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Tuesday, January 27, 2015
Treatment of DCIS
I was diagnosed with IDC in my rt breast in Sept, 2004 (ER 50%, PR neg and Her2+. One + node with only 2 micromets). I also had a 3mm dcis on the LEFT breast - ER 50%, PR 30% - too small to do anything else. Deemed grade 2, crimform with no comedo necrosis. Naturally, at the time, I was far more concerned with the right breast. The Herceptin trial results hadn`t been announced yet and my main goal was trying to get it some way or another (and I did). My IDC treatment was the standard at the time: dense dose 4 AC followed by 4 taxol. I had been premeno at diagnosis but had my ovaries removed to take Arimidex. I had the double lumpy so I got radiation on the right but not the dcis left. In the meantime, I was able to secure Herceptin and after rads, took Herceptin and Arimidex. Now, all this time later, I know the weak link in everything is this no rads dcis. It is the only part of treatment I didn`t get a second opinion. Now everywhere one turns studies say that no dcis is too small not to radiate. I found many studies prior to Feb 2005 (when I started rads) that also say this -especially for women under 50 which I was and still am. How vulnerable am I and what follow up tests besides mammos would you recommend? Do you know of the new screening test with the Dilon? Is this better than mammography?
Thank you in advance
I do not think that you should be overly concerned with the DCIS. Your arimidex may reduce contralateral recurrence and we sometimes do not recommend radiation for a very small area of DCIS if there are good margins. Regular mammography and possible MRI breasts would be standard, along with surgical follow-up with a breast specialist. Is there a family history, and if so, have you considered genetic counseling/testing? I am not familiar with Dilon. I am a little concerned that you are on arimidex and are <50 years old. Are you definitely menopausal as is required for arimidex? Even if you stopped having periods with your chemotherapy, you may not truly be in menopause.
Paula Silverman, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University