Stage IV and Mastectomy

[al from Canada]

Dear Amy,

It's kind of closing the barn door after the horse is out but.........based on the attached published literature, it is food for thought. The problem with the studies however is that they never break-down who was HER2+ and who wasn't. HER2 is an aggressive disease where growth factors have gone wild; that said, some studies have shown that surgical trauma, thus the increase of growth factors, may stimulate the cancer.

Personally, I would opt for neo-adjuvant chemo, that is; shrink the tumor with chemo and then go for the lumpectomy (if any surgery is indicated). Most studies have shown that this approach has the same survival as mastectomy in stages 1-3. I would think you would achieve a similar result in stage 4. Mastectomy and resultant damage to the lymphatic system in stage 4 based on one or two studies doesn't make a lot of sense to me. Just my opinion.

Good luck, Al