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Apr 21, 2019 11:23AM
Apr 21, 2019 11:26AM
TaraLeeOm, a pathologist looking at cancerous tissue taken from the lung can identify if the cancer cells are breast cancer cells or lung cancer cells or colon cancer cells, etc.. The cells are unique to their source location.
As for your surgeon who kept pointing out your risk, he may have gone overboard, but it is important that everyone with a preliminary diagnosis of DCIS from a needle biopsy understand that in about 20% of cases the final pathology after surgery will include some invasive cancer as well as the DCIS. The risk is greatest for those who have large areas of DCIS and high grade DCIS, but it's possible to be upgraded to invasive cancer even when there is only a small, low grade DCIS. Everyone with DCIS should understand this so that there are no shocks after surgery, and it's particularly important that those who are considering passing on surgery know this.
With regard to treatment after surgery, the most important thing that anyone reading should know is that there is no 'one size fits all' treatment option. DCIS can range from a single focus that is tiny and low grade to multi-centric that is expansive and high grade with comedonecrosis. Surgical margins can be close (these days anything over 1mm is usually considered an 'acceptable' margin), or wide (anything over 1cm is considered to be an excellent margin). Some diagnoses present very little recurrence risk with surgery alone whereas other diagnoses might still present a significant recurrence risk after a LX plus rads and endocrine therapy (and therefore might warrant a MX).
The other risk everyone with DCIS should be aware of is the risk of a new primary. After whatever might be the appropriate treatment, most DCIS diagnoses present a small (in the single digits) risk of recurrence. But everyone diagnosed with DCIS faces an additional risk, which is the risk to be diagnosed again - a new diagnosis unrelated to the original DCIS. This second diagnosis might be DCIS again or it might be invasive cancer, it could be in either breast, and it could come anytime in the future - in 2 years or 10 years or 22 years. Like all women, our highest breast cancer risk comes during our 60s to mid-70s. Having been diagnosed with DCIS (or invasive cancer - this risk is the same for women who've had a previous invasive cancer), the risk to be diagnosed again is approximately double that of the average woman the same age who has never had breast cancer. Therefore this second risk in most cases is higher than the recurrence risk from the original DCIS diagnosis. Women who choose to take endocrine therapy after their DCIS diagnosis to reduce recurrence also get the benefit of reducing their new primary risk by 50% during the years that they are taking the meds.
All that is not to convince anyone to take hormone therapy (and in fact I didn't) but to make sure that everyone is aware of this second risk and continues to get screening and remains vigilant. If your recurrence risk after your DCIS diagnosis is low enough to not warrant rads or endocrine therapy, your greater risk for sure is to be diagnosed with a new primary breast cancer.
Dx 9/15/2005 Right, 7cm+, DCIS-Mi, Stage IA, Gr 3, 0/3 nodes, ER+/PR- ** Dx 01/16/2019 Left, 8mm, IDC, Stage IA, Gr 2, 0/3 nodes, ER+/PR-, HER2- (FISH) ** Surgery 11/30/2005 MX Right, 03/06/2019 MX Left ** Hormonal Therapy 05/2019 Letrozole