multi-focal DCIS- is it ever treated with lumpectomy?

What grade DCIS had been found? Mine was intermediate and high (grades 2 & 3) which is more likely to become invasive than low grade (or grade 1). Watch-and-wait seems to be an option for low grade DCIS but less so for intermediate and high grade.

My DCIS was multi-focal also but the two areas that were indicated by the mammogram were close enough that my BS thought he could get them both in one surgery. In the first lumpectomy I had 4 of 6 margins involved. Then I had an MRI that indicated there was much more DCIS than previously thought (it also indicated some spots in the other breast that turned out to be false positives which is often why some doctors don't want to use MRI). I tried a second lumpectomy but had involved margins again, including one that had been deemed clear in the first surgery. DCIS can have skips in the ducts so some researchers think that margins should measure more like 1 cm to be considered clear. For me, the writing was on the wall and I had MX.

3 cm is a sizable amount of DCIS. The fact that it is in two very different areas is concerning. The ducts come from the back of the breast to the front and converge in the nipple, so having DCIS in two very different areas of the same breast might suggest that it is fairly extensive. Having two lumpectomies may result in an unsatisfactory appearance, and if MX would be ultimately required you may not want the additional surgery and scarring.

If you are not worried about the appearance, then it's feasible that you can ask the surgeon to try another lumpectomy. This is what I did, but it only got me the peace of mind in knowing I did every thing I could to avoid MX. A radiologist will not start radiation until there are clear margins.

You have every right to feel anxious! This is an incredibly stressful time. These decisions are grueling. You can get a 2nd and 3rd opinion, have a different pathologist review your slides, and see if anyone suggests a different treatment.

If it comes to it, I want to assure you that having a MX is doable, and there is peace knowing that the cancer is gone. Reconstruction is another can of worms with its own decisions, but it can be done later when you ready.

I wish you some clarity in your path forward. I know this is such a hard decision. {{{HUGS }}}

Tamoxifen is still recommended if you have a unilateral MX.

It is all confusing. It helped me a lot to read the research for myself and make my own assessment. I discussed the research with my BS who was not always up on the most current information!

Just checking in and hoping you are finding a clear path ahead!

I had mutifocal in one breast (I was diagnosed with bilateral DCIS in 2007/2008, but this took 6 months of tests and biopsies to uncover it was in both breasts). I became increasingly uncomfortable with the first surgeon (the one I was referred to after the ultrasound found a 'suspicious' area) after he performed two large lumpectomies on one breast and couldn't get clear margins. I was uncomfortable for two reasons:

1. He didn't believe in 'inking' the specimen margins with different colors so we would know where the remaining DCIS was located in the breast. All we would know was there was a positive margin, but not the location relative to the position of the tissue removed. This struck me as rather shortsighted, but I didn't catch on to this until I requested and read all my medical records.

2. After the second lumpectomy, with a positive margin, he recommend a bilateral mastectomy with no discussion because he considered it multi-focal and because of my age (48). Of course I wondered how could he know it was multi-focal if he never inked/identified the position of the margins, so there was no way to tell if there was really a gap in the DCIS and if it was truly in multiple breast quadrants, etc. And, when I conducted more research my conclusion was that 'yes' in years past many women with multi-focal BC we treated with mastectomy, but research in 2007/2008 was changing those views.

So, I got 2nd and 3rd opinions, a new surgeon, and underwent a 3rd lumpectomy on one side and 2nd lumpectomy on the 'newly' diagnosed side. I still had 'close' margins on one side (1mm) but enough to go forward with radiation and Tamoxifen.

Remember this was 2007/2008 and I imagine there has been some change in how DCIS is now viewed and treated.

I didn't 'not' have the mastectomy because I was opposed to the procedure or worried about losing my breasts (at this point I was rather angry at them for all the emotional and physical trauma there were causing). But I felt my first surgeon was just following his established protocol, with little regard for any advancements in the science of DCIS. I felt like I knew more than he did. I read a lot of journals/articles and scientific papers before I went forward with my treatment plan.

Once I was done with the treatment, I never looked back because my second surgeon was rather wise and told me that if at any time I felt like the stress from the follow-up mammograms/tests were too much, she would book me in for the mastectomy. No questions asked.

It also strikes me that you are being told your follow-up mammogram found more DCIS. My understanding is that only a biopsy can confirm the presence of more DCIS. I had plenty of 'stuff' and other funny areas show up on mammograms after the lumpectomies and it turned out not to be 'more' DCIS. If the radiologist can say for certain a mammogram is the definitive diagnostic tool for DCIS, then I would have further conversation with this doctor.

Changing surgeons was one of the hardest part of my experience because it felt like starting over, but my gut told me to move on. And, to my knowledge, you have time to consider your all your options with DCIS.

So, I guess the short answer (sorry for the long winded reply) is 'yes' you can have multi-focal DCIS and have breast conserving surgery. I did it.