Expert: Claes-Gustaf Nordquist, M.D. - 6/26/2009

Question
Sir:
My wife was diagnosed with a small DCIS after a mammogram and subsequent biopsy.  the affected area seems small, less than 6 mm.  There is also LCIS but all of the DCIS and LCIS is in this tiny area.  There is no comeda and it seems to be no other indications of potential invasiveness likelyhood.  No family history either.  She is 53 and a small breasted woman.  
So, we are trying to figure out what to do.  Masectomy seems very extreme for this and the standard of care seems to be lumpectomy followed by radiation.  For my wife, a lumpectomy might be disfiguring because she is small but that would be ok.
What worries us is the possibility that a lumpectomy might actually cause an otherwise non-invasive DCIS to become invasive by opening the milk duct.  This concern came to us when reviewing statistics of DCIS with no treatment (roughly 40% became invasive) and lumpectomy WITHOUT RADIATION, nearly 32% became invasive after lumpectomy (an average of 9 studies).  This seems astonishing.  Doing nothing results in 40% invasive and lumpectomy alone gives 33% invasive?  Radiation following lumpectomy reduces recurrence by half.  It seems it is the radiation that gives the benefit for simple DCIS.
For a very local DCIS < 6mm nuclear type 1, what would you think of radiation alone?
Could subsequent mammograms detect any changes in the remaining microcalcification areas to invasiveness?

Answer
There seems to be some misinterpretation of the statistics here. The present treatment of choice of ANY small cancer in situ (cancer stage 0) in a breast IS lumpectomy followed by radiation therapy. BOTH treatment methods here(surgery & radiation therapy) are equally important! Without one OR the other the results are statistically much worse in all studied materials. The disfigurement of the surgery can be corrected by plastic surgery. So that is really not an issue here. I do urge you to follow the standard treatment! Good luck!