Surgery delayed again. How long does it take bc to spread?

EbonyEyes

My mastectomy has been delayed for another two weeks because I just can't get rid of this pneumonia. That's the third delay, six weeks all together. It's been sixteen weeks since I found the lump. How long does it take bc to spread? The onco, surgeon. and PCP said my lymph nodes don't feel swollen. They also said the type I have -- solid papillary -- is thought not to spread. Well, we've all heard the "85% chance" through the mammo, ultra, and biop yet here we all are. For that matter, my lifetime risk for bc was assessed at 8%, lower than average. My risk for diabetes was 6% and I got that too. My risk for retinopathy(a type of vision loss caused by diabetes) was determined to be "low" and I already had it when they did they assessment! I don't believe in percentages anymore. From what you've heard, from what you've seen, how long does it take for bc to start spreading? My tumor was determined to be .03 cm.

BarredOwl

Hi EbonyEyes:

I am sorry about the further delay. As someone said in another thread, your doctors are presumably using their best judgment to balance the risks of surgery to you versus that presented by the cancer. Your clinical presentation and various pathology features (admittedly from limited biopsy samples), are what is available to guide your doctors in this assessment.

I hear you about risk estimates. They are based on groups, and many of us have individually busted the odds more than once.

In my layperson's understanding, if some cells had the ability to move, it cannot be known when or if they will actually try to make such a move (or succeed). The only thing I have seen is very general in nature, sort of speculative, and from an older book (copyright 2005) on breast cancer by a breast surgeon. It is from the section "Overview: Lumpectomy Versus Mastectomy." There is no citation in support, and the book was published 10 years ago (emphasis added):

"Given what we know about breast cancer growth rates, it makes sense biologically that both procedures offer the same chances for survival. Most often, breast cancer cells form relatively slow-growing tumors. It can take about one hundred days—more than three months—for just one cancer cell to divide into two. After another hundred days, those two cells would divide into four and so on. By the time a mass of cells is big enough to detect on mammography or feel during a breast exam, it has been present for several years or longer.

If those cancer cells were biologically capable of gaining access to the lymphatic channels or bloodstream, they did so long before the day of your planned surgery. So whether your surgeon excises the cancer plus a small rim of surrounding normal breast tissue (a lumpectomy) or excises the cancer plus a larger rim of normal breast tissue (a mastectomy) has no bearing on the cells that may have already scooted into the general circulation. Cancer cells that are not biologically capable of migrating from the breast can be safely removed with either lumpectomy or mastectomy."

Excerpt From: Carolyn M. Kaelin & Francesca Coltrera. "Living Through Breast Cancer." iBooks (2005).

For whatever it is worth, this passage helped calm me down while I was waiting for surgery. Purely anecdotally, my first suspicious screening mammogram was done on June 27, 2013. It was screen-detectable only (no palpable lump). There followed a diagnostic mammogram, stereotactic core-needle biopsy (July 10), MRI, MRI-guided biopsy, genetic testing (BRCA1/2), second opinion, further diagnostic mammogram, and wire-guided surgical biopsy (left, didn't get it all). The double mastectomy procedure was performed on September 25. I have no idea what happened in there during that 13-week time period.

I hope you recover enough soon so you can have your surgery!! I wish I could send you chicken soup.

BarredOwl

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Age 52 at diagnosis - Bilateral breast cancer - Stage IA IDC - BRCA negative;

Bilateral mastectomy and SNB without reconstruction 9/2013

Dx Right: ER+PR+ DCIS (5+ cm) with IDC (1.5 mm) and micro-invasion < 1 mm; Grade 2 (IDC); 0/4 nodes.

Dx Left: ER+PR+ DCIS (5+ cm); Grade 2 (majority) and grade 3; isolated tumor cells in 1/1 nodes (pN0i+(sn)).

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UPDATE (Feb 8, 2016):

For anyone reading this, a recent retrospective study investigated time to surgery (when neoadjuvant therapy is not indicated). There may be more or less urgency in any specific case, so it is important to consult your providers for current, case-specific expert professional advice on recommended timing of surgery in your case.

JAMA Oncology Article: "Time to Surgery and Breast Cancer Survival in the United States"

Commentary: http://oncology.jamanetwork.com/article.aspx?artic...