Recently Diagnosed and want some input.

Kel, hi so sorry you are here. I am no expert but wanted you to know there is also a DCIS section that has tons of information. I think what the pathology is saying is that it is DCIS with microscopic 1mm that is invasive. So no, it is not 2 different types of cancer.

I also have DCIS which would have probably been identified if I had a mammogram before the age of 56! By that time, I had an invasive tumor.

Confident your prognosis will be good, but after surgery (also a whole section here on that) whatever you choose, once you get the final surgerical pathology the oncologist will make a plan and you should feel much better. Good luck, let us know how you're doing.

Kel, age and family history don't impact the Oncotype score. The score is developed based on a biological analysis of the genetic make-up of the cancer cells. There are 21 genes within the tumor that are evaluated; the best known are ER, PR, HER2 and Ki-67.

It appears that your team is assuming that you have more IDC than just a microinvasion, otherwise chemo wouldn't even be discussed. If you have an Oncotype score that suggests that chemo would be beneficial, then your surgeon is recommending chemo prior to surgery to shrink the tumor - this is only done with IDC and never with DCIS-mi or pure DCIS. So that does help clarify your diagnosis, to some extent.

Onlygirl, in most cases the Oncotype is done after surgery, not after a biopsy. I think this is mostly because the amount of tumor retrieved from a core needle biopsy is usually too small to send for Oncotype testing. I don't understand in Kel's case, if so far only a 1mm invasive tumor has been removed (during the biopsy) how that could be large enough. Perhaps the sentence "Neoplastic focus microscopic in nature measuring 1 mm" is referring to something additional to the IDC and the amount of "Invasive low-grade ductal carcinoma" retrieved is larger, and large enough to submit for Oncotype testing. Another reason why Oncotype testing usually isn't done until after surgery is because the surgery might reveal that the Oncotype test isn't necessary, either because the final size of the tumor is so small and so favorable that chemo would not considered, or because the tumor is so large and/or nodal involvement so extensive that chemo is deemed to be critically necessary. One additional comment. In your case while it's possible that the tumor grew between the biopsy and the surgery, thereby driving a change in your Stage from Stage I to Stage II, what is more common is that the full size of the tumor was not visible on imaging, just as in your case the 3rd area of cancer was not visible. It's not unusual at all for the tumor size after surgery to differ from what was estimated from the imaging. This doesn't mean that the tumor has grown (breast cancer is a relatively slow growing cancer, with some exceptions) but reflects the inadequacies and inaccuracies of current breast imaging.

Most core needle biopsies take many samples - 4 isn't a lot, actually.

Chemo is a systemic treatment - it goes into the whole body - and is used primarily to reduce the risk of distant metastasis. It also can shrink a tumor in the breast, but that's a secondary benefit; chemo is never given solely for this purpose - surgery and radiation are the primary "localized" treatments. DCIS is a non-invasive condition, which means that it does not spread beyond the breast. Therefore chemo is never given for pure DCIS. There is no reason to give such a harsh systemic treatment for a localized disease. With DCIS-Mi, the diagnosis is usually a larger area of DCIS along with one or several 1mm microinvasions. 1mm is the size of the head of a pin (maybe smaller, actually) so the risk of metastasis from an invasive cancer this small is usually tiny - maybe 1%. This is not a high enough risk to warrant the side effects from chemo, and with such a low risk, the benefit from chemo would be just a fraction of 1%.

Edited to Add:

To your other question, "why wouldn't a surgeon just remove a IDC tumor, instead of trying to shrink it first? Wouldn't waiting be putting the person at risk of the cancer spreading?" the answer is that having chemo first before surgery does not increase the risk that the cancer might spread. Here's why: Most breast cancers have been in the breast for 3-5 years before they become large enough to be detected. The time between diagnosis and surgery, even if a few months, is relatively short compared to how long the cancer has already been in the breast undetected. Therefore if the cancer is going to spread (i.e. metastasize/move into the body), it is more likely to have already done so before the cancer was diagnosed. This explains why women who have mastectomies - removing the entire breast with a 98%-99% certainty that all the cancer cells in the breast area have been removed - nevertheless have the same risk of mets and the same mortality rate as women who have lumpectomies. And this is why in situations where the risk of metastasis is high - because a cancer is very large, or there is extensive nodal involvement, or the cancer is very aggressive - chemo will often be given before surgery. This is a more aggressive protocol because it immediately goes after any cancer cells that might be in the body, while at the same time attacking the cancer cells in the breast.

I am newly diagnosed and was told that because of the treatment delays due to covid-19 that oncotype testing is being ordered early. Both my oncologist and my surgeon (they are at 2 different hospitals) said the oncotype testing is being done on the biopsy samples once breast cancer has been confirmed.

Ah, I'm sorry that you couldn't get the Oncotype result but I'm not surprised because needle biopsy samples are usually too small.

The clarity from your MO is helpful. So your diagnosis is primarily IDC (the mass), with some associated DCIS (the calcifications). That makes sense, but certainly wasn't clear from how the biopsy pathology report was written up. Based on this, while the DCIS needs to be surgically removed, it is otherwise not a factor in your treatment plan. Everything recommended after surgery will be based on the size and pathology of the IDC.

Good luck with your appointment this week and I hope your surgery can be scheduled in quickly.