Rethinking treatment?

carlite

The final pathology report came back with high grade dcis,her2 positive, ER,PR+, comedonecrosis, and 1cm with wide clear margins...if I had known this, from the initial biopsy, probably may have had a mastectomy...before I begin rads,I am thinking about a mastectomy instead...any thoughts? please!

mom3band1g

with "wide clear margins" I would be more than happy to stick with a lumpectomy!  A mast is major surgery with a lot of yucky, permanent side affects.  Why would you want to go back in and have the mast?  I wish I could have had the lumpectomy.

Beesie

I just responded to your other post with the same question, in the Treatment Forum.  I'll repost my comments here:

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How wide were your surgical margins?  And did you have an MRI?  MRIs are often very effective at showing high grade DCIS, so if there is anything more in your breast, an MRI provides the best chance of seeing it.  If there is nothing else suspicious in your breast and you have wide surgical margins, then even with though you have an aggressive pathology, your recurrence risk might be quite low after rads, particularly if you choose to take Tamoxifen.  1cm is a small tumor.

You may want to read the following article and input your information into their scoring table. This will give you an idea as to what your VPNI score might be, and based on that, whether you have a high recurrence risk with a lumpectomy + rads.  This would be good information to discuss with your doctors.  As the others have said, it is important to be comfortable with your treatment decisions, but it's also important to make your decisions with good and real information about your specific diagnosis and pathology and risks, not based only on your fears.  

Choosing Treatment for Patients With Ductal Carcinoma In Situ: Fine Tuning the University of Southern California/Van Nuys Prognostic Index

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By the way, personally I feel the same as mom3band1g.  After an excisional biopsy (i.e. the same surgery as a lumpectomy), because I didn't have clear margins, I had to have a MX.  I would have been so happy if I'd been able to stick with a lumpectomy.  A MX presents all sorts of short-term and long-term issues that aren't often openly discussed here. I would agree with mom3band1g when she says "yucky, permanent side affects".  So make sure that you absolutely want to do it and you know why you want to do it, before you make the decision to have a MX. You have to be prepared for the downside of the procedure. 

carlite

Thank you for your input. My margins were <10mm, clear. I am also
HER2+, and NONE of this came out on the MRI nor the 3 mammos I had prior to surgery. the docs were all shocked and brought in others to see if they missed it...I am the lucky few w/ non imagiing cancer! Needless to say I am cynical about the medical imaging being able to pick it up in the future...w/ or w/o rads.

CTMOM1234

Carlite: Three in a row for you to not rethink your treatment. I feel the same as mom3band1g & Beesie. The thought of rads scared the ^%&* out of me, but given the option of lump+rads vs. mx, I appreciated having the choice and chose the former.

Both the lump. surgery and rads were definitely psychologically rough but physically they were less severe than mx and resulting reconstruction (I had met with a plastic surgeon while awaiting my genetic test results and would have undergone diep reconstruction). Your grade and her2+ should be considered, just as my grade and the idc uncovered needed to be considered, but your dr. should be able to tell you the statistics for your situation.

Wishing you good inner peace with your decision. It's been 3 years now for me, and I've never regretted my decision...not even for 1 day and that's the best we can hope for.

0000

I have a similar situation. I went for a lumpectomy for IDC. To everyone's surprise I had an additional 4 cm DCIS. Thankfully, the nodes were negative and if I read the path report correctly, the margins were clear. The down side is that both tumors are Grade 3. So I too, am rethinking having a MX. There seem to be many women with less aggressive BC than mine that are having BMX. I am 59, and not attached to my breasts. I am considering asking my surgeon for at least a left MX and prehaps a prophylactic right MX. Please help with any suggestions. 

Jenifer