Diagnosed with DCIS: How do I decide on treatment?

I was diagnosed with DCIS No invasive cancer low to medium grade DCIS In January couldn’t clear margins and went for another surgery to clear.
The surgeon didn’t clear margins. I had a second opinion after my first surgery and the surgeon said she would have never suggested surgery. My calcifications hadn’t changed in 5 years. She didn’t recommend any estrogen blockers. Mammograms will always pick up calcification which I have. She suggested ultrasound which will pick up invasive cancer. I changed my diet, vegetables, less meat, juicing , soy milk, exercise, green tea, and fasting.

The original surgeon won’t give me an ultrasound without a mammogram.
I prefer not to get a mammogram because I know the results calcification.

Going to get a Sonocine ultrasound which scans the whole breast not just one area. It will pick up 3 mm invasive cancer

Why treat DCIS like cancer it may never turn into cancer?

I have done a lot of research since my diagnosis and decided to wait before I have another surgery and take estrogen blockers

I was diagnosed with DCIS No invasive cancer low to medium grade DCIS In January couldn’t clear margins and went for another surgery to clear.
The surgeon didn’t clear margins. I had a second opinion after my first surgery and the surgeon said she would have never suggested surgery. My calcifications hadn’t changed in 5 years. She didn’t recommend any estrogen blockers. Mammograms will always pick up calcification which I have. She suggested ultrasound which will pick up invasive cancer. I changed my diet, vegetables, less meat, juicing , soy milk, exercise, green tea, and fasting.

The original surgeon won’t give me an ultrasound without a mammogram.
I prefer not to get a mammogram because I know the results calcification.

Going to get a Sonocine ultrasound which scans the whole breast not just one area. It will pick up 3 mm invasive cancer

Why treat DCIS like cancer it may never turn into cancer?

I have done a lot of research since my diagnosis and decided to wait before I have another surgery and take estrogen blockers

Well said —— I was on a spiral for my DCIS stage 0 -thank god my husband was able to reroute my crazy thoughts - I decided to take the wait and see method -despite being offered AI Radiation and mastectomy. I am going in my first 6month mammo -anxiety is tough but I will take each review and process new information. I urge people to take the time and do the research-get second opinions.

I was Diagnosed DCIS Stage 0 in early Feb this year. I found out I was 5th woman in my family to have Breast Cancer so I did Bilateral Mastectomy with back-to-back reconstructive surgery as preventative measure. I tested negative for breast cancer gene. I did do strict Vegeterian diet for almost 60 days prior to my end of March surgery. Strongly recommend Chris Wark's book: Chris Beat Cancer. They also have cookbook: Beat Cancer Kitchen. He had Stage 3C Colon Cancer, did surgery but opted out of chemo and radically changed his eating and is still alive today. He has tons of info about studies that he cites for herbs/foods that are cancer preventive. I still eat this way about 90% of the time. For me, they only found 1 speck of invasive cancer so not doing radiation or hormone blocker, sentinel lymph node was negative so surgeon said there is no way it went anywhere else in my body. Research I read said that they are overtreating DCIS Cancer. Other research I have seen said that we need Estrogen to protect our bodies from disease. My Mom did Estrogen blocker but she had Stage 4 Breast Cancer and died last year, she lasted 4 years though so I think it helped keep her alive and with quality of life. I also had best friend with 2 forms of breast cancer, one that was very aggressive, she did surgery but did do Estrogen blocker for 5 years. I would encourage you to do lots of research for your situation. Hope your results come back negative!

Hello Heydon!
I have been looking for this comment. I had an aesthetic breast reduction surgery last June 2023. DCIS Grade 3 In the pathology was found in a 1.2cm area in one of the left side tissues. I had a gene test, mammogram, and an ultrasound screen came back all clean. There is no sign of it. My Radia-oncology suggested me to have either 16 rounds of Radiation or the pill. I am so confused. And I am thinking to choose the quality of life too. But still! What if?

I was dx w/ extensive, multi-focal DCIS in 2005 at age 39 & the rec then was mastectomy w/ implant reconstruction (hormonal therapy didn't exist yet, at least for that). One radiologist thought it was high-grade, another intermediate grade.

The NCI had just come out in Nov 2005 w/ recs about overtreatment and I asked my Duke doc about why the radiologists could disagree over the type of grade and whether as a result my dx might be in doubt. I'm a trained scientist and so wanted to be privy to the research on my dx as well as areas of debate. I asked about whether i could just wait instead of turning my life upside down (single mom w/ highly successful career & finally back in doctoral program) for a surgery that could be postponed to at least a summer in a year or two. Nooooo--gotta have it. And also, he said he didn't get involved in "questioning the radiologists." I felt very invalidated. But I figured--trust the experts, for the first time in my life. Gotta let go and trust other people.

Well, two weeks after the mastectomy--with NO results given back about whether it was invasive, etc. and NO explanation by a nurse who seemed to dislike me from the outset for some reason--I finally get a call from the doc to the effect of, congrats! It was never DCIS after all. It was "florid hyperplasia." Like I was supposed to be HAPPY!

I was devastated. Some friends said, great! you don't have cancer! But that's like someone cutting off your arm and then saying, see! You didn't have gangrene after all! So when people couldn't understand my dismay, it appeared that I _wanted_ to be sick--probably because I had a very narcissistic Munchausen type mother who seemed envious that I had a dx in the first place, because she really liked being in a sick role and acted like the oxygen was being sucked out of the room if someone else was getting attention. She never even took me to the hospital or a drs appt once, or even took my kids to school during my surgery--"the traffic made her nervous," she said. But she managed to get lots of sympathy from her friends and co-workers. So I felt after the dx turned out to be "fake," in a sense, that I'd somehow falsely asked for others' compassion--made a claim on others' care when I shouldn't. And I'd actually been RIGHT to have pushed back at one of the world's top institutions. I was onto something. But somehow, I was in the wrong. No one could understand why having an unnecessary mastectomy when you'd actually pushed back could be upsetting. I was traumatized.

Why didn't the radiologists--when I specifically raised questions about potential other dx and about overtreatment--send my biopsy result to David Page at Vanderbilt BEFORE my breast was amputated and I lost so much blood that I'd suffer from anemia for the next 7 years until I finally had an iron infusion? My health never recovered since I have severe EDS and stressors like that accelerate problems w/ your connective tissue. My quality of life never recovered.

In response to Vanderbilt's florid hyperplasia dx, the original dx institution sent my tissue off to Mayo, who validated the original dx. My operating institution even had a case conference about it. I only found out accidentally. And one of the radiologists removed his dx from my file, trying to hide it--though a later oncologist realized this, when I brought it to her, and corrected it, and apologized to me.

You want feedback? I have to tell you that truly, my life was never the same.

Today, w/ all of my research into it, I'm pretty confident that had that DCIS not been seen because of another benign lump that led me to the mammogram at 39 in the first place--that it would have turned into invasive breast cancer, at some point. But what's important is that I could have WAITED and CONTROLLED THE TIMING of my treatment-- I could have had mammograms or MRIs every six months or year and then made an informed, planned decision.

And, low grade DCIS CAN involute. And the classification of what's florid ductal hyperplasia, or atypical ductal hyperplasia, or low to high grade DCIS w/ necrosis--that can be debatable too. It's getting better with machine learning, but still, these are human-determined diagnostic classifications at the "stage zero" point. Path-confirmed ADH and DCIS are by definition not an immediate crisis.

Those who say, well, there _might_ be microinvasions--well yes, but that's the case with all of us all the time. Most BC diagnoses as I understand it are of "interval cancers." There's always risk, whether or not you've got a tentative ADH diagnosis. With that mentality, no treatment is ever enough. There could always be _more_.

We have to ask, do we want to get on this ferris wheel of the however well-meaning breast cancer treatment industry, or can we step back and get perspective? The point of treatment is to live a quality life--but what if such an obsession with treatment, to the point of prevention, starts to undermine the quality of that life? Especially w/ adjuvant treatments that can cause a lot of systemic misery?

I respect people's decisions to proactively just cut them off, especially w/ the wonderful reconstructive options today--because they just don't want to deal w/ the anxiety anymore. I get it. Just be sure you have a thorough understanding of your risk and that _you_ are the one in the driver's seat. As long as you're fully informed of all points of view and then are making the decision that supports your values, then you _are_ living your best life.

But w/ stage zero conditions, I highly recommend stepping back, self-education, prayer & meditation, & service. Get away from the whole edifice to ensure you're not being carried along in a wave of unintended overtreatment.

God bless.

Thank you for that kind response. My radiologist told me when I asked her that question that if the whole breast was radiated, the only thing they can do the next time, if the cancer returns, is a mastectomy. If the tumor was really small, they could do a 'partial' breast radiation. But if the cancer returns, they cannot do the radiation again on that same spot. I had my first after surgery visit today with my medical oncologist and told her I was having neither the radiation nor the pill as I had bad side effects from it. She was, rather surprisingly quite ok with that and told me as my cancer was so small, radiation wasn't usually recommended. In fact, she then said that doctors 'recommend' these two options, but they're not, in my case, necessary? It's up to the patient. She told me that over a 10-year period, my chance of the cancer NOT recurring was 90% but taking the Pill it would be 92%. So, taking the Pill for 5 years didn't seem to me to make much of a difference? Now, I have to have checkups every 3 months for two years and a 3D mammogram every year. So, I felt very happy leaving the hospital for the first time since my surgery. Blessing to you also.