Detecting recurrence after surgery

i had DCIS 5 1/2 years ago and they have not done any MRIs or PET scans.  i now only have labs and mammogram one time a year now.  i did radiation for six weeks and had no problem with it at all, but i have REALLY small breast, so maybe that made it easier for me.  praying for things to go well for you whatever you decide on.  Marie

Yes, you do have some crappy margins.  Back when I had surgery it was quite unusual to see rads being recommended after a MX for DCIS, but there have been a couple of research studies released since then (small studies, mind you) that suggest that the recurrence risk for those with close margins is significantly higher than the norm (the norm being 1% - 2%) and as a result, over the past 2-3 years I seen a lot of women come through here who've had rads after a MX for DCIS.  So given that you do have a number of very close margins, I am surprised that your MO didn't recommend rads. 

From what I've read, I suspect your 15% estimate of your recurrence risk is probably about right.  What was the grade of your DCIS?  If you have grade 3 DCIS and/or you had comedonecrosis, then the risk might be higher than that.  Just guessing here, of course.   The grade of the DCIS could also impact the possibility that a recurrence might be IDC, not DCIS.  Generally about 50% of DCIS recurrences are not found until they are IDC but if you have high grade DCIS, the risk might be higher than that.  Rads on average is able to reduce the recurrence risk by 50%.

As for how to detect a recurrence, the first question is, have you had or do you plan to have reconstruction?  With a flat chest, or with implant reconstruction (because the implant is placed behind the chest muscle), your chest wall is pressed right up against your skin.  So a recurrence either against the chest wall or against the skin will become noticeable quite quickly - with the relatively hard smooth surface that you have either with no reconstruction or with implant reconstruction, even a very tiny nodule is easily detected.  This is a big advantage of having the MX - there is no breast tissue in which a recurrence can hide or which can make a recurrence more difficult to find. 

And that's why usually no screening is recommended for those who have a BMX for DCIS. The screening is not likely to find a cancer much earlier than a breast self exam will.  For those who have implant reconstruction, sometimes MRIs are recommended every 3 years or so, but that's to check the integrity of the implant more than to check for recurrence (although of course both ends are achieved).  In my case, I do get alternating MRIs and mammos every 6 months but that's because I had a single MX, not a BMX.  The screenings are for my remaining breast; my reconstructed breast just goes along for the ride, getting checked for cancer and the integrity of the implant.  If I were ever to have another MX, I know that I would no longer be getting these screenings.

It will be interesting to see what your RO says.

Hi Sambo, I've seen so many different comments on the surgery to radiation "gap".  Many have stated something like 6 weeks.  I am treated at Memorial Sloan Kettering in New York City, which is a top cancer center, and I went 2 1/2 months between the re-excision surgeries and the radiation.  I had my last surgery in late October, did the consultation with the RO in December and the radiation began in mid January.  They didn't seem to have any concerns with that.  Again, my diagnosis was "pure" DCIS.  Maybe they treat other diagnoses differently.  I had wide margins by the time I did the radiation.  You do not, so that may help get you in sooner.  I was assigned an amazing RO, so it was worth the wait.

I can't imagine that you would need to fight for the rads.  You have multiple close margins.