Topic: MULTI-FOCAL

Hi. I just read that you are having a mast next week. Sounds like the right treatment. Good luck, you'll be ok. Nada

My research revealed it is not unusual for Low and Intermediate grades DCIS is to be multi-focal.  It just means there are gaps of normal ductal tissue in the duct between the areas of DCIS.  Historically multi-focal DCIS was treated by mastectomy.  I have been told by several doctors this is changing.  With the advent of Digital Mammos and MRI it is now possible to better assess the extent of the DCIS.  So long as it is all removed, the mastectomy may not be necessary.

I was personally facing a diagnosis of multi-centric DCIS (DCIS in two quadrants of one breast) and I probably had multi-focal disease since DCIS was found on pathology on multiple surgeries from different areas of the breast.

Thankfully one of the worrisome suspicious areas in another quadrant of the right breast turned out be ADH.  But when I questioned the doctors about whether a multi-centric diagnosis meant an automatic mastectomy, again the answer now (as opposed to 5+ years ago) is 'no'.  In their opinions the most important part of the treatment is to get clear margins through lumpectomy (I had 3 surgeries on one the right side and two on the left to get clear margins), then follow with radiation and Tamoxifen if estrogen positive.

Again, this is the information I received from surgeons/oncologists/radiation oncologists in my area.  You will get completely different opinions from other doctors.  That I think is part of the frustration with DCIS, no standards of care so women get different treatment opinions in different areas of the country.  As always the choice is up to the patient and what you are comfortable with.  I am frankly done worrying about whether the DCIS will come back, if it does so be it and I will have the mastectomy.  I always keep in the back of my mind that the rate of survival is the same for mastectomy vs. lumpectomy/radiation.  Mastectomy reduces odds of recurrence, but according to the information I have been given, mastectomy doesn't give better survival odds.

Also, I would recommend a great new book just published called Choices in Breast Cancer Treatment by Kenneth Miller, MD. 

Take care and I hope your surgery goes well.

Daphne,

I too have family history.  Three aunts, one elected lumpectomy/radiation, two had mastectomy (one in really early 80's where anything else was probably not an option).  None of them has recurred.

I'm glad I chose try for surgical clear margins (3 times on the right and twice on the left) and complete my radiation.  It was the decision I am comfortable with and I know my risk of re-currence is a little higher than having the mastectomy and I accept that in the end, at some point down the road it may come to that.  Personally, I feel that in the not too distant future more and more breast cancer will be dealt with on a partial breast basis using cryotherapy (freezing) or perhaps high frequency radio waves. 

Dr. Susan Love is trying a therapy to apply chemo right to the duct where the DCIS is located.  A novel idea which could completely alter future DCIS therapy.

I hope all goes well for you on May 14th.