Breast réduction to reduce cancer risk and other things

Yes, it is true that having fibrocystic breasts is no longer considered a "disease", but a benign condition...which 60% of pre-menopausal women have. I am glad they now treat it as a condition, not a disease as it isn't and I think referring to it as a disease scared too many women. I wish someone would tell the life insurance company who called me a couple weeks ago for my phone interview that it is a CONDITION that a majority of women have as they seem under the delusion it is still a disease or a "high risk disease"...!

Yes, cancer can recur in a scar. This is because mastectomy does not remove all breast tissue. It just can't. So the primary cancer can recur in the scar or in the breast tissue that remains. This is usually a local recurrence, and is different than a NEW primary occurrence or mets. And yes, for cancers where lumpectomy is appropriate, it combined with radiation has very similar recurrence rates to mastectomy. There are cases where lx is not appropriate though.

I am not surprised MX is less common there for DCIS (I imagine it is still on a case by case basis, like widespread DCIS or where a woman has a higher risk due to other atypia or a genetic mutation though). There are definitely cultural differences at play. This happens in terms of getting prophylactic mastectomies where one is BRCA1/2+ or has high family risk...uptake rates for preventative surgery can vary DRAMATICALLY across the world. I also think being properly informed has lots to do with it...not only about DCIS, but about the limits and risks of mastectomy. This can vary from doctor to doctor as well.

I think it is great that you can get ultrasounds and MRIs there relatively "easy"...being MRI mad is not a bad thing in my view. Though MRIs do bring back more false positives they are much better at detecting cancers than mammogram..this is especially important in women with dense breast tissue as mammograms have real limitations there. It can be a real struggle for many women here (in both US and Canada) to get breast MRIs.  There are exceptions of course, but it is not routine standard of care. I can easily get mammograms, and I do, but I give a "clear" mammogram little weight since I have dense breasts and they may only be able to see a cancer in that case a minority of the time (estimates range between 25-50% of the time, last time I checked). Anyway, I am in Canada, not US, but I only get mammograms once a year and would not want more than that knowing the limitations and not wanting to add more radiation. As I am high risk, I do also qualify for MRI and ultrasound, but if I was not assessed as high risk I would have to "rely" on once a year mammograms which in my case could miss a cancer. I did have 2 mammograms last year, but one was as part of my workup for surgery. My mammograms (for last 8 years ) have all been digital mammograms, two views of each breast (one from top, one from side). I don't think this is unusual and the reason they flatten the breast is so the tissue spreads out and they can capture more tissue in the image. More views are only done if they spot something..then it becomes more diagnostic.  

It is great to hear that you have trust in your medical team