[Lani]

via PET, MRI, multiple biopsies, etc, but can they be certain they have examined all the different tumors (you did not say how many are seen and by what modalities) Was an MRI and/or PET done pre-chemo?

Since you are in Texas, perhaps MD Anderson would do a surgical oncology second opinion. I know they gave up doing oncologic second opinions on bc patients several years ago (there were too many who wanted them and not enough doctors) on anyone not agreeing to be treated there. At a bc meeting I attended I met a breast surgeon from MD Anderson named Anthony Lucci--don't know if he sees consults but he presented an interesting paper on cox2, walnuts and bc and seemed thoughtful.

Anyone can give you the "company line" that mastectomy is the treatment for multifocal bc. I don't know the answer and have no expertise ...but would suggest you look the person in the eyes, decide if they have the capacity to think outside the box and ask them what the risk/benefit analysis they would tell their sister or mother of going either way.

They probably won't have good stats for you, as it is not commonly done.

Ask them not to let their personal judgement color their answer ie, whether they feel EVERYTHING must be done to decrease the chance of even local recurrence. I know there are figures for the elderly where a large number of the infirmed do not get surgical care. It is just that neoadjuvant therapy is often done on a clinical trial and then there is no freedom to give less than the standard of care--clinical trials must always give the standard of care PLUS something (vs the standard without that something) to be considered ethical and approved.

I came across an interesting paper today and will post it. Remember though that the persons who chose not to have surgery may have been so old, infirmed, demented or without family help that they also did not get the rest of the recommended care ie, remembered to take tamoxifen, get radiation therapy etc.

Will post it to follow...