DCIS Biopsy Grade 2, Surgical Pathology Grade 3, question.

The timeframe should not depend on grade.  There may be options for a shorter, more intense timeframe but that depends on a whole set of factors. Grade makes little difference in recurrence rates in the long run but higher grade does tend to recur faster than lower grade so the recurrence rates look very different by grade in most studies at 5 years but not much different at 10 years. 

The margins are small but negative. Although some surgeons might go back for wider margins, it is controversial. Data generally shows that radiation is  sufficient with those margins. 

momto3boysaz, it's not uncommon to have DCIS that is a combination of several different types and grades.  When there are a bunch of different things going on, it's very possible that each biopsy/surgery will uncover something different.  My stereotactic biopsy found only ADH.  My excisional biopsy found a few different subtypes of DCIS, all of which was grade 3 DCIS with comedonecrosis, and a microinvasion of IDC.  My MX found more subtypes of DCIS (but not all the same ones from the biopsy; in combination I had every subtype that there is) most of which was grade 3 but some of which was grade 2.  Plus it uncovered more ADH and lots of fibrocystic conditions. 

So the fact that your surgery pathology is a bit different than your biopsy pathology isn't unusual. The most important thing is that your surgery didn't find any invasive cancer.

Hi Mom,  yes. 1mm is considered a narrow margin.  You might want to ask the surgeon about that. 2mm or greater is considered a more adequate margin.  Sometimes, depending on where the narrow margin is, it's difficult to do more surgery, so they do radiation. I guess by the time you read this, you will have had the radiation planning, so you are moving ahead.  Radiation is amazing for reducing risk.

Mom:  There is a wide range to what is considered an acceptable margin, from no cancer cells on inked margin to 2cm!  Different doctors, hospitals, countries, etc. all have their own opinion and standards.  It also matters whether or not you had a mx or lx, am having radiation or not, invasive component, comedonecrosis . . . .Glad they are taking your particular case to the team to consider all factors unique to your situation.  Even then, doctors often do not agree.  That was my experience and then I was left up to making a decision.  Hope you get some answers that can put your mind at ease.

Hi Mom, if you are at MD Anderson, they do know what they are doing.  I was treated at Memorial Sloan Kettering.  I did have to have two re-excisions, but after the first surgery, there were no clean margins, the DCIS went to the margins (and beyond), and for the second, I had a margin of less than 1 mm, which I think is narrow by most standards.  Anyway, there was no question that I needed to go back in again, but I was glad to avoid a mastectomy.  Good luck with the radiation, and I defer to TB and her knowledge and research, who had to dwell on this margin issue much longer than I did.  It is good to have a team in which you have pretty much total confidence (if not total confidence).  Best of luck on the next stage of this journey.  Before you know it, you'll be on the other side.