Radiation needed?

1rarebird

Radiation needed?

1rarebird

"Rare bird" is what my surgeon called me when my breast cancer was diagnosed approx. 4 months ago.  He said that in our metro area of over 300,000 folks only a handful of men are diagnosed every year with breast cancer, as compared to a few thousand women with the same diagnosis.  But at age 62 I apparently fit the profile when most male breast cancers are usually found. 

Given my otherwise "healthy as a horse" physical condition (according to my primary care doc who did my annual physical only 3 months before I found my lump), my surgeon recommended that I aggressively treat the cancer if I wanted a favorable prognosis.  So far I have followed his advice by having a mastectomy and receiving chemo (Taxotere, Carboplatin for six 3-week cycles and Herceptin  weekly for a year.)  I also expect to receive hormone treatment for five years when the chemo is over. But I am unsure about whether I should receive radiation for my early stage, node negative, clear margins cancer.

I was referred to a radiation oncologist who has practiced for 30 years and has treated a large number of breast cancer patients. He estimated that he has treated a few dozen men with breast cancer during that time. I am impressed with his apparent knowledge of this disease and his frankness. He clearly states given my stage of breast cancer there is no data which supports a recommendation of radiation treatment for me.  But he said there are really no good studies which have looked at men as a subset of the breast cancer world and therefore recommendations on the treatment men should receive have to be based on what is recommended for women. 

 Here's where it gets tough for me. Despite there being no good data to recommend radiation for me, this doc's personal experience over the years with male breast cancer patients leads him to believe that male breast cancer is more aggressive and subject to local recurrence more often than with women who present with the disease at the same stage.  He has just finished treating a 72 year old man who only 3 years ago was diagnosed with early stage b.c,, received chemo, was not offered radiation and then had the local recurrence.  He claims in his experience with similar recurrences have happened with other male patients he has finally treated.  He stresses that he cannot recommend the radiation for me based on current data and  standards of practice, but he is none the less concerned about what he has observed with men ---like me.

 I have about 2 months before I could start radiation so I need to give what the radiation oncologist says some serious thought.   I would certainly be interested if any male breast cancer patients on this board have had similar conversations with their doctors.

Phil

Larry44

Phil,

It is tough to have a rare disease, breast cancer is a rare disease in men. I chose a lumpectomy so radiation was an automatic recommendation for me. I was told that I would not need radiation if I had chosen a mastectomy. Breast cancer is a sneaky disease so the one case of recurrence your radiation oncologist cited does not guarantee that you will have a recurrence if you don't have radiation.

I had a partial mastectomy, chemo, radiation and I'm close to completing 5 years of Tamoxifen. I have had no evidence of breast cancer since my treatments.

I doubt that your insurance will pay for radiation as it is not a standard treatment for people who have mastectomies, have clear margins, and did not have a tumor next to the chest wall. Have you checked with your insurance company?

1rarebird

Larry, thanks for the reply.

Initially, a lumpectomy was not given to me as an option.  Because of size and shape of the lump as revealed by ultrasound imaging, my surgeon was not comfortable in doing a hollow core needle biopsy. He said he would hurt me more doing it that way and I would have less pain if he just cut it out. So I agreed to having the lump removed with an excisonal procedure. 

Up until the pathology on the lesion came back, all three of the doctors I had seen about it (primary care, mammogram radiologist, and my surgeon) had discounted the likelihood the lump was cancer, So I was expecting a benign diagnosis.  But I wanted the lump out of me and I was happy to let him remove it under local anesthesia.  I actually got to watch him preform the whole procedure which lasted 2 hours. He was very careful and I had little discomfort after the lidocaine kicked in.  Of course when the IDC diagnosis came back 5 days later, I was floored and my new nickname (rare bird) took hold.

So I guess my excisonal biopsy was actually a lumpectomy of sorts.   But since no attempt was made at the time of the biopsy to get clear margins, my mastectomy with sentinel node biopsy 10 days later was the clear choice left for me. 

I hope the way this all transpired doesn't preclude me from radiation, if my doctors think it would improve my chances for  survival.  None the less, I take your advice about checking with my insurance plan carefully.  They have already denied claims filed by my surgeon since his staff did not code my diagnosis as male breast cancer.  I can't understand why there would be such a question by the insurance company.  What other reason would a man under go a mastectomy if it weren't for the fact he has breast cancer???!!  The claims were eventually paid but only after every thing was refiled by my surgeon's office.

BTW, I don't think my radiation oncologist was referring to only one case he has seen where male breast cancers have recurred when they otherwise should not, as compared to the data for similar cases involving women.  He said that actually in his 30 years of practice he has seen the males recur at a higher rate (precentage) than women,which leads him to be more cautious with men. But because male breast cancer is so uncommon, he can not offer data from large studies which confirm or deny his suspicions,  even with early stage male breast cancer.  I believe he would rather err on the side of caution and apply every reasonable treatment now possible when dealing with his male breast cancer patients.  But he is the only radiation oncologist I have seen, so I might feel better after getting a second opinion--if my insurance plan doesn't balk.

Phil

lbrewer

Phil,

If you were ever at Camp LeJeune, please check out tftptf.com

Men stationed there, or who were conceived or lived there have a higher incidence than normal of BC.  They have determined the water supply at the base was contaminated for 30 years, starting in the 1950's.