chance of having BC in other breast?

We’re mixing apples and oranges here. This
is the DCIS forum and when talking about whether or not breast cancer can be
cured, it is very important to make the distinction between DCIS and invasive
cancers.

Although definitions vary depending on the
source, generally ‘cancer’ is defined by the following 3 conditions:

1) Abnormality of the cells

2) Uncontrolled growth of the cells

3) Invasiveness/the ability to metastasize    

What Is Cancer?

Here’s another definition
of ‘cancer’, from The National Cancer Institute.  The same 3 conditions are included: 

“A term
for diseases in which abnormal cells
divide without control and can invade nearby tissues.  Cancer cells can also
spread to other parts of the body through the blood and lymph systems."  NCI Dictionary

DCIS meets the
first two criteria but not the third. This is why DCIS is different from invasive cancer and why DCIS is
considered by many experts to be the only breast cancer that can be ‘cured’.  It’s also why there is so much debate about
whether DCIS is a cancer or pre-cancer.

For someone who
has invasive breast cancer, even if surgery successfully removes every single
cancer cell in her breast, there is always a possibility that, prior to the
surgery, some breast cancer cells may
have moved beyond the breast and might one day develop into a metastatic
recurrence.  Mets could develop within a
few years of the original diagnosis or might not develop for 20 years. This is
why invasive cancer can never truly be considered ‘cured’, because the
possibility of mets is always there, and if mets does develop, then it will turn
out that the original cancer was in fact never cured and has become terminal.  Someone with invasive cancer might be NED (no evidence of disease) for the rest of her life, but technically most experts would say she cannot be considered cured until she dies of something else, without the breast cancer ever having recurred.

The risk is not the same with DCIS. That’s
the big difference between DCIS and invasive cancer. Because DCIS cells are
confined to the milk ducts, DCIS cannot metastasize and there is no risk of spread to other parts of the body.  Therefore for someone who has DCIS, if surgery
successfully removes every single cancer cell in her breast, there is no
risk of a local (in the breast area) recurrence and the patient is fully and certainly cured. Of course this isn’t
to say that someone who had DCIS might not develop a new primary diagnosis at
some point in the future – every woman has that risk, whether she’s had DCIS or
invasive cancer or no breast cancer at
all – but after a diagnosis of DCIS, once all the DCIS cells are removed from
the breast (or killed off by radiation or hormone therapy), the patient is cured of that particular
cancer.  Here’s how Dr. Susan Love puts it:  “The goal of
treating DCIS is prevention. As long as the precancer is completely removed, it
can neither come back nor become invasive.”

So can DCIS be cured?

From The Harvard Medical School:  “DCIS
is sometimes classified as Stage 0 of breast cancer, the earliest stage of the
disease. The question for women with this diagnosis is not “Will I live?” but
“How much treatment will I need?” One of the biggest risks today is
overtreatment. That, too, is changing, as researchers get better at
distinguishing the types of tumors that can be subdued without extensive
surgery or radiation. DCIS is one cancer
that can truly be considered curable. ”  Understanding ductal carcinoma in situ

From the NYU medical
center:  “DCIS is the earliest form of breast cancer, in which the cancer cells
are contained within the walls of the milk duct. It is also known as
intraductal carcinoma in situ (or cancer located within the milk ducts).
Because the cancer cells have not broken through the wall of the duct, the
cancer cells have no access to the blood stream or the lymph nodes, and have no
ability to spread to other parts of the body. As a result, DCIS is completely curable.  Women do not die of DCIS.”  Ductal Carcinoma in Situ (DCIS)

NED  - no evidence of disease,,, that is correct

I very much value all the information and support that is found here.  I am scheduled this week for follow-ups with my surgeon and MO but continue to have questions about whether further testing needs to be done.  I had 2 different primaries and want to make sure that all the appropriate follow-up is being done even though I had mostly DCIS.

My left breast small IDC, grade 1, was found at the lumpectomy along with DCIS with 6 mm margins. ER+/PR +/Her2-. The next surgery to clean up the margins turned into a MX because of issues discovered in the right. The MX found an additional 5mm of DCIS at 1mm from the posterior superior margin.

The right issues were discovered on an MRI after the left lumpectomy that showed an area of at least 5cm. A biopsy showed intermediate DCIS with comedo necrosis with minute foci of central necrosis, with lobular involvement. ER-/PR-.  The bi-lateral SNB was then done as a stand-alone procedure a month prior to the BMX as it was thought that invasive cancer was going to be found and thankfully wasn’t. 

The right breast MX pathology showed ‘at least 2.5cm as measured on a single glass slide, however all four quadrants are involved, so the actual dimension is likely greater.  Number of blocks with DCIS: 7, Number blocks examined: 12. Comedo, micropapillary, flat, Grade III(high) central expansive ‘comedo’ necrosis.  Posterior-superior margin<1mm.  1 mm from anterior-superior and posterior-inferior margins and 1.5 mm from the anterior-inferior margin. Microcalcifications present in non-neoplastic tissue.’

With a mastectomy, are all the tissues examined and reported on?  I find it disconcerting that only one slide on the right breast was written up on the pathology report.  I am on an AI for the left breast but no further testing was ever scheduled. Should I be asking for any specific follow-ups or further explanation on the pathology?

BTW, my TEs got infection about 3 weeks after the BMX and had to be removed after 5 days of vanco and ivanz.  My new TEs are scheduled for 10/22.

Can anyone help me with the right questions to ask?