Do I need radiation? (post BMX)

jumpstart

Sorry if this type of question has already been answered in other threads, but just wondering if I could hear some other experiences to help with my decision on radiation, as I have consulted with two oncologists and they have somewhat different opinions -

I originally had a lumpectomy a few months ago and am currently undergoing chemo. However I have since gotten positive genetics results back, and will have a BMX after I finish chemo. I had hoped in this case to be able to avoid radiation after the mastectomy, particularly considering some potential risks associated with radiation and the gene mutation I have, but my oncologist suggests as I had 3 positive nodes I should still have radiation to the chest wall area after the BMX. The other oncologist I spoke with said usually radiation would be indicated post BMX in my situation, but he could understand the case for not doing it considering there are a lot of unknowns about how the particular gene mutation might play into radiation effects etc.

Just wondering what usual threshold is for recommending radiation after mastectomy and relative benefits it might convey? (oncologist didn't really answer this, just said it would always be recommended in my case.) Is hard to weigh up potential benefits vs. (uncertain) risks and side effects.

Thanks in advance.

Linda

MinusTwo

Lumpectomy means radiation unless there are very special circumstances. That's one of the reasons I chose mastectomy. I did not have rads at that time, but when I had a recurrrence - yes up by the collar bone w/no breasts - I did have radiation.

jumpstart

Thanks for the reply! My question is about radiation still being recommended to me after a BMX and in what cases that would be indicated

MinusTwo

Jump - it's always possible that micro-mets can be in your system before/after a BMX. That's what happened to me - only they didn't discover it for 2 years after BMX because I had clear margins. Have you talked to a radiation oncologist yet? It think I'd do that next.

Hopefully Beesie will have some stats to add.

hnsquared

jumpstart....I had chemo and then a bilateral mastectomy. I have a PALB2 genetic mutation. My surgeon found a suspicious node during a manual exam, biopsied it and it had cancer...that’s why we did chemo first. After chemo the node still had micromets but of the 14 nodes taken it was the only one with cancer. Radiation was recommended due to the 1 positive node. I know my plan was aggressive due to my age and the genetics. I didn’t really want rads but I did it...finished 12/17/20. I think with 1-3 nodes they recommend rads even after a mastectomy. I’m sure someone with more knowledge than I have will comment. Best of luck making that decision.

jumpstart

Thanks so much MinusTwo and hnsquared - that is really helpful! Hnsquared - it sounds like my plan would be similarly aggressive. congrats on finishing rads!

Redkitty815

My RO said that radiation after mastectomy reduces the rate of local recurrence by 75% so they use it in cases where recurrence risk is higher (positive nodes, larger tumors). I had a BMX and also just finished radiation. It was rough, but similar to above posts, my team is throwing everything they can at it given my age (43 at diagnosis)

jumpstart

Thanks so much Redkitty - sounds similar for me (I am earñy 40s). useful to hear about lowering risk of local occurrence by that much - I didn't know that! Congrats on finishing your radiation and other treatments