DCIS....

I sent the General Surgeon, Dr. Demore, an email to let her know that the MRI results were available.

Dr. Demore responded with the following:

Hi Lara,
That's a great report. Your films will be reviewed in conference before I see you next week. I just want to clarify to see if you are still planning on a mastectomy, reviewing my note I mentioned I did not think you would be a breast conservation candidate because of the extensive calcifications. Calcifications are not seen on MRI, so if you are not considering mastectomy then we will need to get a mammogram to access the degree of calcifications, which usually don't go away with chemo.
Thanks,
Nancy

I told her that I was interested in exploring any new options available to me. I also wanted more information about the calcifications. She said that calcifications don't show up on MRI's. They show up on mammograms.:

"Just to clarify, MRIs show enhancement (blood flow) which can represent DCIS, but that is not the same as the area of calcifications on mammogram (which also represent DCIS). The blood flow (enhancement) may have gone but the calcifications usually don't change with chemo. Let's go ahead and add a mammogram and see what it shows."

They are scheduling a mammogram for Friday, Jan 22 in Chapel Hill at 10:30am. I'm both nervous and excited to learn the results. I'm praying those calcifications have melted away!!

I found the following information on DCIS on www.dcis.info :

Ductal carcinoma in situ (DCIS)

Although breast cancer has been a human illness for thousands of years, ductal carcinoma in situ or DCIS (also known as intraductal carcinoma) is a relatively new diagnosis. We are learning more about it all the time. Until mammography became a routine part of medical care, we didn't see much DCIS. Now, we do. Approximately 24% of all new breast cancers diagnosed in the United States are DCIS, with one case of DCIS detected per 1300 screening mammograms in North America.

Most breast cancers (carcinomas) arise in cells that line the ducts and lobules of the breast. We still don't know what happens exactly, but for some reason the cells start growing when they are not supposed to be growing. When cells in the lining of breast ducts are growing inappropriately, this is called hyperplasia; when they grow inappropriately and do not appear normal under the microscope, they are called atypical.

DCIS is a term used to describe cells that are growing inappropriately inside the ducts of the breast (see diagram) and look like cancer cells under the microscope. These abnormal cells have not spread into the surrounding fatty breast tissue or to any other part of the body. They are totally confined to the duct.

Some cell changes are important, while others are less important. DCIS cells lack the biological capacity to metastasize, or spread elsewhere in the body, like cancer cells do. So why do DCIS cells fall into the category of cancer cells?

Some DCIS cells can change genetically and become true cancers, and women should not be lulled into thinking that a DCIS diagnosis can be ignored or dismissed. We still do not know for sure which DCIS cells will change and become invasive and which will remain DCIS. It is probably most useful to view a diagnosis of DCIS as an indication that a woman has a greater risk of developing breast cancer, especially if she receives no treatment for the DCIS.

Data suggests that ductal carcinoma in situ represents a stage in the development of breast cancer in which most of the changes that characterize invasive breast cancer are already present.

There are different kinds of DCIS. It is important for the individual who is diagnosed with DCIS to know how aggressive or risky her cell type is. For example, comedo is considered more aggressive (high-grade) than cribiform (low-grade). This information is part of an accurate diagnosis by the pathologist, and helps define treatment options, which in turn affects whether DCIS becomes invasive breast cancer.

A diagnosis of DCIS depends on the pathologist, and the diagnosis may be controversial. Therefore, second opinions may be important. If a woman seeks a second opinion, she needs to take her tissue slides and tissue blocks that contain samples of the cells taken during her biopsy to another pathologist, and she must be prepared to pay for this additional opinion.

People often fail to get a second opinion for pathology. However, if the pathology is incorrect, the treatment choices are much more likely to be incorrect and possibly ineffective as well.

You can also request second opinions for mammography, ultrasound, and treatment. If you choose to have a second opinion for mammography or ultrasound, it is important to take the original films, not copies, to the physician, and to carry them to the radiologist yourself if possible.

Whether your doctor refers to DCIS as cancer or pre-cancer, it requires careful treatment and follow-up to avoid the possibility of an invasive breast cancer developing.

In this web site, we refer to DCIS as a cancer.

I found the following info on another website:

DCIS or intraductal cancer is considered a direct precursor of invasive breast cancer. The constituents of DCIS (the individual DCIS cells) are clearly cancerous and exhibit the same cytologic features, receptor status, and genomic deletion and expression profiles as their invasive sequela. However, as long as the lesion remains within the milk duct, it has no access to blood vessels or lymphatic channels, meaning it cannot metastasize through these routes. Accordingly, this stage of disease can be considered a benign condition because it does not infiltrate or destruct adjacent tissue or cause metastases; therefore, it is consistently curable with only local treatment (surgical excision with or without radiation therapy).

DCIS is a heterogeneous disease: High-grade DCIS lesions exhibit fast growth rates, high mitotic indexes, and after a relatively short intraductal period, these lesions will almost always progress to high-grade invasive cancer.