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Breast Cancer

DCIS diagnosis

10/07/2009

Question:

I am 49 years old and on September 1, 2009 I was diagnosed with DCIS in my right breast after a biopsy completed on August 24. During this initial biopsy, it was a challenge for the radiologist to obtain enough microcalcifications for the sample.

I had a Lumpectomy on September 10. Prior to surgery it was difficult for the radiologist to locate the microcalcifications to place the wire to guide the surgeon. After the wire had been placed the technician could not locate the exact positioning of the cells in several mammograms. She had to then take me to another machine and 2 technicians plus the radiologist had to help locate these cells on a mammogram. The technicians advised me not to worry that after the biopsy, the cells had been shifted and they were having trouble locating them. I was extremely concerned at this point since I was worried that the biopsy had actually stirred up the cancer. I was so delayed that the surgery was going to be postponed for the afternoon. The surgery went on in the morning about 45 minutes after schedule.

Regardless to say, I am very concerned about whether the surgeon was able to remove all the cancer cells. How can I insure that the entire breast is actually cancer free if the pathology report comes back clear.

I was also told that I would need Radiation to the breast after I heal from the Lumpectomy. I am due to see the Surgeon on Oct 2 for the pathology results.

Is all this uncertainty common with a DCIS diagnosis and treatment? I do NOT want to have radiation. I believe I am a very healthy woman. I am 5`5" and weigh 134 lbs and was running 5K every single morning before I had the Lumpectomy. I have never smoked and I have a very healthy diet. I am also a mother of 3 children 17, 15, 14. My 15 year old has a rare cognitive disorder and needs constant care. I want to avoid any further treatment unless my life is at risk.

Answer:

These are good questions but should be discussed with your doctors. Meet with your surgeon and the radiation oncologist. Get second opinions if your questions are not answered. Be sure you are seeing the most qualified specialists in your region. Is there an NCI designated cancer center or university-affiliated hospital nearby? In general, surgery is considered complete for DCIS if the tumor is removed with a rim of normal tissue > 2mm. Radiation to remaining portions of the breast reduces the chance of in-breast recurrence, and is generally recommended for all but the smallest, low grade DCIS. Tamoxifen pills for 5 years is also recommended if the DCIS is estrogen receptor positive. Biopsies do not stir up the cancer, so don't worry about that. Good luck with your decisions.

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Response by:

Paula  Silverman, MD Paula Silverman, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University