I'm so confused!

I'm so sorry that you are having to make these decisions. Have you had an Oncotype test? Genetic? At the very least you can get a second opinion. I had to finally decide which Dr. I trusted the most and go with his recommendations.



Prayers, Sharon

How confusing indeed.

All I can add is that DCIS is cancer (not pre cancer).  It is cancer but it's not invasive, meaning it cannot leave the ducts at the point in which it is pure DCIS.

Radiation is not always needed for DCIS but that tends to be for low grade, small area with clean margins.

Could you get somebody to clarify the surgeons statement? as they have used the word invasive - in my opinion that would definately warrant radiation.

Somebody will be along soon with more information for you. xxx

Deanna,

Whether DCIS is considered to be cancer or pre-cancer simply depends on 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 meet the first two criteria, but not the third.  This is why some doctors consider DCIS to be a pre-cancer.  Usually it's oncologists who take this position, and that actually makes some sense when you consider that most of their patients have invasive cancer and face the risk of metastasis and death, and their job is to work with the patient to keep that from happening. With DCIS patients, oncologists only have to be concerned about local (i.e. in the breast area) recurrences so it's not surprising that many classify DCIS as a pre-cancer. 

What DCIS most definitely is not is "invasive". Since all your other doctors agree about the DCIS diagnosis, are you sure that your surgeon said that your cancer was invasive?  Not "pre-invasive"?  Or "malignant"?  The terms pre-invasive and malignant both can be used to describe DCIS (although those who consider DCIS to be a pre-cancer might not use the word "malignant") but DCIS cannot under any circumstances be described as "invasive".  This is something that you need to clear up.  Do you have a copy of the pathology report?

Whatever DCIS is called - whether a doctor chooses to call it pre-cancerous or whether a doctor chooses to call it cancer and say that it's malignant - the treatment guidelines are the same.  For those who have a lumpectomy, unless the area of DCIS is very small and the DCIS is low grade and the margins are very large, radiation will always be recommended. This is to reduce the risk of recurrence.  That's important because although DCIS is pre-invasive and cannot develop into mets, DCIS can continue to evolve and at some point most DCIS will develop into invasive cancer.  50% of recurrences after an initial diagnosis of DCIS are not discovered until the cancer has become invasive, so obviously reducing the risk of recurrence is important.  Rads generally can reduce the risk of recurrence by approx. 50%.

For those who have a DCIS pathology that indicates that rads should be given, another option is a mastectomy. Usually rads isn't required after a mastectomy, although if it turns out that the margins are too close to the chest wall, sometimes rads will be recommended even after a MX.   

As for which doctor to believe, an OB/GYN is not an expert on breast cancer so that's the opinion that I would put the least weight on. When it comes to a decision on rads, a Radiologist has skin in the game so he/she is almost always going to say that rads is required and that it won't be harmful. A Surgeon's opinion is valuable, but a surgeon's expertise is surgery, not post-surgical treatment.  The expert on post-surgical treatment is the Oncologist. That's the opinion that I would trust the most. 

My suggestion to you is that if you are uncomfortable with your Oncologist's recommendation, that you get a second opinion from another oncologist. Looking at your pathololgy - 2cm area of grade 2 DCIS and very narrow margins - I'd guess that it's virtually certain that another oncologist would also recommend rads, or suggest a mastectomy instead.  Talking to another oncologist might help you better understand the rational for that recommendation and help you with your decision. 

Good luck!