Surgery options for Stage III, Grade II IDC

Hello BC Sisters,

Like many ladies, I have visited the discussion boards since the early days of waiting for biopsy results and have finally decided to post in the hopes of getting some feedback on my particular situation.

After my sister was diagnosed with IDC, stage I, at the age of 51 in August of 2009, I was also diagnosed with IDC, Stage IIIA, in early November 2009 at the age of 48. My aunt on my mother's side also had IDC and unfortunately passed away a few years ago from secondary lung cancer at the age of 67.

In November 2009, I had a core needle biopsy of a left breast mass and axillary lymph node. They both tested positive for IDC. I am stage IIIA, tumor in both my left breast and lymph nodes are grade II. Mammograms and ultrasounds on both breasts have multiple hypoechoic areas all under 1cm ( the tumor in my left breast according to the ultrasounds was approximately 3.5 cm) however, I have a permanent cardiac pacemaker and therefore am unable to have breast MRI to further investigate if these "other" hypoechoic areas are potentially precancerous, or, God forbid, cancerous. I also have extremely dense breast tissue in both breasts which we all know complicates early detection of BC...

So, my breast surgeon, Oncologist and Radiologist discussed my case thoroughly at the time of diagnosis and recommended neoadjuvant chemotherapy so we could monitor not just chemotherapy response on the known malignancies, but also if any of the other hypoechoic areas were responding by use of mammograms and ultrasounds after my first four treatments of DD A/C instead of doing lumpectomy and axillary node dissection prior to chemotherapy.

The plan was a good solution because it should make surgery options clearer once chemotherapy is completed and further mammograms and ultrasounds have been assessed. I have completed the four DD A/C and as of today, also ten of twelve weekly Taxol treatments. We( my Oncologist) myself and my family are now beginning to consider surgery options for mid to late June 2010.

My Oncologist is suggesting that she would recommend breast conserving surgery ( probably quadrantectomy) on the affected breast and five weeks of rads ( axillary lymph node dissection is unavoidable), providing the breast tumor has decreased substantially ( it was reduced to approx 2.8 cm after four DD A/C treatments) and there are no other changes in any of the other hypoechoic areas. She used the studies we've all heard about which suggest no benefit in mastectomy so long as breast conserving surgery is followed up with rads, to support her recommendation...

Initially, after reading the studies that say breast conserving surgery and mastectomy have almost the same percentage of recurrence, although mastectomy DOES reduce the percentage slightly, I was leaning in the direction of my Oncologist's recommendation. Now, after a long five months in chemo and all the side effects, as well as listening to my husband and kids concerns of recurrence, higher risk of new cancer in unaffected breast and the huge disadvantage of not being a candidate for MRI until new MRI technology is available for implanted cardiac pacemaker patients, I am leaning heavily towards BMX.

I think that when I discuss further with my Oncologist, she will push back, but the fear of recurrence or a new cancer is so real for me and my family and knowing that without the benefit of MRI, which is especially beneficial for those of us with extremely dense breast tissue, a new or recurrence could easily be missed with mammogram or ultrasound, makes me want to push for BMX. Then there is the reality of having to go through chemo again should cancer return, which I hope I will never have to endure again and still ending up with mastectomy... These factors, to me and my family, make it seem more sensible to be aggressive with the surgery options than just keeping our fingers crossed that mammograms and ultrasounds will pick up anything in the early stage if we go the breast conserving route. 

I know so many of you have struggled with this decision and I'd like to know if you think it's reasonable to expect that given my disadvantages of having very dense breast tissue and not being able to use MRI because of my pacemaker, my Oncologist should support me in asking for BMX.. I know my family would feel more comfortable with this decision and frankly, it would be incredibly hard on me to look in their eyes and see pure fear again should cancer return. Just like your families, my cancer diagnosis has been very hard on them and I think given there are no guarantees for any of us that cancer will not return, it seems to me that if I go the BMX route, then I will have done all I can do to prevent recurrence in my affected breast or new cancer in what we think ( but do not know for sure) is a healthy right breast. If cancer returns after those measures, then so be it.

I would really, really appreciate any insight or comments that you might have. I have taken great comfort already in reading many posts on the discussion boards have gained much knowledge.

Thanks