Rad or mastectomy ?

[haleuow]

Hi

My wife recently been diagnosed stage 2a ER/PR- HER2+, invasion breast cancer 17/01/2013. The tumor got invasion size 10mm and outside about 20mm Per cancer unit (I think that is mean IDC 10mm plus DCIS 20mm), grade 3. we did the lumpectomy around 01/02/2013. there are 6 nodes been moved. doctor said the path report see there was a tiny dot on one node surface, I do not know whether it should be 0/6 or 1/6.

Doctor give us 6 round TCH followed by one year herption as an treatment, but the problem for us need to determine whether to take an Mastctomy or Radi after the Chemo, she had 5 rounds done, and we are close to make this decision. She has an aunt(her mom's sister) has breast cancer and is living well for about 20 years so far, she had one side mastectomy at that time. My wife also did the Gen test which are Neg for BCRA1 and BCRA2. Doctors said will be no difference for both options, meanwhile my wife's parents think mastectomy probably a better way.

My wife is only 29 years and I am in early 30s, we do not have a lot of money to pay for on-going cosmetic expense if it is private. I am not sure how successfully the reconstruction will be, how she will feel afterwards. I am not sure how much on-going expense that well be.

Advice and help will be appreciate!

['lizbeth]

http://www.bmi.wisc.edu/Courses/542articles2006/19%20NSABP.pdf

welcome to our board.

I'm sorry that you and your wife are dealing with a diagnosis of cancer. The link above is for a large study that showed no statistical difference in survival between mastectomy and lumpectomy plus radiation.

reconstruction can be a challenge. I personally would choose the lumpectomy with that diagnosis.

others on the board should be able to share their own experience making the decision between mastectomy and lumpectomy.

[Becky]

I had the same diagnosis as your wife as you can see below. I had lumpectomy with radiation. The survival of lumpectomy with radiation is the same as masectomy but everyone has to decide on their own.

[jra40]

Sorry that your wife is dealing with a breast cancer diagnosis but you are in good hands here with all the advice and support you may need going forward.

I was diagnosed at 39 and also had early stage breast cancer. I immediately wanted a mastectomy due to fears of recurrance. I had one of the best surgeons in Pittsburgh and he is a believer in breast conserving surgery if possible. After he talked with me about my options, I took his advice and went the lumpectomy/radiation route. I'm happy with my decision but what I learned is that it is a personal choice. Every cancer diagnosis is different and every road is not the same in this battle. Take time to really talk with both your surgeon and oncologist on their opinions and advice. I know if I had went with my first instinct, it would've been different.

Best of luck and many prayers!

[jaykay]

Sorry that you and your wife have to go through this. Having a mastectomy is no guarantee of no radiation (I had one, 1 node out of 4 sentinel positive) and am just about to finish radiation.

If a lumpectomy is recommended by your doctors, then I would go with that. BTW, insurance does pay for reconstruction in the case of cancer/mastectomy.

Best,

Janis

[sarah]

I had DCIS (only in breast), had mastectomy and then 5 years later it came back, same breast and invasive, then I had radiation.
While I don't want to suggest an opinion to you, I would say get another opinion until you feel confident of your choice. The first time around, they wouldn't give me herceptin - only gave it to metatastic people. so would herceptin or would having had radiation made a difference in my case? I'd say yes but which or both??? Definitely I believe herceptin would have made a huge difference.
I wish your wife good health.
health and happiness
sarah

[CoolBreeze]

I can tell you that if I was your wife, I would do the lumpectomy. I had no choice but to have a mastectomy and I have had structural problems, some pain and stuff since. Since the studies show that survival is the same, I would go with the easiest operation. And, of course, you can always do a mastectomy later, but you can't go back once it's been done.

So those are my thoughts but it is entirely up to you and whatever you decide, just make sure there will be no regrets later.

All reconstruction costs and any plastic surgery should be covered by insurance.

[tricia keegan]

I chose the lumpectomy and rads and I'm now almost eight years out with no regrets, good luck to your wife in making this decision thats right for her.

[roz123]

stick with the lumpectomy...I decided to go back in for the mastectomy and reconstruction (for me) and it has been a nightmare. Fear is what drove me, you be the voice of reason for her. Reconstruction is no picnic, coolbreeze is correct that it changes you entire way of moving. She will be followed closely after this diagnosis.

[haleuow]

Thank you all for these valuable advice and it is great helpful for us. Bless you all .

[kvogler]

I was diagnosed in July 2011. I was stage 2B. I did chemo, mastectomy, then radiation also. I don't regret my decision. For me, I would have regretted a lumpectomy. It makes me feel better thinking I hit it as hard as possible the first time around. I know survival rates are about the same, but it was a mental thing for me. I'm glad to look at my scar and see that the cancerous breast is gone. Could have done lumpectomy, but I wasn't well-endowed to begin with. (36B) Personally, I don't miss it as much as people think I should. I don't even think I'll do reconstruction even though insurance covers it since I had cancer. I wasn't the type of gal that wore low cut shirts anyway. It doesn't bother me to wear a bra with a prothesis and I've found swimsuits on the internet with prothesis pockets that actually look good. So it's a really personal choice. My advice is for her to really think about how much her breasts mean to her. If they are important, lumpectomy. If she's like me and honestly, honestly doesn't think that much of her boobs then possibly consider mastectomy. I had to do radiation no matter which operation I chose due to its characteristics.

[Cannon]

I'd like to point out also, that while SURVIVAL rates are the same, RECURRENCE rates are not. I had no choice about having cancerous breast removed, and went ahead and had the other removed 'prophylactically.' I have no regrets either. You have to go with your/her gut.
Best.

['lizbeth]

I discovered this study published a couple years ago that showed the recurrence rate was lower for lumpectomy compared to mastectomy. Please refer to table 2, 6.3 lumpectomy vs 9.8 for mastectomy.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228157/


There is an interesting pattern that shows the timing of recurrence for lumpectomy is much different than for a mastectomy.

I am sure there are others published studies on lumpectomy vs mastectomy. If other board members are aware of specific peer reviewed studies could you please post the link.

[NEDenise]

Haleuow,
So sorry about your wife's diagnosis...but glad ou found us. Welcome!

I'm with Roz...I had a lumpectomy initially...margins were not clear...opted for bilateral mastectomy...thought: better safe than sorry...get it all...don't want to recur...won't miss them...etc...

Hidsight is 20/20, but if I had it to do over...
I would NOT have had a mast at all
Another lumpectomy would have done the trick
I could still have had recon to even out breasts
I recurred anyway and am stage IV now
Recovery/rehab would have been MUCH less problematic
My new breasts - though created by world class surgeons (not exaggerating here) are not lovely...for many reasons...they're just okay
I have virtually no sensation on chest/abdomen, even after nearly 2 years...
I could go on and on.

My advice...start small...you can always do more...but once you go big...there's no going back.

Best of everything to both of you!

Denise