Oncologist reccomends Lumpectomy before mastectomy...SCARED!

Erinsoule

I was diagnosed May 5th, and although it feels like Ive been waiting years to have this thing OUT, its been only almost 2 months I guess. My original plan from my surgeon was to do a double mastectomy, to relieve my future worries, even though she said tumor was small and I was early detected. My oncologist came on board and didn't like that recommendation at all...so of course I ended up very confused! He talked me into a lumpectomy with radiation (chemo undecided until path of tumor after surgery). He claims that this procedure is just as effective as a mastectomy and in some cases even better outcome, while still saving the breast...Im worried now. Is this true? I have stage 1 (possible 2) Invasive Ductal Carcinoma with a tumor size of 14mm (very small still surgeon said) with no "known" lymphnode involvement, they will check that at time of surgery. I was HER2 negative, still waiting on BRCA test to come back this week. Help! I feel so confused and really want to trust my oncologist badly!

mdg

I would take a breath and decide what you can live with.  I don't like surgeons or doctors that pressure you into anything.  My surgeons were very neutral and told me I was a candidate for either surgery.  They supported my decision either way.  I would ask what proof there is about better outcomes with lumpectomy.  Recurrence rates are slightly higher with lump vs MX though survival rates are similar.

Lily55

REcurence rates if you have good clean margins and rads are the same as mastectomy, why not have a read through the posts in research news on here as I know there are some posts in there about research on this.  A double mx is a very radical step to take and one you may regret in future (or you may not, but once its done its irreversible of course and its easy to make wrong decisions in fear) 

Sunshineinky

We sound very similar in diagnosis! Mine was 12mm. I chose a lumpectomy and rads because I felt it was the right choice for me.  If you are ER postive make sure they send it out for an Oncotype test. 

My medical oncologist had no say in my decision. My breast surgeon, my husband and I all made the decision using the available research we had.  A lumpectomy and rads are equally as effective as a masectomy. Two months seems like a long time to wait for surgery.  I was diagnosed and had a lumpectomy 17 days from being diagnosed.  

My husband and I talked today and if it ever does come back... then we will look at doing a much more aversive procedure.  

Ridley

erin - you could have the lumpectomy, get your oncotype (if estrogen positive), and then decide.  That ended up being my path, although for slightly different reasons.  I had a low oncotype so didn't need chemo and was able to avoid radiation by having a mastectomy (one side was recommended based on a complicated pathology and the other was my choice).  I ended up having recon at the same time (diep), so it all worked out, although I'm not quite finished on the surgery front.

Having the lumpectomy first let me take some time to figure out what I wanted to do.

Good luck

BrooksideVT

Indeed, statistically, your chances of recurrence are similar whether you choose mastectomy or lumpectomy plus radiation. You can (as I did) have the lumpectomy and sentinel node biopy, then check out your pathology and your oncotype, and, at your leisure, decide whether to go ahead with the mastectomy.  I fully expected to schedule mastectomy (Double?  Single?) and DIEP, but was surprised at how much I appreciated still having my breast, and how greatly I wanted to avoid the possibility of some of the post surgical issues others have suffered.  I highly recommend reading all the mastectomy and reconstruction (if that interests you) threads on this site, as the bigger the surgery, the greater the risk for some of those pesky, and occasionally long term, side efffects.

aviva5675

I had dcis not invasive, but otherwise situation was similar. Did an lx, with reduction, and was going to do rads.  They found other tumors tho in the tissue so I ended up with double mx.  Lucky no nodes tho, and super low oncotype score.  No one can tell you what is right for you . The research does seem to indicate that in tumors ok for lx , with rads , the outcome is similar to mx, as others have mentioned. It is definitely an easier surgery than mastectomy...Get a second opinion from a different doc - it might help you figure things out and give another point of view.

bevin

http://www.health.harvard.edu/blog/for-early-breas...

http://www.medicalnewstoday.com/articles/255497.ph...

It is so confusing, so I thought I'd share these articles that talk about the sucess vs risk of both. Its interesting to see those with lumpectomy faired better.

Good luck with your decision and keep us posted.

edwards750

I had the same Oncotype score as bevin - 11. My BS is all about saving the breast. He said I had a wimpy cancer - whatever that is - but the tumor was small. I did have a micromet in the SN but that was not discovered until after the Path report which came after the lumpectomy. My ONC then decided since it was so small to order the Oncotype test. The results of that test decided my treatment - 33 RADS. I heard the same thing about survival rates. I know it is hard to believe but apparently sometimes cancer cells even linger after a MX. Bottom line is though it is your decision and your life - not theirs. Don't let anyone talk you into anything. The vast majority of us did our homework once we were DX. Your doctors are there to advise and treat you but again don't be afraid to decide against their recommendations. Just so you know a friend of mine did just that. She took her case to the West Cancer Clinic here and pretty much told them what she was going to do. What are they going to say? No? She is a nurse at St. Jude so clearly she has been exposed to cancer/patients. Good luck.

Diane

Erinsoule

Thank you so much ladies!! This website and forum have been so helpful, and this journey nuts! I keep waiting for the "Have to fight" feeling, and have worried that I haven't felt it...until now! I think THIS is my fight...decisions. Haha! So I had the lumpectomy on Monday, and although the Sentinel Node mapping procedure was terrible, the surgery was not. Its only been 4 days recovering, and I haven't even had to take any of the pain meds they prescribed. I took off the outer guaze bandages yesterday, leaving only the steri strips over the stitches, and can honestly say I cant even see the  incisions! Maybe when all the bruising goes away a bit I will. 

Erinsoule

My onco score came back a 19, said I was in the middle...whatever that means? However he did say that with that score, my benefit of chemo is only about 1%...so the choice was mine to make...ugh! ANOTHER CHOICE, that me, who has never had cancer before has to make   So, I decided for only a 1% benefit, I would move straight onto Radiation treatment. My Radiology Oncologist said studies show a good outcome with higher dose/less time of rads...so looks like I will have a higher dose for only 4 weeks and a day. GO ME...I think? haha!

Sassy_Seven

Erinsoule, I know it's not funny but I had to laugh when I read your post "ANOTHER CHOICE... me, who has never had bc" Laugh because that is my standing joke... I get to decide? Like we have all the education and experience, right? I get that it is wonderful to have doctors who want us to make the best choices for our own bodies, and I appreciate that. Just sometimes it is good to have an expert who has been doing this for 20 years tell us their real opinion. 

Sounds like you did make the best decision for you...GO YOU!! You'll do great!

Katy

JohnSmith

For a score of 19, you're right on the cusp between low and medium. You probably already saw this but if not, here's the breakdown:

Recurrence Score lower than 18: The cancer or DCIS has a low risk of recurrence. The benefit of chemotherapy for early-stage breast cancer or radiation therapy for DCIS is likely to be small and will not outweigh the risks of side effects.

Recurrence Score between 18 and 31: The cancer or DCIS has an intermediate risk of recurrence. It’s unclear whether the benefits of chemotherapy for early-stage breast cancer or radiation therapy for DCIS outweigh the risks of side effects.

Recurrence Score greater than 31: The cancer or DCIS has a high risk of recurrence, and the benefits of chemotherapy for early-stage breast cancer or radiation therapy for DCIS are likely to be greater than the risks of side effects.

Cowgirl13

Erinsoule, I had a shorter radiation schedule.  I had a total of 19 rads and that included boosts.  It was very doable.

Good luck!

Meow13

I didn't have a choice 2 tumors multicentric. I had mastectomy 99 percent of my pain was emotional I wish I could have the DIEP surgery at the same time. I had to wait 4 months due to doctors schedule. I am very happy now every thing i've read says lumpectomy with radiation just as effective if not better. Plastic surgeons hate dealing with radiated skin but I have 2 friends that had radiation before choosing DIEP the results were both good.

when I say i'm happy I mean they did such a detailed pathology of all the breast tissue. The report was able to confirm the only cancer found was in the 2 small spots 95 percent confident the were 2 totally separate tumors. My surgeon said that report gave me the best outcome. They believe the tumors formed at the same time. Perhaps my immune system was overwhelmed that is my belief. If I could have had lumpectomy I might not have that info, now I am happy with mastectomy and 

Ineke254

Just wanted to let you know that I was scared too at the time of making a decision..Well, I decided to have a lumpectomy instead of the mastectomy. It was recommended by my oncologist and surgeon so I went ahead and had it done on August 5. I figured that if a mastectomy is to be done in the future and I do not have a choice, I will have it done .My breast surgeon did a marvelous job, no pain,no  bandages, no drainage, just derma bond on my incisions (the sentinel node was also done). Radiation therapy is ahead of me..

Wishing you all the best on your journey...and speedy recovery...