DCIS - looking for Seattle area 2nd opinion

I'll be honest.  If you have a large enough area of DCIS that a MX is being recommended, then it's highly unlikely that you will find any doctor who is willing to agree to an active surveillance approach.

Active surveillance is not the standard of care for any diagnosis of DCIS, but there are some doctors who will agree to active surveillance in low risk cases.  A low risk case would be a situation where someone presents with what appears to be only a very small amount of low grade DCIS.  

The problem with DCIS is that until it's removed, there is no way to know that it really is just DCIS.  Approx. 20% of women who are thought to have DCIS based on a needle biopsy end up being upgraded to invasive cancer once they have their surgery.  Screening and pre-surgery diagnostics are unfortunately not able to distinguish between DCIS and small areas of invasive cancer.  And a small area of invasive cancer, if it has unfavorable characteristics (a triple negative cancer or an HER2+ cancer) can be a very serious and life threatening diagnosis.  

The risk that some invasive cancer will be found hiding in the middle of the DCIS is considerably lower than this 20% average for those who have small amounts of low grade DCIS, and that's why active surveillance is sometimes seen to be an acceptable option by some doctors.  However if the clinical (pre-surgical) diagnosis suggests a large area of DCIS or if the DCIS is high grade and/or has comedonecrosis, then the risk that some invasive cancer may be present is higher than the 20% average. A combination of these factors - having a large area of high grade aggressive DCIS - could put the risk as high as 40%. 

I don't know any of the details of your diagnosis, so it could be that you do have a diagnosis that lends itself to active surveillance, as a relatively low risk option.  But just the fact that you mention that a MX has been proposed has me thinking that you have a large area of DCIS, and in that case, unfortunately until you have surgery and remove the entire suspicious area, you really don't know that your diagnosis is DCIS, and not invasive cancer. 

My apologies.  I am truly sorry that my reply offended you, and I am sorry that no one else has posted with any suggestions in response to your question.

I was not offering medical advice.  There is a difference between offering specific treatment advice to an individual, vs. detailing what is the current standard of care and explaining what you might expect to hear from a doctor. The former should never be done on this site (but unfortunately is done quite often); the latter is frequently done and usually is considered to be helpful since it can prepare the patient for her discussions with her doctors and arm her with questions to ask.  That's all I was trying to do. I realize that's not what you were looking for, and I apologize.

To your question, because "active surveillance" is not the current standard of care for DCIS, finding any doctor or group in any city who will agree to follow this approach is likely to be difficult, and those who are willing to do this likely have very strict criteria (in terms of the specifics of the diagnosis). Although there is a lot of press about how DCIS is being over-treated, the only doctor that I know of who actively recommends following the "watchful waiting" approach is Dr. Laura Esserman out of UCSF.  Since you are interested in this approach, it's great that you will be getting an opinion from them.  If there are any groups or doctors in the Seattle area who also follow this approach, I'm sure they will know.  And I'm sure that they will advise you on whether or not your specific diagnosis fits Dr. Esserman's criteria for watchful waiting.  As I said in my earlier post, "I don't know any of the details of your diagnosis, so it could be that
you do have a diagnosis that lends itself to active surveillance, as a
relatively low risk option."

As an FYI, here are the NCCN Guidelines for Patients, Stage 0 Breast Cancer.  These are the treatment standards that I was referring to and that are used as the starting point for treatment discussions by most doctors in North America.  As you can see, the "active surveillance" option is not even mentioned.  It's just not part of the mainstream yet.  That's not offering medical advice; that's just a fact.

Best of luck finding a doctor who will follow the approach that you are looking for.

i had a very different take on Beesie's reply to you.  While reading her response i was thinking how generous it was of her to take the time to give you that very informed response. She is always generous to newcomers and i am shocked at your rude response to her. Stunned in fact.

Swedish Cancer Institute is really fantastic!