HER2+ - evidence for mx over lump/RT or bilat mx?

Driftway

I was diagnosed with approx 8mm ER- HER2 + Grade 3 IDC Right side, and still agonizing over whether to get lump/RT, right Mastectomy, or bilateral mastectomy.

The problem is the large studies for lump/RT did not separate out HER2 status at the time. What if HER2 + have a much higher local recurrance rate?

And, there is one study which "postulates" a higher risk of a second cancer on the other side if HER2+. It just seems that since there is not enough info on the HER2+ regarding future local recurrance, one should err on side of caution and just get the bilateral mx..



There is also the dense breast issue. Our local surgeon fully supports bilat mx since future surveilance would be tough, but the breast surgeon at Memorial in NYC still says lump/RT.

Finally, does anyone know if they are looking at RT for HER2+? I know triple negatives do better with lump/RT than with mastectomy no RT....



thanks HER2/neu folks....

rozem

hi driftway

it is a very tough decision, I consulted several MO's and BS's.  You can see from my signature below that i did have a lumpectomy after neoadjuvant chemo but will be having a bmsx in september. All the docs said a lump/rads was sufficient in my case HOWEVER i am going ahead with the bmsx because:

1.  my chances of getting a completely new primary cancer is about 15-20% LIFETIME risk, which is way too high for me.  I am young (43) so that is a significant risk

2.  even with close monitoring, if (and this is a big IF) i do end up with a new primary and it is her2 again, you are in for chemo again because even with really small her2 tumors you have to do the treatment again.  I think if i was her2 neg then I may have considered keeping them and being monitored closely

3.  I have very dense breasts which are difficult to monitor.  Apparently now than I am in menopause (thank you chemo) they should be easier to monitor b/c the density will change but I am terrified that something may be lurking in all that breast tissue and won't be caught early

I don't believe your chances of a local reccurance are greater if you are her2 - i think this depends on how close your margins are, skill of your surgeon etc.  I actually am not as concerned about this as I am with a new primary/getting screened

Also note that you may still be in for rads even if you have a msx - I had to have rads b/c of LVI but if you have a large tumor or any positive nodes you may still have to do rads

good luck with your decision

Driftway

Here is a study from Ireland, see bold print. 

It feels like there are no real studies lump/RT vs mastectomy and bilat mx which address Her2neu patients. Maybe there is a higher risk of local recurrance in either breast with Her2neu....... 

Bilateral breast cancer: analysis of incidence, outcome, survival and disease characteristics.Kheirelseid EA, Jumustafa H, Miller N, Curran C, Sweeney K, Malone C, McLaughlin R, Newell J, Kerin MJ.SourceDepartment of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland. rashmed1111@gmail.comAbstractThere has been conflicting evidence on the impact of bilateral breast cancer (BBC) on the survival and management of patients. The objectives of this study were to address the incidence of BBC and to investigate its characteristics and outcome compared to unilateral cancer. Data were acquired from the prospectively maintained NUIG breast cancer database between 1988 and 2008. BBC were then categorized as synchronous (within 12 months) or metachronous (after 12 months of first tumour). SPSS was used for data analysis. The incidence of BBC in our population was 4.4% (112 of 2,524). Of those 2.1% were synchronous while 2.3% were metachronous. Compared to unilateral cases, bilateral cancer patients were younger (P = 0.021) and had smaller size (P = 0.001) and earlier stage (P < 0.001) tumours at diagnosis. We identified the HER2/neu positivity as a risk factor for developing contralateral breast tumour and ER negativity as a risk factor for developing metachronous tumours. While there was no significant difference in survival for patients with bilateral compared to unilateral tumour (P > 0.05), the synchronous tumour was associated with poorer survival (P = 0.010) in comparison to metachronous tumour. This large single-institutional experience does not support the increasing practice of prophylactic mastectomy but does justify regular follow-up with mammography for early detection of contralateral tumour.