DCIS, BMX/MX, and radiation ladies

I had my follow-up at Emory Monday, but am still awaiting final recommendations from the tumor board about radiation. I will wait to give all the details on that once they are in.

In the meantime, something more shocking has come up. The medical oncologist from Emory called me yesterday to say that upon closer review of my slides they found a 3 mm area of invasion on my left side. My lymph nodes (3) that were taken were still analyzed as clear. My stage has been changed to T1a on the left. She now recommends I go on Tamoxifen to reduce the risk of metastasis, which she says is very, very low...but exists since I now officially have IDC.

I am dismayed that 3 other pathology reviews missed this. I know it's small, but...come on. I'm losing faith in the medical profession! This better not have spread in the 4 months that I have been hanging out unprotected. Rant over. For now!

Audrey - is your margin anterior (near the skin) or posterior (near the chest wall)?  Typically rads is recommended if close margins are near the skin.  If near the chest wall and the pec fascia was removed, that serves as a barrier, and since DCIS by definition can't get out of the ducts, you do not need rads if the margin was posterior and the pec fascia was removed.  I hope that helps.  

Hi Kim,

This is an old discussion.  I'm not sure if the others who posted (back in 2012) will be reading your post.

I had about the same amount of high grade DCIS taken from three lumpectomies (probably somewhere between 5 and 6 cm).  I was told that since the first lumpectomy found around 4 cms and it was all pure DCIS, that it was unlikely that invasive cells would be found in the follow-up re-excisions.  It was all pure DCIS, thank goodness.  You have an even larger sample, as the entire breast was removed, so if they didn't find invasion, again, it's not likely.  On the other hand, if you are worried, especially given the few invasive cells found in the nodes (thought to be there due to surgical procedure), you should go for a second opinion on the path slides.  It's so easy to do.  Plus you have that "close margin" issue.  You can have slides sent anywhere you want (best to have them sent to an NCI-designated hospital, although the other option is Dr. Lagios, whom many women have used on this board).  Good luck.

I know about what you are saying--that different pathologists see different things (sometimes necessitating two second opinions).  Make a plan to do something to ease your anxiety and answer your questions (meeting again with surgeon, path second opinion, radiation oncology opinion, etc.)  Then, when you are satisfied that you have done all you can do, then take a deep breath and keep going.