Topic: Post-Mastectomy Radiation for DCIS

I did a web search to see what I could find about this.  Here's one article:

http://patient-research.elsevier.com/patientresearch/displayAbs?key=S1072751507001536   It mentions a 5% recurrence rate, but this is for high grade DCIS with <1mm margins.  The suggestion here is for either a re-excision or radiation.

In my case, I had 1mm margins at the incision on my skin after my skin-sparing mastectomy.  Both my surgeon and oncologist agreed that radiation wasn't required.  While there is some risk of recurrence, both felt that it was only 1%-2%.  As my surgeon explained it, although some breast tissue might remain against the skin and chest wall, DCIS is contained only within the milk ducts and it's highly unlikely that any milk ducts remain after the surgical scraping.  So he felt that small margins are fine for DCIS after a mastectomy.  This certainly wouldn't be true with IDC, which can be found within the small amount of breast tissue that remains after a mastectomy.  And it wouldn't be true after a lumpectomy for DCIS, since milk ducts would remain in the breast.  The other point that he made is that if I do have a recurrence, it will be evident quite early on, right on the surface of my breast and likely, at the incision.  With an implant placed behind the chest muscle, the chest wall and skin are pressed together right at the surface of the breast.  This makes it easier (relatively speaking) to detect recurrences. 

Even with that explanation, I was a bit nervous.  I resolved that by asking my PS to remove an extra small area of skin near the incision.   She did this during the replacement surgery, when I had the expander removed and implant added.  The incision had to be opened anyway for this surgery and because it hadn't healed all that smoothly, she probably would have done this anyway.  If your close margins are near the incision point, this could be an option for you. 

BTW, I was 49 at the time of my surgery, and my DCIS was Grade 3 with comedonecrosis and a microinvasion (though the microinvasion was nowhere near the close margin).

Hi,

I am 42 and recently had a bilateral mastectomy.  I had both DCIS and a small amount of invasive cancer in one breast.  I opted for a double mastectomy because I am also poitive for the BRCA 1 mutation.  I am now considering my options for further treatment.   The radiation oncologist I have spoken to recommended radiation because of the amount of DCIS and other factors.  She recommends this despite the fact that it is not the standard of care.

I would be very interested to know what your final decision was regarding further treatment.

Thanks so much.

Hey Lollbeth - not sure if you will see this - but I am looking for infor. on same infor. similar dx, I am getting cold feet and will not start my rads until Sept ( I will be 12 weeks out from Mast, but had infection and other surgeries in July) I am really looking to someone that has been through this issue with risks of radiaiton - how decided your case outweighed the benefits.  I am finding more infor. about the long term effect  rads everyday - not to mention my risk of losing implants later.  Any help would be appreciated. Holly

Sheila - you might need to send her a PM, I have very similar to yours, My bi-mast June 3.  I you.  We can try to keep up with each other progress.  There are not many of us out there with those close margins, Do you know the grade of your cancer.  I will PM you.   Holly

Ladies,  please feel free to PM me and we can talk more extensively. I don't all of the considerations, but  I do know that factors that weighed against radiation for me included: no microinvasions, lower grade (2), location of close margin (skin) and the fact that there was only one close margin.

lollybeth