Radiation or Masectomy? How do I choose?

Marie,

It's generally wise to operate until the tissue removed reveals "clean margins": tissue free of any cancer or precancer involvement by at least 2 mm. Sometimes this is not technically feasible, such as when the cancer is next to the chest wall.

Radiation is effective in killing cancer cells, but usually is given when the bulk of invasive cancer is gone. 

Cosmetic views are important too. Will a third lumpectomy take more and still leave enough breast so that it suits your looks? 

Lastly, your surgeon should review local recurrence risk with you: most indicate if a recurrence occurs, your outcome is as good as if a mastectomy (then done) was done initially. But every once in a while, a recurrence results in a more aggressive character or a positive node(s). 

So, lot's to consider. You may wish to get a second opinion to review it all again with a different oncologist.

Sorry you've had a time of it. Please push for solid answers until your heart and mind are content.

My best to you,

Tender

I have been in the same boat for the last 3 months - I have LCIS and ADH - first seen as just calcs that resulted in biopsy.  Lumpectomy- Surgery for the ADH resulted in finding  DCIS, lobular - three excisions and 2 tumors found unexpectedly - 2mm and 4 mm,node neg.  They had just been going for the calc removal and came up with tiny cancers.  I was all set for rads after the first surgery and tumor - and even still, after the second.  But then on my final mamo prior to rad - there were still more calcs remaining - and now everyone is all over the place about what i should do - mx or rads.  The rads camp says, just go for it and if later you need an mx, you'll do it then - the mx camp says, how will you make a mx decision down the road, if your mamo still shows uncertain calcs - that we cant be sure of without removing them - either yet another lumpectomy or a mx.  After a summer to think about it - i am going for a mx - because, i just won't be able to know how to evaluate future mamos that show calcs - I am wondering if i am hoping for more tumors to be found in the mx breast when they test it??  Would the rads have killed off any tumors that may be remaining??  Could I have saved my breast and had no negative consequences because it is a non aggressive tumor??  Who knows?

Looking back, for me, the choice was relatively...not easy, but maybe more clear cut. My cancer was on the left side and with a strong family history of early heart disease and a strong personal history of pneumonia, I wanted to avoid rads, was urged to consider the potential problems by my doctors if I chose rads. I also wanted to minimize local recurrence risk as much as I could by getting rid of as much breast tissue as possible. For several other reasons that were very important to me, I chose a double mast.

In my case, I was fortunate in my choices as the original area included 3 tumors(tho tiny) along with DCIS, and the pathologist said the entire breast was literally peppered with DCIS(unknown to all of us before mastectomy) and the other, supposed healthy breast had a large amount of ADH.

It's not easy and I wish you peace in your choice. Weigh your pros and cons along with your own risk or lack of risk factors, then quiet your mind and let your logic and your instincts guide you.

Okay...well the (young) lady from left field wants to know what the pathology of the cancer is.

 Generally, IF the cancer is ER+, then I'm "voting" for lumpectomy (with or without rads...you make the call...based on what your onc says.)  IF the cosmetic outcome is projected to be poor, the mastectomy may leave you looking better (but keep in mind that the nerves are cut...so you will be Mrs. Doubtfire for the rest of your life.)

 IF the cancer is ER-, then I'm voting for the mastectomy (with placement of an expander).  And, I might go as far as to say bi-lateral.

In your particular case...multiple types of bc with unclear margins x2, I'm voting for the mastectomy with follow-on rads (particularly if your onc recommends it.)

 I would also do my best to get breast MRI...check the "good" boobie, too before making another surgical decision.

 Radiation does carry its own set of risks.  However, if the cancer is not extensive, you will probably take a limited dose.

Say YES to chemo.  Maybe a couple of shots of Taxotere ("insurance" policy.) 

Follow on tamoxifen for ER+ will help reduce risk. 

As Marlene aptly puts it...there are no guarantees.

Speaking as a person who did the "full metal jacket" (at my young age), I am well aware that breast cancer is a formidable disease.

What we do is the best we can.

tl