DCIS and the inevitable "STANDARD OF CARE" recommendations

I am 10 month post radiation, (no tamoxifen as I am hormone receptor negative), and after the initial skin issues with radiation, I don't see any lingering effects. I did experience short lived skin issues which resolved quickly after radiation was done. I did have the shorter protocol.

Anib, regretfully I welcome you here. Apparently you've been handed the typical confusion associated with papillary carcinoma. Please bear with me, while we take a few steps backward to better review your dx.

- It is common for MRI's to miss papillary tumors 5 mm and smaller, said several breast surgeons. Papillary lesions can occur in multiples, especially the papillary variant type found along the periphery (chest wall, outer edges).

- Solid papillary often is associated with DCIS. Unfortunately it is associated with a conventional invasive component half the time, and multi-focal invasions are not uncommon. Often intermediate grade 2. It is wise to obtain 2nd opinion(s) on your final surgical pathology because I had 4 different pathology opinions on the invasive components and papillary variants.

Assuming your papillary tumor was "intra-ductal", your invasive component would determine staging, oncotype dx and treatment. This is why accurate pathology is crucial.

Please check out the Papillary Carcinoma thread here on BCO. Best wishes.

Owl, Oncotype DX assay is for invasive components, if any. DCIS is off the table. Solid papillary (with or w/o invasions) is primary lesion.
O

Hi Weareconnected:

As you can see from line 1 of my prior post, I was talking about the "eligibility" for the "Oncotype test for DCIS", which requires pure DCIS.

Again, in general, in connection with the question of added radiation, if a person initially diagnosed with apparently pure DCIS received the Oncotype test for DCIS on biopsy tissue (it is preferably given after breast conserving surgery), but is later determined not to have pure DCIS, the test result (Oncotype type for DCIS) would be disregarded in connection with decisions regarding radiation therapy. In other words, patients who do not have pure DCIS after definitive breast conserving surgery are not eligible for the Oncotype test for DCIS.

Anib should clarify her complete diagnosis (based on all biopsies and surgeries) with her team and request expert confirmation that the reason her Oncotype for DCIS test result is being disregarded in connection with radiation therapy in her particular case is due to a non-DCIS diagnosis.

BarredOwl

Hi Weareconnected:

As you noted, in this DCIS Forum, the nomenclature for the rare non-DCIS cancer you are discussing is likely to be confusing to patients with pure DCIS (Stage 0, which may have "papillary" architecture).

We are each emphasizing two different points, which are not inconsistent in any way:

(1) that the result of a DCIS test (the Oncotype "12-gene test") (re radiation therapy) would be disregarded [Edit: or not relied upon] if a person did not have pure DCIS (Stage 0);

and

(2) that assuming the actual diagnosis was not pure DCIS (Stage 0), but was a type of Stage I disease, then the patient should inquire about the Oncotype "21-gene test" (re whether to add chemotherapy to endocrine therapy) with their Medical Oncologist.

(By the way, even with pure IDC that is node-negative (N0), hormone receptor-positive, HER2-negative, if the tumor is "Tumor ≤0.5 cm including microinvasive", then NCCN guidelines do not include the Oncotype "21-gene test", and in such case it is often not done.)

BarredOwl

Hi Anib, WHOA is right! Some people need to chill. Thanks for that info... Congratulations on a non-invasive pathological consensus. I had my fingers crossed for you. A couple minor details need clarification. Its getting late, so when I have my laptop tomorrow, I'll PM you, if that's Ok.

Owl, we don't encourage plagiaristic comments. Or was that your rhetoric? Intellectual property owned by Genomic Health needs to be credited to same. People may visit GenomicHealth.com for info on Oncotype DX assays. Most of us know that, so I mean no disrespect.