[Becky]

Oh Marie. First a big hug to you. I do know all about DCIS as I had it on the other side. First, I am assuming she will need to get the DCIS completely removed. When that happens, pathology will tell you a couple of things. One is whether or not there are clean margins. If not, she will need to get clean margins. DCIS can grow one of two ways. It can grow up the duct and completely fill it (laterally). If this is the case, clean margins may be impossible (like a straw filled with liquid, you keep cutting but you never get a clean margin so the entire breast has to be removed for a good cosmetic outcome). The other way is a one point eventually growing outward or just beginning so it hasn’t traversed the entire duct. This makes for a good lumpectomy with clean margins. After that, you HAVE to make sure there is no invasive component. Then it changes from DCIS to IDC if you do. This is important. Important enough that you must send the slides for another pathology opinion. You have to (without a shadow of a doubt) make sure she does not have invasive cancer just beginning. If she does, she needs to have the sentinel node checked. You’ve taken Ed to Dana Farber so that would be a great place for a second opinion that it is truly only DCIS. Lastly is the pathology – is it ER+/PR+, Her2 etc. If she has a small DCIS with lumpectomy with wide excision margins – DO NOT opt for no radiation without at least 3 opinions. I was stupid on this but I didn’t know so I have wide excision lumpectomy with no radiation. However, Dana Farber says that no DCIS is too small not to have radiation (my DCIS was ER+/PR+ Her 2 neg and only 3mm) but none-the-less!!!! Keep us informed. We will help you along the way. We all love you Marie. Hang in there. My mother (who also had a small IDC and a survivor) always tells me that God doesn’t give you more than you could handle. You must be one hell of a woman darling’!!