Hi again Kaa,
As a pathologist working with a breast cancer team (when I'm not dealing with my own breast cancer) I can tell you that breast cancer accompanied by scattered calcifications and equivocal MRI spots is the bane of the medical team's existence. So many of the calcifications turn out to be benign and other people turn out to have extensive DCIS which was undetectable by any method.
I suspect given the small size of the known cancer, that the medical team won't want to go straight to neo-adjuvant therapy. They will look at all the info they have and I suspect they'll advise biopsy of at least some of the suspicious areas followed by or concurrent with lumpectomy of the known cancer (with sentinel node studies). If scattered calcifications are invasive cancer, they'd likely use neo-adjuvant chemo before surgery. ('Lizbeth's provided a great summary of the latest neo-adjuvant therapy above) In Australia, if the calcifications turned out to be DCIS, they'd go for surgical removal first because DCIS is harder to treat with neo-adjuvant chemo and we don't have access to Perjeta as a component of the therapy here either (yet).
If it turns out there is extensive DCIS around the cancer, they may be able to remove it without taking the whole breast or they may have to go to mastectomy. Sometimes if calcifications are really diffuse and biopsies are inconclusive, mastectomy turns out to be the only way of knowing what is happening with the disease. I hope that won't be necessary for your sister, Kaa, but sometime you have to bite the bullet.
Mastectomy sounds scary but removal of all the primary tumor can save your sister's life. It is also comforting to know that all the bad areas in the breast are gone. Chemotherapy is also going to be necessary because HER2 cancer really requires this in almost every case. Radiation may or may not be required.
Reconstruction is a personal choice. I haven't decided yet. While surgery/ chemo/ radiation needs to go ahead fairly promptly, decisions about reconstruction can often be delayed (I went to an international breast cancer conference on this before I got cancer and delayed DIEP seemed to be a good option from what I understood). The plastic surgeon should be able to advise about this, after the diagnosis of the extent of your sister's disease is clearer.
As far as I can tell from the current information you've provided, it sounds like your sister is in the early breast cancer group. You'll know for sure once more workup/ surgery is done. Recent advances have revolutionized the treatment of early HER2 cancer markedly improving survival. New treatments have even helped many ladies with more advanced disease live much longer.
Through this website, we'll try and support you and your sister on this journey. You'll note that we'll sometimes provide too many suggestions and it gets confusing - sorry! Some people get overwhelmed by information and some people gobble up every snippet.
If possible go with your sister to her oncology and surgical appointments. Take a notebook and pen!. Some places have a breast care nurse who can translate the info for you. A good primary care doctor can sometimes help too. I'm attaching a link to a helpful book.
http://www.booktopia.com.au/breast-c...980631111.html
The main large hospital chemo centers have good info on the web, but remember that your sister's health team know her individual circumstances so they'll have to guide her.
Wishing you both strength for the journey,
Aussie Girl