Topic: Post-Mastectomy Radiation for DCIS

Thanks, I will definitely look at the link.  Your comments reflect what my surgeon said about the likelihood of recurrence and the relative "ease" of detection of a recurrence on the surface.  The medical oncologist is the one who raised this issue, and I'm trying to figure out whether this would really be over-treatment or not. Each speciality seems to have its own agenda and it's hard to figure it all out.  None of the treatment decision -trees seem to contemplate further treatment after mastectomy for DCIS and make no mention of margins.  I will check out the idea of taking some of the skin from my biopsy site (which is actually in a "good place" cosmetically) at the time my expanders are changed out with my plastic surgeon.  Good health to you. 

Peacemom,

My case went before the tumor board and they agreed that the risks of radiation in my case outweighed the benefits.  I had "only" DCIS, "only" one close margin and that was on the skin side.  Your microinvasion might make a difference in your treatment plan....

Hi all -- I'm new to this forum, I just had a bilateral mastectomy last Wednesday (Aug. 13) with DCIS diagnosed only on the left side (6 and 7 o'clock). My surgeon just called with pathology results and I'm almost identical to lollybeth -- lymph and invasive are both negative, but margin was less than 1mm. This isn't at incision site -- it's almost where the breast meets the chest wall. More DCIS was found in the left, and atypical hyperplasia on the right. I have my followup with my oncologist on Aug. 27, so I'll be curious to see what he says about treatment and I"ll post again then. I also have a followup with my plastic surgeon on Aug. 25, so I'll ask him too about options. It makes sense that with DCIS, if the milk ducts aren't up against the skin, the chance of any remaining cancer cells seems like it would be small, but could some cancer cells migrate during surgery I wonder? Just throwing that out -- I have no idea if that's possible. My breast surgeon definitely seemed concerned about the close margin.

Sheila 

Hi, lollybeth,

If your doctors feel that the benefits of you not having radiation outweigh having it, I would probably  go with the doctor's recommendation.  I had radiation 38 times on my left side, up to my neck, under my left arm, and almost down to my waist.  I am triple negative and had lymph node involvement, however, but I think every treatment you can take to prevent reoccurence is definitely worth it.  I know you want reconstruction, but the treatment is worth the wait if it gives you a better chance of no reoccurrence.  I decided against reconstruction, at this point, because I still have my right breast and I could not do the "inlfation" procedure because of my size.  Right now, I am okay with the prosthesis.  And, I'm not really experiencing much in the way of side effects from the radiation, but it seems like my chemo side effects keep lingering on.

In 1985, my situation was similar to lollybeth's....I had DCIS and a mastectomy. I had 0/35 nodes. There was a close margin. The doctors at U Penn recommended radiation. The doctors at NYU and at Dana Farber both did not recommend radiation.  Dana Farber looked at my pathology and was certain there was a margin before they made the recommendation.  So I did not have the radiation.  And I have not had a chest wall recurrence or any problems.  But this is one where I would think that getting a second opinionwould be very helpful.  In my case since my second opinion was so different, I got a third opinion.

All the best to you.

Mandy 

Follow-up to my previous post on Aug. 19 -- I went to my oncologist last Wednesday, who wouldn't commit one way or another as far as radiation. My surgeon had said that he wouldn't do a re-excision because in the spot with the close margin (there was only one place with a negative margin less than 1mm), he had already gone down to the skin to remove all the scar tissue from the biopsy, and he would have to remove skin at this point. He said that since the margin was on the skin side, it would be easy to detect any recurrence. My oncologist agreed with that, and said that since there was only DCIS, it was less likely that radiation would be needed, but he still sent me to a radiation oncologist. I saw the radiation oncologist this morning, and she didn't even hesitate to say that there was absolutely no reason for radiation. She based it on the type of cancer (since there was no invasive cancer) and the fact that I had a mastectomy rather than lumpectomy, so there is no breast tissue left. I fully expected her to say that I should have radiation for the extra measure of safety because of the close margin, so for her to state emphatically that there is no indication whatsoever for radiation definitely convinced me! And that was on top of both my surgeon and oncologist leaning against it too.

Christianne, was your mastectomy your second surgery? When you say "resection" that makes me think it was the second time, and your margins in that surgery were negative (meaning there was clear tissue removed all the way around -- no cancerous areas next to any remaining tissue).Your situation isn't exactly like mine, but having DCIS at the narrow margin is definitely better than having any invasive cancer there -- which is probably why no one is recommending radiation. The radiation oncologist also told me that if there's invasive cancer with a very close margin, there's a chance that some lesions could have been missed, but with non-invasive and all breast tissue removed, there's very little chance that any cancerous cells were left.

Sheila 

I also had a mastectomy for DCIS, with a margin in the upper outer quadrant of less than 1mm.

I'm having a second opinion done with the breast sample, as I had 6 attemps at a biopsy, and i don't see how any ducts would be in the upper outer quandrant. I think the close margin is due to the biopsy. ( They say that doesn't happen) I was also nuclear grade 3. I was also told no radiation  from a radiation oncologist, and yes from a medical oncologist. In looking at the anatomy of the breast I don't see how DCIS would have a close margin except at the nipple, or front of the breast. the rear of the breast has lobules, and the ducts appear to be very central in the breast, surrounded by fat. Just a thought since there are so many of us.

I also had a close margin -- between 1mm and 2mm on the posterior margin which is the back of the chest wall -- surgeon said it could not be improved -- went as deep as he could.   My DCIS was grade 3 with necrosis, so I was worried about this too.

They also found a small invasive portion (3mm) after lumpectomy but this was not near the close margin.   I had many opinions since I switched hospitals where I was being treated.    Two rad oncs did not recommend radiation, saw three oncs and two breast surgeons -- no one recommended radiation.   So based on the agreement of all the doctors, I was comfortable with that.   They said it was not necessary for DCIS -- 

I did go on to have a mastectomy however due to the extensive amount (6cm span) of DCIS.   With just a lumpectomy, radiation is the standard of care.

M.

Bumping for momof3kidz.

After dx of DCIS I had the double mx 10/13 with immediate reconstruction and my pathology came  back questionable in one lower area near the skin. I had a re-excision on 12/8. that patholgy came back okay but with only a clear margin of 1 mm. I met with an oncologist who confirmed no need for chemo or hormone therapy. she did want me to see a Radiation Oncologist due to the 1 mm clear margin size being small. Has anyone else had a situation like this? My reconstruction was excellent and I have read about the affect of radiation after reconstruction. also, once you have radiation isn't it true you can't do it again? I meet with the radiation oncologist Monday.

Good Morning Lolybeth,

I am new to this webisite, I was dx way back in 89 with DCIS. I had a lumpectomy followed b radiation. Back then I only remeber I was living in a daze with 3 small children. This may sound crazy ,but after all these years of  being thankful of the outcome deep down I hate the way my breast looks form the radiation (Im very small chested). I finally got up the courage to ask to be referred to a PS, but was not to encouraged  with what I was told. It seems you ladies are all so well informed with all the details of your dx. All I remember the dx, told what to do and that was that. I hope to get a copy of my records and look them over. I really had know idea of the whole recurrence situation. I think Im getting off track here. What I want to say was the PS said, because I had the radiation the any choices I had were may not help me look any better. I was a little sad about that. I wish I could talk with someone who did dcis,lumpectomy, radiation, and also is small breasted that has had some type of reconstruction or implants. I have a second opinion with another PS the end of the month. Thanks you

Spirit08: I have a friend who had DCIS, radiation and is now having reconstruction. She was a small AA breasts. Her doc is in Richmond and says she's done a wonderful job with her radiated breast so far. She has the expander right now. She had to have muscle taken from her back to put in the radiated side so it would have something to cling to, so I believe there is hope for you. Doctors can perform some miraculous jobs...