Second cancer in the same breast

Walden1

My mother was just diagnosed with breast cancer for the second time in the same breast. She beat triple negative, grade 3, twenty years ago with lumpectomy, radiation and chemo. This time it’s Er/Pr positive (HER 2 equivacle). Her doctor said radiation and chemo cant be given twice and recommended mastectomy, despite the fact that the tumour is very small. She is surprised that lumpectomy is not an option but has accepted the mastectomy and plans to proceed in two weeks. Anyone out there with a similar circumstance advised to proceed with a lumpectomy without radiation? I would be very grateful to hear if it was part of a trial or which doctor was involved

rrshannon

I had TNBC In 2003 and now have ER+ PR- her2- In same breast right next to original tumor. For TNBC I had lumpectomy radiation and 4 rounds of AC. I knew the first time that If it came back im the same breast radiation wouldn't be possible again.

I just finished 4 rounds of Taxotere and cytoxan. And will Be having my BMX next month.

Did your mom get a second opinion? My second option agreed on the same treatment plan as my first which helped but my mind at ease.

Wishing you both all the best.

Walden1

Thank you so much for your advice. I agree a second opinion would be a good idea.

My mother is 75 so the mastectomy surgery may be tougher on her than a younger patient. Did you do oncotype to decide on chemo? I thought it was strange that chemo was ruled out without an oncotype, but my mom can’t remember some details due to the shock. Maybe it was her age that suggests against chemo? She originally did 6 rounds of AC so it’s my understanding that other chemo drugs could be prescribed, as in your case. I’m trying to ask questions on her behalf that will reduce the risk of over treatment with surgery and chemo. That said, she feels very comfortable with her doctor, Rhonda Janze

Congrats on completing your chemo, and best wishes for your upcoming surgery.

Beesie

Walden,

Has your mother been speaking with an Oncologist, or has she only seen a surgeon?

If she has not yet seen an Oncologist, I would suggest she do that, or at least not take anything the surgeon says to heart about anything other than the surgery. The surgeon handles surgery; the Oncologist handles the rest.

With regard to the surgery, if she has a small, indolent cancer - single focus of cancer, HER2-, grade 1 or at most grade 2 - it is certainly an option for your mother to decide to proceed with just a lumpectomy alone, without rads. Of course it would be important to get wide surgical margins, so breast size relative to the size of the tumor would come into play. My mother was diagnosed just one time, when she was 80, but she decided on surgery alone without rads, although she did have a re-excision to widen the margins. She also opted out of hormone therapy. She's 94 now.

The current NCCN Treatment Guidelines (the gold standard) do present the option of passing on rads for patients 70 and older who have a favourable pathology, but only if the patient has hormone therapy: (see the area I highlighted in pink)

With regard to chemo, that's where the Oncologist comes in, and I would think that if your mother is healthy enough to handle chemo, and Oncotype test would be ordered, assuming the tumor ends up being HER2-.

Hope that helps.

rrshannon

Walden1 Yes I had the Oncotype (I am now 51) and it showed that I should have chemo though my 2nd opinion doctor stated she would have done chemo without oncotype as I had a 2.6cm tumor and the Ki-67 was 46% and grade 2. Adriamycin also has a lifetime limit thankfully because it made me really sick when I had it.

Due to her age I would think things over and depending on her health. My moms cousin was 73 last year when she went through it she tolerated Chemo (I think Taxol or Taxotere) well and the BMX. She has some health issues though nothing major. Though everyone is different and a lumpectomy with good margins might be an option as well. You can also get a second opinion from a breast surgeon.

Walden1

Thank you Bessie. It is so helpful to see these references in NCCN guidelines. I have yet to confirm, but her biopsy result noted 3+, which I think means grade 3. In which case, it looks like NCCN would still recommend a mastectomy for a woman over 75 with a small (7mm) tomour.

So far she has only seen a surgeon, so given the shock she may have misinterpreted her comments about chemo. In any case, we do plan to consult with an oncologist, but it appears that referral wouldn't happen until after the surgery. I may try to push for it to happen sooner, but I think my mom would prefer to take it one step at a time, which I respect. I know from my experience that information overload can be exhausting especially in the early days. That said sometimes it gives you additional surgery options

edwards750

Totally agree with Bessie about the Oncologist making the call - not the BS. My BS told me I would get chemo after a micromet was found in my SN. It showed up in the Path report after my lumpectomy surgery. Instead my oncologist ordered the Oncotype test to see if chemo was warranted. She said women had been over treated for years and this test offered details about my specific tumor. The test came back with a score of 11 so I dodged chemo. I had radiation instead.

Point being the surgeon’s job is just that - surgery. Treatments are determined by the oncologist.

Diane

wallan

Sorry about your moms diagnosis and angst. What a shock to have BC show up again after so many years!

I was Dx a second time in the other breast after 13 years. The first time I had a mastectomy ,rads, and AC-T chemo and hormone therapy.

This time the BS told me I only needed a lumpectomy, but I decided to have a mastectomy for ease of mind of local recurrance. It was a good thing I did, because tiny tumors that were not showing up on the imaging were in my breast. I did not need radiation or chemo this time around, just hormone therapy again. The BS told me I would need chemo and radiation. And she told me I had 5 new primaries that act independently of each other.

My MO told me if I had been older (I was 54 at second Dx) she wouldn't even have treated my BC at all. She said the multitumors are common and didn't even seem worried. My tumors were tiny, hormone positive and grade 2. My oncotype was 14. But due to my relatively "young" age, she prescribed the hormone therapy. So the BS scared me and over reacted. The MO was calm and I don't even see the MO at visits. I see the nurse practitioner. I did ask the MO if I was to have chemo, she said I could have it. But I didn't need it.

So for your mom to say she can't have chemo again seems weird to me. Unless she has some health issue or something. Anyways, I agree with the other ladies here. The BS is for surgery and not prognosis or treatment. The MO is your best source of reality.

Hugs to you and your mom. It sucks anyways.

wallan

pupmom

Oh my gosh, I met with two oncologists before my surgery, and I had a pretty straight forward case. In your mom's situation I think it would be essential to meet with an onc before surgery. Best wishes!

Salamandra

My radiation oncologists at Memorial Sloan Kettering told me that the radiation doses they use for lumpectomies are nowhere near lifetime limits and they are sometimes using/seeing the use of 2nd and even 3rd lumpectomies after an initial lumpectomy plus radiation. If your mom would prefer a lumpectomy, I think she should seek an opinion at a state of the art cancer center. Some will give remote second opinions where you get all your test results sent and they review them and then speak with you over the phone.

purplestargazer

I can only share my own experience. I was dx'd triple negative in June 2017. I had lumpectomy with radiation plus ACT chemo (followed by Xeloda chemo and an immunotherapy clinical trial).

I had a reoccurance, diagnosed about a month ago. My team has recommended BMX and a different type of chemo.

My oncologist said the standard of care with a reoccurance is always a mastectomy. At this point, that's what I want as well, so I didn't seek out other opinions.

A second opinion is always a good idea if you're uncomfortable, though.

Walden1

Thank you all for your good advice. Like some of you here, my mom also felt comfortable with the surgeon, and had little interest in seeking a second opinion about the surgery itself.

Thought I would let you all know that she is very pleased with the outcome of the mastectomy. It’s been 10 days since the surgery, and she feels great; no pain, no noticeable change in arm mobility. Her surgeon and the hospital were wonderful. Apart from sleeping more often, you wouldn’t know she had surgery. Her biggest challenge now is letting other people take care of her for a change. As for chemo and her other treatment options, we will know more when the pathology comes back

Thanks again!

rrshannon

Walden1 glad to her that surgery went good and she is recovering well. Hoping for good a pathology report and continued healing.

Beesie

Great that your mother is doing so well!

Thanks for the update!