overwhelmed

angsam95

Hi. I was just diagnosed 2 days ago. I am 43 years old. Biopsy came back as invasive ductal carcinoma grade 1, ER positive 90%, PR positive 80-90%, HER negative. My mass is about 7mm. I had dimpling on my breast. Mammogram was negative, found on ultrasound. I saw the surgeon today. He said that first, I need CT chest, abdomen, and pelvis to check for any other tumors. He recommended a mastectomy in that breast with reconstruction at the same time. He said he would do a sentinel node biopsy and if they show cancer, he will take the others. I will see the plastic surgeon this week. He said that due to my age, this could be aggressive. Because of that and also needing my nipple and areola removed, a mastectomy with reconstruction is the best choice. Then he said I would see the oncologist. He said I'd likely need chemo followed by hormone receptor meds. He didn't suggest removing both breasts. Does this all sound reasonable for this type and grade of cancer at my age?

sensitivehrt

Hi angsam95- Sorry you have had to join this group.  Everyone on the boards are very helpful.  I'm still fairly new but thought I'd share my experience since we have some similar stats.  I was DX with IDC Stage 1 Grade 2.  ER+ 8%  PR - and HER-.  My tumor was 6mm.  My BS actually stated that normally a lumpectomy and Rads would be offered in my situation, but I have other health conditions that made the mastectomy the better choice for me.  BS took 3 SNB, all were negative so no others were taken.  I met with oncologist after surgery.  I chose to go with a BMX because of family history and piece of mind.  I have not had any of the CT scans.

I'm sure others will give you good info too.

HuskerFan

angsam95, I was diagnosed in April with IDC. I was ER/PR+, HER2-. I had a BMX 3 weeks ago with SNB, 0/2. There was never any mention of chemo as all of my imaging indicated it hadn't spread to any nodes and the surgery confirmed that. I am taking tamoxifen for at least 5 years.

Meow13

I don't see anything suggesting chemo would be beneficial. I mean grade 1 less than a cm, er and pr positive. I wouldn't think being 43 would say anything about aggressiveness. I would definitely talk to the oncologist.

ElaineTherese

I agree with Meow that chemo is unlikely to be beneficial, though your oncologist should order an Oncotype test to be sure. Given that you have a relatively small tumor that is growing slowly (Grade 1), I don't see why your surgeon didn't discuss lumpectomy and radiation as an alternative to mastectomy. My cancer WAS aggressive (Grade 3, HER2+), and I opted for a lumpectomy (was going to get radiation anyways).

I was 46 when diagnosed, and my oncologist did think that I was somewhat "young" to get breast cancer. But, my cancer was deemed aggressive because it was dividing rapidly ("growing like kudzu in the lab," I was told), not necessarily because of my age. Best wishes!

Sjacobs146

I would get a second opinion, what your doc is suggesting is a more aggressive treatment than what you normally see for your grade, size, and characteristic of tumor. By definition, Grade 1 is the least aggressive type of BC. Are you being seen by a Breast specialist, or just a general surgeon? Have you had genetic testing yet to see if you're positive for the BRCA gene? I would run, not walk to another hospital, ideally one with a Breast center that specializes in Breast cancer.

I was only 5 years older than you when diagnosed, and my tumor was more aggressive and I had a lumpectomy. I did have a positive node, and an intermediate Oncotype score, so I also required chemo, but we didn't decide that until after the surgery. In fact, going in to the surgery, my docs were not thinking that I'd need chemo because we caught it so early.

Denise-G

I totally agree with kayb - get that second opinion at an NCI Designated Cancer Center.  Myself, my mom, and my sister were all diagnosed with breast cancer within 3 years.  Did we learn ALOT!   The most important thing we learned is to get that second opinion immediately.  HUGE difference.  If you have to drive a long way, it is WORTH every mile to get that opinion.  It could save your breast and save you from treatments you might not need.

Sending my best!

angsam95

Thank you for your advice. Initially he recommended lumpectomy and radiation but when he examined me and realised that the lump was under the areola right next to the nipple, he said that he would have to remove the areola and the nipple to get clear margins. He said if I did a lumpectomy, the breast would cave in and wouldn't be able to be fixed cosmetically. That's why he changed his mind and recommended a mastectomy with reconstruction.

angsam95

It is not possible for me to go to a breast center. I can get another opinion. I gathered that the mastectomy was recommended for cosmetic reasons.

Mcfrenchy65

Hi, sorry to hear the news, but I thought I would post reply since I got diagnosed with same 2 months ago. We did MRI and petscan, and during massectomy did biopsy sentinel nodes. It all sounds reasonable (I should specify that husband is doctor so at home advice too...) we also did and you should do the DNA testing, which in my case was positive (BRAC2) because of that, although only left breast had cancer we did double mastectomy. We will also do ovarectomy and utersctomy (not sure how to spell) Take it one day at a time, each step brings you closer to recovery. I know easier said than done, but you are not alone. I found a lot of comfort reading other women's posts and answers. Take care.

ElaineTherese

OK, I can see why the surgeon might have recommended mastectomy, but definitely ignore his thoughts about chemo right now. Sometimes, it is too far away to go to a NCI Designated Cancer Center but whoever is determining your treatment plan should be following guidelines like those discussed in kayb's post.

msphil

hello sweetie i know that feeling of overwhelmed i was diagnosed while planning my 2nd wedding at age 43 But once treatment plan in place things will settle down some. Praise God i am a 22 yr Survivor this yr. So hangbin there. msphil idc stage 2 Lmast chemo rads n 5yrs on Tamoxifen.

ChiSandy

I will join the chorus recommending a second opinion--definitely with a breast cancer surgeon and a breast cancer reconstructive surgeon. You didn’t specify why you can’t go to a specialty breast cancer center. If distance or expense is a consideration, there are charities that provide free or greatly reduced-cost transportation (including air) and even lodging for your family or caregiving friends. There are plenty of women on these threads who thought they were stuck with their local healthcare providers but were able--despite distance and insufficient financial resources--to get at least their initial care (surgery) at places like Memorial Sloan-Kettering, Dana Farber, M.D. Anderson and Johns Hopkins.

You have a tiny tumor that at Grade 1 is sometimes described as “indolent.” Without doing an OncotypeDX there is NO reason to assume chemo would be advisable. And there are breast cancer surgeons who can do a lumpectomy even with the tumor in an inhospitable location--and oncoplastic breast surgeons who can take over to give you symmetry as well. Your surgeon’s assumption that your breast would “cave in” is also rash and unwarranted. Your tumor is 6mm. My friend had 6 cm (that’s ten times as big) of Grade 3 DCIS, behind her nipple, and was given the choice of lumpectomy+radiation or mastectomy. (She chose a bilateral mastectomy for personal reasons). If your surgeon is a general surgeon, run--do not walk--to a different hospital STAT! General surgeons--especially older ones--tend to be territorial (many will recommend an excisional biopsy so they can get the fee, rather than refer the patient to a breast radiologist who can do a core biopsy) and set in their ways (they were trained to do mastectomies and are not about to change.....and would probably charge more for one). A mastectomy almost always requires at least a 1, if not 2-day hospital stay, with more time spent under general anesthesia, higher risk of complications (and if you add reconstruction to that, an even longer recovery). That’s not to say you should never have mastectomy with or w/o reconstruction, but you should be given an informed choice--and your surgeon is incorrectly or incompletely informing you.

General surgeons are great for abdominal surgeries like appendectomies, hysterectomies, colon resections, hernia repairs and the like. I wouldn’t entrust my breasts to one......and I count several among our friends. You wouldn’t hire a probate lawyer to defend a DUI. You want someone who does breast cancer surgery (all types) and nothing but---and does several per week and has several hundred under her or his belt. And if you need reconstruction, you need an oncoplastic breast surgeon--not a plastic surgeon who does mostly augmentations & lifts.