely estrogen dominant. Now that I am postmenopausal, my estrogen levels have dropped and my doctor just started prescribing bio-identical estriol cream for my hot flashes and sleep disturbances.

My treatment for DCIS in 2007 was a lumpectomy. I elected to opt out of radiation and tamoxifen after consulting with Dr. Michael Lagios, a world renowned DCIS expert and pathologist with a consulting service that anyone can use. He used the Van Nuys Prognostic Index to calculate my risk of recurrence without radiation as only 4 percent. Although typically radiation reduces risk by 50 percent, with such a low risk, the 2 percent reduction I would get was not worth it to me. Beside, since you can only use radiaition once, I wanted to save it in case I ever got invasive cancer.

DCIS is a non-invasive cancer that cannot get out of your milk ducts into your breast or the rest of your body. It will not kill you. All treatments are aimed at preventing a recurrence because 1/2 of those can be invasive. Usually even these can be successfully treated with surgery and/or radiation. Because of this you can take your time considering what treatment options are right for you.

If you have any questions, please feel free to send me a private message. You can also read more of my story at: http://dciswithoutrads.com/

Wishing you all the best,

Sandie

Don't have much more to add, but wanted to say that as another clean living, healthy 45 year old I understand how you feel.   My mother was diagnosed in September, but prior to that there was no history of breast cancer in our family, so being diagnosed a few weeks later than her came as quite a shock to the system!

As for recovery time after a lumpectomy, I would guess that you will fall somewhere in between the one week and 4 weeks.   My lumpectomy incision didn't bother me much at all after the first couple days, but the incision where they took the lymph nodes from (which was both deeper and closer to the armpit) was more problematic, but I still had full strength and range of motion well within 4 weeks.

Laurie,

Tamoxifen is routinely recommended to women who've had a lumpectomy for ER+ DCIS.  Tamoxifen serves the purpose of both reducing the risk of recurrence, and reducing the risk of the development of a new cancer in either breast.  Whether one chooses to take Tamoxifen is a personal decision. I had a single MX and while I could have taken Tamoxifen as a protection for my remaining breast, in assessing my risk and the risk reduction that I'd get from Tamoxifen, I decided to not take it.  The benefit wasn't worth it to me.  But each of our situations is different - both in terms of our risk levels and in terms of what risk level we are willing to live with - so this is an assessment that we each have to make for ourselves.

With regard to the node removal, checking your nodes because of where your DCIS was found simply doesn't make sense.  DCIS cannot spread into the nodes, no matter where is it found.  It is not the standard of care to do an SNB on patients having a lumpectomy who've had a biopsy showing only DCIS. In rare cases a surgeon might recommend an SNB because of concerns that the risk of finding invasive cancer is very high, but even then, because an SNB can be done later, the SNB is optional and most surgeons don't recommend doing it at the time of the initial surgery for DCIS.  From your biopsy, what is your grade of DCIS?  And from your imaging, how large does your surgeon believe your area of DCIS to be?  These would be the factors that would determine if you are high risk or low risk to have invasive cancer along with your DCIS.  In any case, given what you do for a living, you should read up on lymphedema, and determine whether you want to put yourself at risk by having node removal when it's not necessary for DCIS.  It's your decision to make, not your surgeon's.

Laurie~  So much good advice so far, but I want to chime in from a hairstylist's point of view.  I had a "golf ball" sized tumor removed from the lower outer quadrant...basically a lumpectomy in 1988, and returned to work in about 1 week.  I had no trouble doing the work and everything seemed fine.  I did develop a large hematoma that opened the incision and needed another week off to let that heal.  Who knows if that would have happened no matter what type of work I did?

This January, I had a BMX and SNB and ended up off work for 10 weeks.  I PROBABLY would have been able to do the work at 6 weeks post-op had I not had cellulites and LE complications.  I am 13 weeks post op now and still not working more than 6 hour days...I'm used to 10-11 hour days...because it is too much for my arm.

I wanted to give you both senerio's even though it sounds as if you are leaning toward the lumpectomy if possible.  There is a lot to consider, and thakfully a lot of great information here!  Good luck making your decision, and if I can be of any further help, please contact me!

Tami

I predicted 7 weeks for the BMX...cancelled clients that were already booked and booked out for the time.  This was very stressful for me!  I wanted to call each client personally.  Then the day before I was supposed to come back, I developed cellutites.  Salon had to call and cancel the week's clients.  Then I saw the Dr. every Monday and she would tell me whether I could go to work that week...VERY stressful.  Finally I was able to go back, and I was sooo relieved that my clients were very happy to have me back and not the least bit annoyed!! I decided that this was life's way of helping me become more patient! 

You will be ok and your clients will be ok!  Don't make decisions based on them...do what's best for you and they will understand!