Dec 26, 2011 10:35PM Beesie wrote:
It's certainly possible. Whether or not it makes sense depends on the specifics of the individual case. Ultimately what it comes down to is what the recurrence risk will be without radiation, and whether this is a risk that you can live with. Recurrence risk after a lumpectomy for DCIS can range from as low as around 4% to as high as around 50% or 60%. Some of the factors that go into the determination of recurrence risk are the size of the area of DCIS, whether it is a single focus of DCIS or whether it is multi-focal, the grade/aggressiveness of the DCIS, and most importantly, the size of the surgical margins. Generally with a 4cm area of DCIS (which is large) and grade 3 DCIS (which is high grade/aggressive), the recurrence risk after a lumpectomy will be quite high, unless the margins are extremely large (1cm all around or greater).
One thing to keep in mind is that approx. 50% of recurrences after a diagnosis of DCIS are not found until the DCIS has already evolved to become IDC (invasive cancer). This is why it is considered important to reduce recurrence risk as much as possible - and that's the reason why radiation is usually recommended after a lumpectomy for DCIS. Radiation cuts recurrence risk by approx. 50%.
I had a very large area of high grade DCIS - over 7cm. My only option to remove it all was a mastectomy. Generally with a mastectomy for DCIS, unless the chest wall margins are very close, radiation will not be recommended. So that is another option to consider if your recurrence risk is too high after the lumpectomy alone and you are concerned about radiation.