"I have a Ductal Carcinoma in Situ (DCIS), a type of localized cancer. Why have I been advised to have a mastectomy when other women with invasive cancer have lumpectomies?"
Ductal Carcinoma in Situ (DCIS) sometimes presents a difficult dilemma. Most patients with DCIS can undergo successful breast-conservation therapy but not all. The diagnosis implies that this is an "early" form of cancer in the sense that the cells have not acquired the ability to penetrate normal tissue barriers or spread through the vascular or lymphatic channels to other sites of the body. It is important to realize that breast cancer is a wide spectrum of diseases and no comparisons should be made just on the basis that someone you know has "breast cancer" and shares a different treatment approach with you.
However, the millions of cells forming the DCIS have accumulated a series of errors in their DNA programs which allow them to grow out of control. There are varying degrees of disturbance, called "grades," of the normal cellular patterns. Low grades are more favorable, and high grades are less favorable.
The DCIS cells originate from the inside of the breast gland ducts (microscopic tubes). As they multiply, the cells fill and spread through the normal ducts of the breast glandular tissue. With many DNA errors already in place and millions of these cells exposed to the usual risks of additional DNA damage, a few cells will ultimately become invasive. This invasive change is the real risk of DCIS.
Treatment which does not physically remove all of the DCIS seems to leave a substantial risk of recurrence and, therefore, invasive disease. This risk of recurrence is particularly increased in the high-grade form of DCIS. In cases where the DCIS has spread extensively through the breast ducts, even though the disease is in a sense "early" because it is not yet invasive, it may still require a large surgical resection, at times even a mastectomy (removal of all or part of the breast).
This article helped me to better understand the treatment of my cancer, but I think the most important part of the article was the advice that was given... "It is important to realize that breast cancer is a wide spectrum of diseases and no comparisons should be made just on the basis that someone you know has "breast cancer" and shares a different treatment approach with you."
As it says here, I think it's important to make your decisions about your breast cancer, and not compare it to the breast cancer others have. I've often wondered why my chemo treatment was so different than others with the same cancer. But, every cancer is unique - just as every person is unique. Do your homework, and research, and then make your decisions about treatment based on your research, the opinions of your doctors and other caregivers, and what you feel best about doing.
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