Options about surgery after chemotherapy

[cjjhero]

My sister has 3 rounds of chemotherapy of TCH left. She will have an MRI & bone scan before her surgery. The doctor's nurse talked to her today about her options for her breast surgery. My sister is HER2+/estrogen-progesterone negative. Stage 2B breast cancer. No lymph node involvement or spread of cancer.

She spoke to her breast surgeon over 2 months ago and the regimen she suggested (first MRI/CT scan came back clean) was a lumpectomy/radiation. My sister was adamant about having a double mastectomy and reconstruction. Because the tumor is in one breast only.
The nurse said that the survival rate was about the same as a mastectomy as with a lumpectomy/radiation.

My sister does not want radiation because of our mother dying from the affects of radiation. Our mother had cervical cancer and had radiation therapy. The radiation therapy killed her kidneys. She didn't die of cancer she died from kidney failure.

Should my sister stand her ground with the double and chemotherapy/herceptin therapy only? Thanks.

[Coux92]

Hi cjjhero, your sister is half way though the tough part! Congrats to her. The surgery decision can be difficult, mine was such a small spot (1 cm) and just under the skin,lumpectomy/radiation seemed logical. I was told the same regarding survival rates. Regarding radiation damage, I think the risks are low with today's precise targeting. I don't know when your mom had treatment. I did well with radiation. Good luck and smooth going whatever the choice.
Elizabeth

[crb]

Did your sister have the genetic test done? That might help in her decision.

My surgeon was fine with my decision to have a double mastectomy (have 2 malignancies, but in only one breast) because I would not be covered with taking Tamoxifen and still have a chance getting the hormone type of breast cancer on the other side. I was concerned b/c of my age, grandmother had BC twice (20 yrs apart), and of the increased radiation/screening/probable biopsies of the other side if I left it (they have already biopsied a normal spot).

Ultimately, my surgeon and I discussed this multiple times, as I did with my hubby, mother, etc. Good luck to your sister!

[BonnieR]

I recommend a second, and even third, opinion. It helps offer clarity to talk things over with a new professional And then one can feel they made a decision based on feedback from various sources
Keep the faith

[cjjhero]

My family has no history of breast cancer. There are no female relatives ever diagnosed with cancer except my mother who had cervical cancer. Her cancer was caused by HPV. My father cheated on my mother and she ended up with STD.

There is no family history of cancer on either paternal or maternal. We are unsure what triggered her cancer. One suspect is she came in contact with a carcinogen at her former job. Thanks for the answers.

[Catherine]

I like the idea of a 2nd opinion. I had chemo, surgery and then radiation and then Herceptin. Because of the number of tumors and how close they were to the chest wall, the doctors made it clear to me that radiation was very necessary. Good luck with your decision.

[Adriana Mangus]

Hi cjjhero,

Just wanted to thank you for helping your sister during this difficult time.

All the responses you received from my sisters are pretty clear and straightforward, your sister will have the final decision as to which way to go
next.

Also, I'm the youngest in the family with no history of breast cancer from Mother, cancer of the prostate from my father's side, only, no women with any type of cancer have ever been diagnosed. SO just like in your sister's case no idea where it came from.

Please keep us posted. We care about you and your sister.

Take care,

Adriana

[cjjhero]

Thank you for your kind words. Will keep you in prayer for your condition. Blessings to you.

[PinkGirl]

why is your sister stage 2B if her nodes are clear?

[suzan w]

Hi there! You did not say what type of bc your sister was diagnosed with...I made the decision to have a bilateral mastectomy based in part on the fact that I had invasive lobular carcinoma in my left breast. It was a small tumor. Invasive lobular has a high risk of recurrence in the other breast. I had the oncotype test done which also put me at a high risk for recurrence. No family history of cancer. I have never had a moment of regret for my decision. In fact, as you can see by my signature, when I eventually had the BRCA 1+2 test done I did test positive for BRCA2. Good luck to your sister with her decision.

[mjm]

My understanding is that medically the 2 options have similar enough outcomes that it really comes down to what the woman feels most comfortable with (unless a mastectomy is medically required). It may help her to discuss all her questions and concerns with her doctors (and maybe get additional opinions) so she can be really clear about the risks and benefits and details of each option.

But ultimately, the decision should be hers as its her body.

Best wishes to you and your sister.

[JessicaV]

Emotional safety is central to living well. If your sister would feel safest with a double mastectomy and if not doing so will leave her living with much more fear and limitations, given the family history, it may be the best choice for her to make. I have had to have one mastectomy in January for a large cancer, and am told that it is easier to get breasts to match if they are both reconstructed than if one is the original and one is reconstructed. I may well choose to have the other breast removed if I opt for reconstruction. Getting tested for genetic factors could also be worth doing to help decide whether to have one breast or both removed.
The Susan Komen page
http://ww5.komen.org/BreastCancer/De...umpectomy.html
has a section about deciding between Mastectomy and Lumpectomy. They say that one advantage of a Mastectomy is no radiotherapy is needed unless the lymph nodes are affected. The studies they look at (from 2005) show that there is a higher rate of local recurrence with a lumpectomy than with a mastectomy, but that because these patients are monitored, the 20% who had a local recurrence were then treated and the overall survival rates of both procedures were pretty much the same.
For myself, I feel safer having had a mastectomy and not having a higher risk of local recurrence that goes with a lumpectomy, and not having to have radiotherapy.
(These recurrence figures may well be changing though with herceptin and its family of drugs which help no doubt. I have not been able to find figures on local recurrence rates based on trials or research from the last couple of years. Does anyone know of any? )

[Lisalou]

Mastectomy=radiation +lumpectomy. Your sister needs to do what she is most comfortable for the long term. I was also radiation adverse and opted for bilateral mastectomy, in part for the symmetry and yes the rates of contra lateral breast ca are low but greater than general population. The risk for breast ca in the other breast goes up by about .5-1% per. Year so over 30 years that is an increase of up to 30%. I was fortunate enough to be early stage that with mastectomy I could avoid radiation. As you mention there are other long term side effects with it. Other opinions should be helpful and I would include one or two plastic surgeons in those additional opinions as well.
Good luck with your sister's decision.
Lisa

[Carol Ann]

Hi cjhero, I decided on a double mastectomy because of the fear factor, etc ... see my signature below, and then it sure was a good thing I did. The MRI that said my left breast was "healthy" was wrong. That's where my HER2+++ tumor was found.

I'm not saying your sister's tests are wrong. I AM saying she should go with her gut feeling of what is best for HER, no matter what the statistics say. That's what I did, and it ended up being the best decision for me.

That's all anybody can do ... and like other women here have said, second and third opinions are always a good thing. She has to be sure in her own mind that she's made a good decision.

Your sister is so lucky to have you!

Carol Ann