dense breast HER2 postive Lumpectomy or mastectomy

findingsolace

Hi there. I was recently diagnosed in June. They told me the biopsy showed ER+/PR+/HER2 +++ 8mm invasive ductal carcinoma, Grade 3 and High-grade ductal carcinoma in-situ- right breast only.  I am just learning about all of these terms.  From what I have read on these helpful forums and my surgeon discussed, I need surgery, followed by chemo (with Herceptin).  My question is on the surgery. He said lumpectomy with rad is same survival rate as mastectomy, which I have read confirmed in these posts. There may be a 1% higher recurrence rate for lumpectomy with radiation though. So I thought I would do lumpectomy but then I have read that people with very dense breasts (which I have) will have to go back for followup every 3 months. They never saw my cancer on mammogram but were doing an ultrasound because my breasts are so dense. The area they were looking at in ultrasound was totally fine but then they "inadvertently" found my cancer in another area. So my question which may influence my decision is will I have to go every three months forever (I am 46yrs old) to get ultrasounds, and maybe further biopsies etc to monitor for recurrence?  It seems I then should just do the mastectomy.  Also when they talk of recurrence, are there stats for local recurrence and not local recurrence, such as mets somewhere else?  Are most recurrences not local? I know that is the purpose of chemo and herceptin, to eliminate mets elsewhere.  I am just a bit unsure if lumpectomy, which is what I felt I wanted given the small size,etc, is the course I should go. I will talk to my surgeon since he is the first person we have met. I don't even have an oncologist yet and they have put me down in the books for the lumpectomy. Also I have a MRI guided biopsy next week since the MRI picked up something that the ultrasound did not. They feel it will be negative. If it is not, I would have to opt for mastectomy but if it is negative, they felt they could do lumpectomy with good cosmetic results. Sorry to ramble. Any advise would be helpful. Thanks

Mocity

Sorry you are going through  this.  I was dx at 37 in 2008.  I remember having to make all those decisions... I think that was the hardest phase... making all these life changing decisions.  Hang in there.  It is a personal decision. There are arguements both ways.  Even my doctors didn't agree or give me the same advice.  In my case, I had it in my left breast but due to the shape a lumpectomy wasn't an option.  Then I actully opted to so a bilateral mastectomy.   My Onc didn't think I should take the healthy breast but at the end of the day the decision was mine and one I am glad I made.  Good luck to you.  They are hard decisions.  Hugs,

findingsolace

Thanks ChristlC for the message.  More and more people are encouraging mastectomy. Your dx sounds like mine and you are three years out so that gives me encouragement. You rock.  

SpecialK

Not advising you - just want to relay my story since I was also offered lump/SNB/rads for what was thought to be a less than 2cm tumor, IDC, in a good position. Pre-surgical MRI did not show any positive nodes or other areas of concern, other than the original tumor.  I had dense breasts too - even at 54 yrs. old.  My tumor was not seen on my annual mammogram, but was definitively seen on US, which was followed by a biopsy.  I have been followed for the last 20 years because of many fibrocystic masses, I have had needle aspirations multiple times and always have been diligent about annual mammo, which is almost always accompanied by US because they could feel the cysts but they did not show on mammo.  Because of this extensive history I felt that I would always be waiting for the other shoe to drop if I just did the lump.  I knew in advance of the surgery that I was triple positive, so knew I would be having chemo.  I did elect bi-lat mastectomy without the need for rads.  Post-op path found IDC and DCIS in the right breast, and atypical ductal and lobular hyperplasia in the left.  My SNB was also positive and I did have a complete axillary dissection 5 weeks later, which yielded another larger area of cancer in another lymph node, the other 11 were clear.  I have no regrets about the BMX - it was the right choice for me, I knew I couldn't relax in the future with constant exams. Best of luck to you.

Wendyspet

Dear Finding: The test-and-wait period was way too stressful for me, so I opted for mastectomies.  All the doctors I talked to started out asking me why, and when I told them I was her2neu and stressed out, they didn't question me further.  My 1.1 cm tumor was also very close to the right nipple, and my first BS said the nipple might 'die and fall off' because she had to take bigger margins, so that pretty much made my decision easy. 

My right mast. report showed "multiple foci" of DCIS.  The left one was clean.  So I made the right decision for me, but I did meet alot of women who opted for lumpectomies and then radiation.  (One said her radiation was every day at the same time for a month!)  You might check the radiation forums to see what they are experiencing.  Best of luck to you!