Whole breast radiation? Decision time is here

njmae · February 2011

Hello all,

I am at a fork in the road as far as decision on radiation.

I was hoping to have Mammosite and had the device put in. Went for the simulation and I flunked. Out came the device. This was last Friday.

I had a 7 mm mainly tubular tumor and the margins are extremely wide due to the anticipated Mammosite. I requested that the pathologist look again at the slides to determine degree of tubularity (not the same as tubules). The percentages in the studies of this subtype of cancer determine that anywhere from 70% to 100% are required, otherwise it's mixed. I know mine is over 70% but want to know the precise number.

Onward... I went to the oncologist on Tuesday and also saw the surgeon. Both have given me the standard of care guidelines (lumpectomy + radiation) but have said that I do have the option of foregoing whole breast radiation. Both said it is unlikely to recur but if it does locally I can also have another lumpectomy and play the radiation card then. The oncologist thought I could do radiation or an AI, but doing both is probably unnecessary. I was actually surprised that she would offer that. The breast surgeon said that if anyone could likely get away without doing radiation, it would be me.

I see the radiation oncologist this afternoon. Due to the ex-tumor's location, I believe all they have to offer is whole breast, rather than the partial external beam. I am resisting it because I'm not so sure it gives me much, in light of the particular tumor type. In addition to being tubular, every other factor is extremely favorable (the lowest possible Grade 1). I'm 61 and the tumor is 90% estrogen positive.

Since one reads about standard of care, it makes you stop a bit before venturing off the beaten path. That's why I'm here.

If anyone would care to offer an opinion, I'd be very appreciative.

ProudMom_Wife · February 2011

Sorry, can't offer much of opinion, only wanted to share with you that you are not a lone. Just wanted to let you know that I am in a similiar, yet different boat, needing to decide on radiation. Doctors opinions are split with my pathology, although I had a BMX and not a lumpectomy. Your pathology that you posted looks good. Do as much of your own research as possible and then based on that and the opinions of professionals (I got different opinions) go with your gut. You need to do what is best for your body. Also, which side was the cancer on, right or left? That may weigh into the deicison also, since left side radiation carries more of a potential risk to your heart.

Good luck!

dlb823 · February 2011

njmae ~ You may need to get opinions from more than one rad onc. When I was in a quandry about whether or not to do rads (for entirely different reasons), I spoke to several rad oncs, including a renown radiology professor emeritus with many years experience. His pro rads recommendation (after several others) really helped me to realize that doing them was probably the wiser choice for me. Sometimes you just have to hear opinions yay or nay from multiple docs to make a more informed, confident decision. Deanna

njmae · February 2011

Visit with radiation oncologist went very well. He spent an hour with me discussing recurrence rates and other factors specific to my situation. He acknowledged that my rate of recurrence was on the low end but radiation could shave a few points off that. He said it was such a low grade that he thought the Canadian short protocol of 15 days would be appropriate. Has anyone had that or heard about it? I am still concerned about using up the one shot at radiation on a really tiny, low-grade cancer.

Whole breast radiation? Decision time is here

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