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DCIS, lumpectomy, atypical hyperplasia. Margins clear, so now what?

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Since suspicious groups of microcalcifications can appear even in the absence of DCIS, a biopsy may be necessary for diagnosis.

Dear Cancer Coach.

Image result for image of dcis

I was diagnosed by sterotactic biopsy with ductal carcinoma in-situ (DCIS). I had a lumpectomy performed. The surgeon called regarding pathology report there was no more DCIS it had all.
Apparently all of the DCIS had been removed previously with the biopsy.

The biopsy did show some atypical hyperplasia.  Margins clear, so now what?

  • Radiologist wants to radiate
  • my oncologist want’s me to take Tamoxifin for five years and the
  • Surgeon suggest watchful waiting.

The labs we 10 percent estrogen binding 90 percent progesterone.    Any suggestions? Thanks, Diane

Hi Diane-

Several things. First and foremost, DCIS is not cancer. You can call it pre-cancer, cancer stage 0 or abnormal cells. Yes, DCIS does slightly increase the risk of a breast cancer diagnosis. The adjuvant therapies recommended by your radiologist and oncologist will reduce the risk of a breast cancer diagnosis but only slightly. You must weigh the risks of side effects of radiation and tamoxifen with the possible benefit of reducing your risk of BC diagnosis. I will list all this info below.

Finally there a host of evidence-based, non-toxic therapies that research has shown will also reduce the risk of a full-blown BC diagnosis.

My suggestions are as follows-

  1. Consider an Oncotype DX DCIS test- this will give you more info to help you think about your risks going forward.
  2. Based on the thinking outlined in the second study below, I would not undergo radiation therapy. The risk of collateral damage outweighs any possible benefits.
  3. Finally read the article linked below about the risks and benefits of tamoxifen. Then decide. I can’t help you on this one.
  4. Last, I have spent years researching non-toxic therapies to reduce cancer. Whether you undergo radiation and or tamoxifen or not, please consider adding these therapies into your day.

To learn more about DCIS and the evidence-based therapies that can help you prevent its spread into invasive breast cancer, please watch the video below:

To download the DCIS Guide, click here.

Let me know if you have any questions.

Thank you,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Ductal carcinoma in situ

“DCIS has been classified according to the architectural pattern of the cells (solid, cribriform, papillary, and micropapillary), tumor grade (high, intermediate, and low grade), and the presence or absence of comedo histology.[6] DCIS can be detected on mammograms by examining tiny specks of calcium known as microcalcifications. Since suspicious groups of microcalcifications can appear even in the absence of DCIS, a biopsy may be necessary for diagnosis.

About 20–30% of those who do not receive treatment develop breast cancer.[7] It is the most common type of pre-cancer in women. There is some disagreement as to whether, for statistical purposes, it should be counted as a cancer: some include DCIS when calculating breast cancer statistics while others do not…”

Oncotype DX Ductal Carcinoma in Situ Score Reliably Predicts Tumor Recurrence

“Similar to Oncotype DX in the adjuvant setting, Oncotype DX DCIS is a 12-panel gene test with a scoring system that categorizes cancers as low, intermediate, or high risk for local tumor recurrence over 10 years following treatment with breast-conserving surgery alone…”

For this controversial breast abnormality, is radiation treatment needed?

“But there is a more fundamental problem. The absolute risk of recurrence is so small that the higher relative risk of 26 percent is grossly misleading. Absolute numbers are more meaningful: the difference in risk of developing breast cancer is about 0.8 percent, or fewer than one woman in 100. “This is an example of [a finding that is] statistically significant and clinically irrelevant…

A 2015 study of 108,196 women found that 20 years after their DCIS diagnosis, 3.3 percent had died of breast cancer, almost identical to the rate of women generally. And crucially, those who received radiotherapy had the same risk of dying of breast cancer 10 years out as those who did not. “Why should patients use radiation when we know from many studies that it has no effect on mortality?”

2015 study found that, six years out, 98.6 percent of women who had surgery were still alive, versus 98.8 percent of those who did not, adding support to the idea that DCIS can be managed with active surveillance…

Risks and Benefits of Tamoxifen Therapy

“In this article, we will review the beneficial effects on bone and lipids and on the reduction of contralateral breast cancer, as well as the data on endometrial cancer to try to answer the following question: do the benefits outweigh the risks?”


Leave a Comment:

Regression of Ductal Carcinoma In Situ (DCIS) with Evidence-Based Non-Toxic Therapies - PeopleBeatingCancer says a couple of years ago

[…] DCIS, lumpectomy, atypical hyperplasia. Margins clear, so now what? […]

DCIS Lumpectomy- Atypical Hyperplasia, Clear Margins. Suggestions? - PeopleBeatingCancer says 5 years ago

[…] DCIS, lumpectomy, atypical hyperplasia. Margins clear, so now what? […]

demerson says 10 years ago

Hi Diane-

Thanks for contacting PBC. Excellent question. I will address your question now but please read the rest of my email below as the post covers several issues that you need to understand going forward. To answer your question "Any suggestions?" frankly, each suggestion by your docs will have risks- ADH increases your future risk of  BC, radiation increases your risk of cancer and has side effects, tamoxifin increases risks and has side effects. My personal opinion as a long term cancer survivor living with several side effects is to watch and wait and lower your risk of BC with diet, moderate exercise and nutritional supplementation.

If you are interested in specific examples of what these are- diet, supplements- let me know and I will be happy to make suggestions. I don't want to get off the topic here.

If I understand correctly, your current situation is:

1)  there was no more DCIS it had all-been removed previously with the biopsy, lumpectomy performed
2)  it did show some atypical hyperplasia
3) Margins clear

If I understand your email below, you have 3 recommendations thus far to include:

1)  Radiologist wants to radiate
2) Oncologist was me to take Tamoxifin
3) Surgeon suggest watchful waiting

First, let me address "atypical hyperplasia"-

"Atypical ductal hyperplasia, abbreviated ADH, is the term used for a benign lesion of the breast that indicates an increased risk of breast cancer.[1]
The name of the entity is descriptive of the lesion; ADH is characterized by cellular proliferation (hyperplasia) within one or two breast ducts and (histomorphologic) architectural abnormalities, i.e. the cells are arranged in an abnormal or atypical way.

In the context of a core (needle) biopsy, ADH is considered an indication for a breast lumpectomy, also known as a surgical (excisional) biopsy, to exclude the presence of breast cancer.[2]


ADH, if found on a surgical (excisional) biopsy of a mammographic abnormality, does not require any further treatment, only mammographic follow-up.

If ADH is found on a core (needle) biopsy (a procedure which generally does not excise a suspicious mammographic abnormality), a surgical biopsy, i.e. a breast lumpectomy, to completely excise the abnormality and exclude breast cancer is the typical recommendation.



Diane- this exchange on Breastcancer.org addresses your questions- please read-


First Name: Diane
Last Name:
Comment: Diagnosed by sterotactic biopsy with DCIS  lumpectomy performed. the
surgeon called regarding pathology report there was no more DCIS it had all
been removed previously with the biopsy, it did show some atypical
hyperplasia.  Margins clear , so now what?   Radiologist wants to radiate
Oncologist was me to take Tamoxifin  labs we 10 percent estrogen binding 90
percent progesterone.  Surgeon suggest watchful waiting.  Any suggestions?

David Emerson
Multiple Myeloma survivor
Founding Director, Galen Foundation

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