so, what exactly is dcis?

Many of you have written me to say, “I’ve never heard of this before. What is it?

I had never heard of DCIS before, either. Believe me, when I got the call, the search engines on my computer were consulted and were then humming for several days. When the doctor phoned to lay the news on me, she spouted Latin: “You have ductal carcinoma in situ.” I reached all the way back to my eighth grade Latin class with Mr. Gilchrist for a response. I could have conjugated the verb “amo” (to love), but that didn’t seem appropriate. And, um, I remembered one statement, oddly, but “agricola sum” (I am a farmer) didn’t seem relevant, and besides, I am not a farmer, so that would have been a lie. I simply jotted down the diagnosis and fired up my laptop for more information.

Micro-calcifications had shown up on my mammogram for the third straight time. Just before I left for Africa, I had gone for a needle biopsy because of the re-appearance of these little buggers, and the diagnosis of DCIS was the stunning result.

What I have learned so far is that all women get micro-calcifications in their breasts. By the time a woman is in her eighties, she’s probably got plenty of them. They cannot be detected by feel because they are too tiny. They can, however, be seen on a mammogram. Since women are going for mammos earlier and more regularly these days, micro-calcifications show up more and more and call attention to the fact that an invasive cancer could be on the horizon. They aren’t really a problem unless they are clustered together. Mine, apparently, like hanging out together in large groups, sort of like teenagers at the mall.

When will they become an invasive cancer and for whom? That’s something that can’t be predicted yet.

So, the doctors tell me that some action should be taken, even though, at this point, the cancer is confined to the ducts and is not life threatening.

The first line of a defense is the needle biopsy. Then, if it is diagnosed as DCIS and not just a grouping of some random atypical cells, you get to graduate to an incisional biopsy, or lumpectomy, with which I had the pleasure of getting acquainted three weeks ago.

If the surgeon is able to get “clear margins” from this biopsy, the treatment then calls for radiation. After that, you’re done, except that you have to go in for mammos every six months, and you are put on the list of “high risk” patients. In my case, clear margins were not part of the picture. That, along with the fact that there is breast cancer in my family history and the fact that I am of Jewish Ashkenazi descent means that I am at even “higher risk” (different category).

So, now I am in the process of figuring out what’s next. I am immersed in a sea of doctor’s appointments, conversations with women who have been through this before, reading and thinking.

Strangely, I want to make pictures during the whole process. (It’s always been my way of trying to fully understand what’s going on around me.)

I have received some really great cards and letters from breast cancer survivors; they are full of encouragement and hope. Ironically, I have photographed survivors for the past four years at a Kansas City hospital's breast center. These women have rallied around me with full support. They have written things like this, my favorite, which came from Ida, a woman well into her seventies: “Do you remember taking the photo of me and my dear friends – four old lushes swizzling wine, that is? I strongly encourage you to celebrate your recovery with good friends enjoying a good wine!”

I still can’t really get my mouth around the words “I have breast cancer.” But I absolutely intend to do what Ida recommended: once on the other side of all this, celebrate with good friends “swizzling” a good wine.