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Monday, May 04, 2009 Grace asks

Q: I was diagnosed with DCIS, Should I have a double Mastectomy?

I was diagnosed with DCIS. I had a lumpectomy, the Doctor said I had clear margins. Now I'm going through radiation treatment and then, I will take tamoxophen for five years. My question is  am I doing the right thing, or should I have a double Mastectomy?

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Answers (5)
PJ Hamel, Health Guide
5/ 4/09 7:19pm

Grace, in my opinion, you're absolutely doing the right thing. Having a double mastectomy comes with all kinds of issues - do you want/need reconstruction? If not, a prosthesis? And how about that surgery - it's pretty serious. If you don't have to put yourself through all that - why do it?

 

The data shows that a woman who has a lumpectomy and radiaiton is no more likely to die of breast cancer than a woman who has a single mastectomy or even a double mastectomy. In other words - having a mastectomy does NOT reduce your risk of dying from cancer. Your risk of having a recurrence, yes. But your risk of dying - no. That's why I say, have the lumpectomy and radiation. Esp. since that treatment, for DCIS, is something like 99.8% effective at preventing a recurrence.

 

DCIS is an incredibly mild cancer; some doctors don't even call it cancer. So do what you feel you must for peace of mind, but I'd go with the lumpectomy and radiation. Good luck - PJH

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PJ Hamel, Health Guide
5/ 4/09 7:20pm

P.S. - Please read our DCIS FAQS. Hopefully they'll help set your mind at ease. PJH

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Phyllis Johnson, Health Guide
5/ 4/09 8:37pm

Grace, as PJ says the effectiveness of lumpectomy and radiation compared to mastectomy is well established.  The only piece of information you haven't mentioned is whether you might have the BRCA gene.  If you are under 40 and have a family history of other breast cancers in young women, then you might want to talk to your doctor about genetic counseling.  Some women who have tested positive for either of the known BRCA genes do decide that double mastectomy will make them less likely to have breast cancer.  Even a double mastectomy cannot reduce the risk to zero because there is always a little bit of breast tissue that the surgeon can't remove.  

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5/ 5/09 3:45pm

If you've already had a successful lumpectomy, I don't see the need to go through a mastectomy.  I could understand if the margins weren't clear, but since yours were there's not much reason unless you're at extremely high risk of recurrence.  I just completed my 9th breast surgery, and I'll tell you reconstruction is hard, painful & time consuming.  It's not something I would recommend doing unless it is your absolute last option.  This is a decision that only you can make, but in all honesty the treatment path that you are on is one that is equally successful.

good luck!

Angi

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5/ 8/10 10:00pm

I'm a 25 year old female with dcis.  I also have family history of breast cancer,ovarian cancer,and pancriatic cancer.  I'm don't know if I should get a mastectomy or a lumpectomy?  The dr. is supposed to test me for the family gene,but that takes 3 weeks to get the results and the dr. wants to take care of it before then.  lumpectomy? Mastectomy?

 

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PJ Hamel, Health Guide
5/ 9/10 5:35am

DCIS isn't something you have to take care of quickly - you absolutely have time to have the test and use the information to make an informed decision about this. Without a significant family history or positive BRCA genes, I'd go for the lumpectomy - you can always take more later, if you need to. And lumpectomy is a much less aggressive surgery.

 

If you feel you'd be very stressed about the possibility of breast cancer going forward, then you might opt for the mastectomy anyway; it does cut your risk of recurrence compared to lumpectomy (though it doesn't increase your survival risk - which is no big deal, since the general survival risk for DCIS is like 99.8% anyway). This is a tough decision, I know; but one which you should make by using all the data possible, and that means the BRCA test. Good luck - PJH

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By Grace— Last Modified: 03/24/11, First Published: 05/04/09