Wish you the best! Got diagnosed last week!

Plz let me know how things went with radiologist. I am in exact same position. I am to decide what I want to do. Rad/oncologist appointment coming week. Not certain what questions to ask. I need your input. Thanks.

@deborahlanyi5535 I found 17 factors associated with risk of recurrence, based on a review of the scientific literature. They include: (1) age at diagnosis (over 65 is low) (2) whether DCIS was found by screening (low) versus palpation, (3) being post menopause (low), (4) grade of DCIS (1 is low), (5) cell types (criboform, micropapillary are slower growing), (6) whether there are microinvasions or comedo necrosis (absence of these is low), (7) estrogen & progesterone receptor positive (low), (8) size of DCIS (mine was small), (9) surgical margins clear and at least 2 mm (I was mixed, as 5 of 6 margins were bigger than 2 mm, but one was smaller), (10) no lymph node involvement, (11) no history of smoking (low), (12) low use of alcohol, (13) regular exercise (I was higher risk because I am quite sedentary), (14) normal weight (I was medium risk on this because I'm overweight), (15) genetic factors (my genetic tests showed I had no mutations on 71 genes for cancer), (16) family history (I was high on this as my biological mother had cancer at 65 but died at 85 of unrelated causes), and (17) non African American (this is low as African American women are at higher risk). In spite of me being low on 13 factors, and medium or high on 4, my local radiologist wanted me to have 4 weeks of whole breast radiation based only on the small margin. I asked about radiation side effects, and he said I would have scarring to my lung and that the breast would likely become smaller and firmer. He refused to consider any other course of treatment, and pressed me to make the next appointment to set up treatment. I had ma y questions, but he would not meet or talk with me by phone, having his nurse tell me to write my questions down & bring them to the simulation appointment. What he didn't tell me was that a 4 week course of radiation would mean that if I had a recurrence in the future, mastectomy would be my only option. I sought a 2nd opinion from Mayo Clinic. They had their own pathologist examine the tissue slides from my surgery & met with me to discuss the benefits & risks of radiation. They felt I had a low risk of recurrence, and they would recommend 1 week of partial breast radiation, which would reduce my risk of recurrence over the next 10 years from 15% to 7-8%. Their methods would not cause lung or rib damage, as they would deliver NO radiation to any tissue but the breast. The radiation oncologist also believed it was my choice whether to do it at all, since I would have an 85% chance of no recurrence, and only about half of recurrence are invasive breast cancer. I've chosen to do active surveillance instead. I.also used a website from the COMET study of DCIS, that you can put your age & the grade of your DCIS into, along with which treatments you are considering (lumpectomy, radiation, hormone blocking treatment, etc) to see what your chances of recurrence & survival are in 10 years. The site is dcisoptions.org/ and the study is described at cometstudy.org/ in case you want to look at it yourself. I hope this helps. I think a 2nd opinion is helpful, & Mayo was more in line with the research results I'd been reading. Let me know if you have specific questions. Everyone is different, in terms of what risks they are comfortable with, but I have asthma & didn't want radiation to damage my lungs unless it was absolutely necessary. I can't say enough about how respectful Mayo was - they answered my questions (2 typed pages) and collaborated with me in exploring my options. Best of luck! Cindy

You're welcome

Thanks for your comment. DCIS, like all In-situ cancer, is cancer without the possibility of spread. The problem is that DCIS is not seen on breast imaging and even if we see changes that suggest DCIS, the imaging is poor at predicting the extent thereof and presence of micro invasion. One usually only know the true extent of it after surgery. I think a lot of treatment guidelines are based on outcomes which do not always reflect the patient's experience. Things like recurrence risk. If an asymptomatic, non-life treating problem recurs, it makes no difference in the lived experience of the person. Shared decision making is the answer, where the well informed patient is an equal partner in the process. Some countries / medical systems are better at this than others.

@DrEttienne In my case, it was very clear on the mammograms, but in your video, you say it isn't cancer, yet in your comment, you say it is cancer.

To be correct, I said it is not a disease yet, in the sense of causing symptoms or loss of function. Cancer cell are just cells which proliferate uncontrollably, but some cancer may remain asymptomatic indefinitely. The challenge in DCIS is predicting when we can treat it less aggressively. I hope that makes sense?

@DrEttienne It does, but in the UK, cancer is legally protected against discrimination. The problem is, even though I've been treated as a cancer patient, some people think I haven't had cancer. It could cause legal issues. The health community needs to decide if DCIS is or isn't cancer.

i’m so

Hi, thank you for your comment. I understand your disappointment. Unfortunately,one has to make decisions based on the information available prior to surgery and in your case is seems the MRI was more concerning. Imaging does not correlate with the pathology in all cases. My experience is that MRI can overestimate the lesion size, especially if done after biopsy has been performed. DCIS is even more difficult. In general we try to consider the option of breast conservation in these cases through an oncoplastic type of operation where one can remove a whole segment of the breast while still getting a good result. In our unit, immediate reconstruction is always considered and discussed for all patients where mastectomy is planned. I hope your team have discussed your reconstructive options with you. My suggestion is to focus on the better than expected results and plan further treatment carefully, I wish you well with your further treatment.

Thank you for your reply Dr Ettienne. I did speak with the plastic surgeon but after weighing the options i decided to just go flat. I thought its a done deal after mastectomy and didnt realise chemo is next! After reviewing the post op surgery report which indicated my cancer was early stage 1 but a grade 3 so chemo is next! I've accepted this unfortunate outcome and will continue with the treatment as proposed by the oncologist. Did my 1st chemo on 23 Oct with 3 more to go. Hopefully no further surprises as far as treatment is concerned. I had the side effects of chemo and had mild constipation, sore throat, aches ard my neck and light headedness for the 1st 3 days and thankfully I'm feeling ok now.

@@MikaailTan-v9r. How are you doing? I am hoping for the best for you

Hi, sorry I missed your question. One can leave a needle for use soon after placement although the risk for infections seems to be higher. If possible, we try to give the port 7 days before using it. We will frequently use a peripheral line or even a normal central line for the initial treatment in order to let the port settle. Protocols do, however, vary from unit to unit. I hope your mom's treatment went well.

Hi, a biopsy is the only way to know if the microcslcificstions are malignant. There are specific cases, where there are competing health concerns where we would opt to continue survalance with the intention of reacting to signs of invasive cancer. Active survalance might be option in younger, healthier patients but only after biopsy has confirmed the reason for the microcalcifications. This is a decision which needs to be taken within a Multidisciplinary team only.

That is why careful discussion with each patient is so important. In some, their anxiety prompts more aggressive treatment, but that doesn't mean it is appropriate for everyone. As long as the doctor and patient are clear on the reasons a specific option is chosen. Most women would prefer less destructive treatment options and are happy to trust the evidence that is makes no difference in their outcome.

Exactly why I opted for mastectomy. Less cells with ER receptors…. Less bombs available to do their own rogue behavior.

I would not want to be treated for a “cancer” that I dont have when the treatment is the same as if I have cancer. IF it becomes invasive, then give me the treatment….

There is no evidence that chicken or eggs have an adverse effect on breast cancer outcome. There is data linked to having more fish in one's diet.

I disagree..egs and chicken do not contribute to cancers..

Eat The Lion Way! Stop Sugar! Look up Dr. Kiltz and Dr. Ken Berry .

​@@DrEttienne 10:41

Hi, you are very fortunate to have such good results. It would seem you have an excellent prognosis. The risk for recurrence should be very very low but it is never completely impossible.

Mine was just like yours…8mm. Rest same. I was told my recurrence rate would be 4percent if I took the pill 5 years and 10 percent if I didn’t. I had an oncotype dx score of 15 so they said no chemo.

@@sheila7814 Oncologist said if I take the meds for 5 years, 2% recurrence . 🙏🏼

@@teresa8363 I like those odds even better. ❤️🙏🏼😃

Glad it was helpful!

There is no evidence that it prevents of changes the behaviour of DCIS.

He has discovered that cancer feeds in glucose & amino acids. The drug he developed blocks glutamine. So they eliminate carbs & pulse blocking glutamine with no side effects. He is forced to administer minimal chemo to prevent his team from losing their licenses. Maybe one day, this will be released.

Vir infiltrerende borskanker was estrogeen reseptor positief is, toon die data dat 'n minimum van 5 jaar se anti-estrogeen behandling nodig is. Vir In-situ kankers, is die situasie anders. Dit is belangrik om die besluit met jou onkoloog te bespreek en te vra wat die verskillende opsies is en hoe dit jou risiko sal affekteer.

Can I ask what treatment did you have for this diagnosis

DCIS with microinvasion increases the risk for future invasive breast cancer and does require appropriate treatment of which removal with clear margins is the most important. Fortunatly it has an excedingly good cancer specific survival. It is important to continue with appropriate follow-up.

@@maryheffernan2627 I had a lump removed removed and arimadex for 10 year's and and 6 weeks radiation

How are you?

Metaplastiese borskanker is 'n skaars subtipe was gewoonlik redelk vinnig ontwikkel en 'n meer agressiewe gedrag het as die meer algemene tipes. Dit is gewoonlik nie sesitief vir Estrogeen / Progesteroon nie en dit druk ook nie HER2 uit nie.

Die antwoord is ongelukkig ja vir meeste mense. Dit is omdat die estrogeen vlakke nog laer gedryf word deur die behandeling

Chirurgie is 'n baie belangrike deel van borskanker behandeling en dit is net in mense met verspreide / ongeneeslike kanker waar ons chirurgie sal uitlos.

Baie dankie vir jou terugvoer. Ek is dankbaar die video's kan 'n verskil maak.

Good day, I somehow did not see your question, so I appologize for the late reply. Microinvasion is already invasive although at a very early stage. Cancer spesific survival is lower than pure DCIS but better than T1a invasive breast cancer. ER/PR negative, HER2 positive microinvasion is seen more frequently than in DCIS and does seem to increase future risk for recurrence / progression.

Yes