DCIS lumpectomy margin showed ALH

Hello

I'm a new poster so please forgive me if I don't have everything correct. I've learned so much from all of you so courageously sharing your stories, fears, treatments...you truly have been a blessing during these crazy last few nonths. I was hoping for some insights and advice from anyone who may have been in a similar situation or know someone who has. My doctors so far aren't answering my questions as directly as I would like...my next steps are to call the pathologist and/or seek a second opinion. DCIS is a blessing and a curse when trying to decide treatment post op.

DCIS grade 3 ER/PR +. Lumpectomy with no lymph node removal. 6mm with clear margins but one margin had ALH with loss of ecadherin and cytoplasmic p120 expression.

My pathology report stated clear margins even with the ALH. My assumption is that the ALH was very tiny and clear margins were achieved around it, as well. But this is something I would like to confirm with the pathologist.

My googling, reveals that that ALH can be a marker for ILH. From what I've read ILH is more elusive and quite frankly scares me more than the DCIS. Which started out post biopsy as grade 1-2 with cibriform, pappilary and solid with no necrosis to post lumpectomy grade 3 cibriform, solid and still no necrosis.

My breast surgeon says that the grading is subjective. That if I didn't want rads, he would agree but probably recommend the genetic test for recurrence and probability of invasive cancer. He also doesn't think I will need endocrine therapy.

I just met with radiation oncologist, she's of the mind set that since I'm 46 and grade 3, whole breast radiation 3 weeks with 5 day boost. She doesn't support the genetic testing because she feels there's not enough statistical data to support the value of it.

The ALH scares me. I think I should have an MRI to make sure there's nothing else lurking out there before I start any kind of treatment. My breast surgeon told me not to worry about it and just move forward, they got it all and I'm cancer free. At my first appointment I explained that the biopsy doctor and nurse mentioned that I might need an MRI due to my dense breast tissue. He said no you don't your breast tissue is not that dense.

If my DCIS was just DCIS, even grade 3 no necrosis, I'd want the genetic test and if my numbers were low...I might forgo the radiation.

My concern with radiation is that if I use it now, I may not to be able to use it in the future, if I have a recurrence. Hoping that if I do it's just another straightforward DCIS. And at that point again lumpectomy and I would opt for the radiation.

And both docs tell me, you may never have anything again. From their lips to God's ears. But I have to make the best decision now for the next 30 years. And let's just say which I'm sure you all get, it isn't easy at all. Oh and the clock is ticking on getting radiation started. Lol. No pressure.

I apologize for the long post. Thank you to anyone who stayed reading it this long. Thanks in advance for any responses.