Right mastectomy 3 yrs ago....now left side?
 

Good Afternoon,

I joined this group about 3 1/2 years ago. I can't recall if I ever posted or just peeked around.

I'm searching for answers to curiosity questions:

I was diagnosed Her2 Positive/Stage 4 in August of 2010. Metastasis was to liver and right lung. Immediately, chemo was started then in December a right mastectomy and 47 right axillary lymph nodes removed (all of them) followed with radiation in February and March 2011. During and since, I've been on every three weeks Herceptin infusions. After about a year of Herceptin only, some more spots were seen in right lung and Tykerb was added to my treatment.

Fast forward to current: A week ago I had a routine mammogram on left breast which showed a number of small areas of Bi-Rads 4 "highly suspicious for malignancy" calcifications. I'm scheduled for a stereotactic biopsy on Friday, May 30th.

When I was first diagnosed in 2010, and informed that a mastectomy was necessary, I asked for a double mastectomy but was discouraged and pretty much told no. I LOVE the care and professionalism I receive where I'm treated but have never really understood the reasoning behind a unilateral mastectomy. I specifically asked, per leaving my left breast alone, "what about cancer showing in the existing natural breast and possibly having to go thru another mastectomy." My answer was (condensed); "Her2 doesn't work that way. IF you should get cancer in your left breast it would be coincidence where Her2 is concerned. It won't be because that breast wasn't removed."

Here I am today looking at "highly suspicious for malignancy" in my existing natural breast. I know that I may be "putting the cart before the horse" with the questions below before getting my actual findings, but, haven't we all been there?

My questions are:
1) Have any others here experienced a parallel to what I've described above?
2) Are there any of you who would have a clue as to what I might be looking at, per my history, concerning either/or radiation, or chemo, or mastectomy.....or combos?
3) Would anyone know if these areas prove to be malignant if they'd be most likely Her2 or an different type breast cancer.

If these areas of concern are malignant... I nearly made four years. I think that's pretty good, don't you? I've been told that it was not a matter of IF cancer returned but rather WHEN. In the interim I chose to live as that wasn't factual.

Choosing Joy has been and will continue to be my mantra....however, I do recognize that this isn't joy at all, but life all around it can still have joy.

Thanks for reading such a long post.

Blessings,

Deeze

Re: Right mastectomy 3 yrs ago....now left side?
 

Hi Deeze,

That sure is frustrating to be denied a bi-lateral only to find a new cancer in the opposite breast 3 years later!

I was talked out of a mastectomy in 2003 when I was diagnosed with a stage I (1.2 cm) Her2+++ breast cancer with no lymph node involvement. 3 years later, after I made an appointment with the original surgeon, we found that the lumpectomy she performed had missed a chunk of cells and the new growth had been misread (by radiologists) to be scar tissues. So I insisted on a bilateral mastectomy - partly because I didn't want to take any risks again, partly because of insurance concerns.

Then I requested for the BRCA gene test (thanks to what I'd learned from knowledgeable members on this Board. Marcia alerted me of the Jewish settlement in ancient China) and assessed the genetic risks. A year later, after a new cancer case occurred to a family member, I located the cancer cluster called Lynch syndrome (HNPCC) and decided on a prophylactic hysterectomy/oophorectomy ... (The surgeon found hyperplasia in the uterine cells.)

Below is the abstract of a recent study about cancer in the contralateral breast. One of the reasons why surgeons prefer to cut less than more is 'angiogenesis' - growth of new blood vassals from a wound/cut/operation that helps cancer to spread.

JAMA Surg. 2014 May 21. doi: 10.1001/jamasurg.2013.5689. [Epub ahead of print]
Social and Clinical Determinants of Contralateral Prophylactic Mastectomy.
Hawley ST1, Jagsi R2, Morrow M3, Janz NK4, Hamilton A5, Graff JJ6, Katz SJ7.
Author information
Abstract
IMPORTANCE The growing rate of contralateral prophylactic mastectomy (CPM) among women diagnosed as having breast cancer has raised concerns about potential for overtreatment. Yet, there are few large survey studies of factors that affect women's decisions for this surgical treatment option. OBJECTIVE To determine factors associated with the use of CPM in a population-based sample of patients with breast cancer. DESIGN, SETTING, AND PARTICIPANTS A longitudinal survey of 2290 women newly diagnosed as having breast cancer who reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries from June 1, 2005, to February 1, 2007, and again 4 years later (June 2009 to February 2010) merged with Surveillance, Epidemiology, and End Results registry data (n = 1536). Multinomial logistic regression was used to evaluate factors associated with type of surgery. Primary independent variables included clinical indications for CPM (genetic mutation and/or strong family history), diagnostic magnetic resonance imaging, and patient extent of worry about recurrence at the time of treatment decision making. MAIN OUTCOMES AND MEASURES Type of surgery received from patient self-report, categorized as CPM, unilateral mastectomy, or breast conservation surgery. RESULTS Of the 1447 women in the analytic sample, 18.9% strongly considered CPM and 7.6% received it. Of those who strongly considered CPM, 32.2% received CPM, while 45.8% received unilateral mastectomy and 22.8% received breast conservation surgery (BCS). The majority of patients (68.9%) who received CPM had no major genetic or familial risk factors for contralateral disease. Multivariate regression showed that receipt of CPM (vs either unilateral mastectomy or breast conservation surgery) was significantly associated with genetic testing (positive or negative) (vs UM, relative risk ratio [RRR]: 10.48; 95% CI, 3.61-3.48 and vs BCS, RRR: 19.10; 95% CI, 5.67-56.41; P < .001), a strong family history of breast or ovarian cancer (vs UM, RRR: 5.19; 95% CI, 2.34-11.56 and vs BCS, RRR: 4.24; 95% CI, 1.80-9.88; P = .001), receipt of magnetic resonance imaging (vs UM RRR: 2.07; 95% CI, 1.21-3.52 and vs BCS, RRR: 2.14; 95% CI, 1.28-3.58; P = .001), higher education (vs UM, RRR: 5.04; 95% CI, 2.37-10.71 and vs BCS, RRR: 4.38; 95% CI, 2.07-9.29; P < .001), and greater worry about recurrence (vs UM, RRR: 2.81; 95% CI, 1.14-6.88 and vs BCS, RRR: 4.24; 95% CI, 1.80-9.98; P = .001). CONCLUSIONS AND RELEVANCE Many women considered CPM and a substantial number received it, although few had a clinically significant risk of contralateral breast cancer. Receipt of magnetic resonance imaging at diagnosis contributed to receipt of CPM. Worry about recurrence appeared to drive decisions for CPM although the procedure has not been shown to reduce recurrence risk. More research is needed about the underlying factors driving the use of CPM.

Re: Right mastectomy 3 yrs ago....now left side?
 

When I was diagnosed, I had cancer in both breasts. However, the left breast was the ER-/PR-/HER2+ cancer and was much larger. The cancer in the right breast was ER+/PR+/HER2-. I was told that these were 2 different cancers.

I opted for a double mastectomy although I was told I could spare the right breast. Like you, I didn't see the point in having just one removed. My Dr. agreed.

Based on my experience, it is possible to have a HER2 cancer on one breast and a different cancer on the other breast.

I wasn't told by my onc to expect a recurrence. She never said anything about it being a question of "IF but WHEN".

I wish you the best...think positive

Re: Right mastectomy 3 yrs ago....now left side?
 

Hi Deeze, Welcome back!

I can just imagine how disappointed you must feel about the hospital/doctor/insurance
company denying you to have a double mastectomy.
Wait until the May30th procedure and see if indeed those
are Her2+cancer cells, or a new type of cancer. Don't even think much
about it since you really don't know yet, and frankly is a waste of time to
worry about something we have no control over it.

Jackie07 has provided you with useful information regarding your case.

I'm also stage IV- - long term cancer survivor. Don't despair, treatments
are better than what they used to be years ago.

Stay positive, go to the movies, park, museum anything to keep your mind off
BC. I know, Deeze, it easier to say than done. The wait is the worse part, but is nothing one can do about it.

Please, keep us posted.

Adriana

Re: Right mastectomy 3 yrs ago....now left side?
 

Hi Deeze,

sorry to hear about your recurrence. I believe breast recurrences aren't considered as big a deal for survival than mets to other areas, so if you've got through the original liver and lung mets and still doing well I'm hoping this will be a 'road bump' rather than anything more (please don't take that as dismissive of how stressful any more cancer and surgery is).

Mum had a unilateral mx and her doctor is leaving it to her as to what to do regarding the other side - he said there is a small increased risk of recurrence in the other side which was cancer free (I think he said 5 or 10% over 5 yrs but I'm not 100% sure), but not high enough that he would recommend surgery, but it's up to her what she prefers.

They seem to be pushing the least-acceptable surgery line at the moment, and in some ways that's good (avoid overtreating that's purely based on fear) but conversely some women are happier with the reduced risk of a local recurrence from having a mastectomy or double mastectomy and I like it when a doctor offers sensible advice but lets people make informed decisions about their own body.

Re: Right mastectomy 3 yrs ago....now left side?
 

In 2005, when I was diagnosed, I was told, it's not IF, it's WHEN. I had invasive lobular carcinoma in my left breast. My decision for a bilateral mastectomy was never questioned as invasive lobular spreads single-cell through the bloodstream. Even though I was stage 1, I was given a poor prognosis due to ILC and Her2+++. In order to get herceptin, at that time not yet approved for early stage BC, the protocol was chemo first.
All that being said...now, almost 9 years later...herceptin has completely changed the course of Her2+ breast cancers. As has the BRCA1 and 2 testing. Every day new research and trials are revealing more and more information leading to different treatment protocols.
We do the best we can with the information we have at the time we are making these decisions...usually making decisions rather quickly considering the gravity of the choices. It is very hard not to look back and ask the "what ifs" . Stay informed, ask questions, go for another opinion...
Best of luck to you, Deeze...let us know how things go!!!

Re: Right mastectomy 3 yrs ago....now left side?
 

Wow! Wow! Wow!

I'm a positive person, really, but I had found myself quite discouraged....then each of you who've replied to my post really helped a great, great deal.

Thank you, Ladies, for taking the time to educate me further and mostly encourage me during this waiting period before my biopsy.

If there has to be a recurrence to endure -I'd rather it be my existing breast than in any other place within my body.

So much was gained by me from each of you.

THANK YOU MUCH!

Blessings to all.

Re: Right mastectomy 3 yrs ago....now left side?
 

Deere, best wishes for tomorrow! I pray it is not cancer again.
I had my lumpectomy one year ago on the right and Tuesdays mammo showed clusters of calcifications on the left! I'm doing the stereotactic bx on June 9th......may we both have benign results!
Elizabeth

Re: Right mastectomy 3 yrs ago....now left side?
 

Deeze and Elizabeth, I am sending best wishes and positive thoughts and energy to both of you!

Carol Ann

Re: Right mastectomy 3 yrs ago....now left side?
 

Deeze and Elizabeth I'm wishing you both the best and that all results are benign for both of you. I have appts with surgeons tomorrow and on the 9th , I will surely be praying for all of us and thinking of you 2 on these days.

Re: Right mastectomy 3 yrs ago....now left side?
 

Hi deezie
Hoping your biopsy is negative. If you do wind up with cancer in the other breast it is considered new disease, not recurrence. The risk for breast ca in the unaffected breast is less than 1% (about .8) per year so roughly 4-5 % over 5 years or 8-10% over 10 years Increased risk greater than the general population per year. Good luck with the biopsy and hoping for the best
Lisa

Re: Right mastectomy 3 yrs ago....now left side?
 

Hi deezee.we all knoww how you feel...Pray tell all to our lord allyour worrie s everything.dont worry gods in charge.

Re: Right mastectomy 3 yrs ago....now left side?
 

Hi Deeze, thinking of you and praying you have gotten good news, please update us when you are up to it

Re: Right mastectomy 3 yrs ago....now left side?
 

Elizabeth & Deeze, In my thoughts and prayers. Plz update - How are you?
Joanne

Re: Right mastectomy 3 yrs ago....now left side?
 

I'm happy to report I got the call this morning that my calcifications are benign. I'm praying that Deeze got a good report as well.
Elizabeth

Re: Right mastectomy 3 yrs ago....now left side?
 

So glad to hear that, Elizabeth! Thanks for letting us know.

CA