80 years old with DCIS

I can't imagine why they would advise a mastectomy in an 80 year old woman with a non-life threatening form of non-invasive disease that some call a pre-cancer.  Her DCIS may NEVER become invasiive in her lifetime.  It seems very drastic to me and I would absolutely get a second opinion.

That said, my mother had invasive cancer at 77 and had a mastectomy and did okay.  She died a year later of alcoholism.  She was pretty debilitated because of her alcohol abuse but still managed to recover from the surgery.  She didn't do reconstruction, of course.  That is much harder to recover from.  If her doctors all agree she needs the mastectomy, she'll do okay.

Please get another opinion.   In a 40 year old woman, DCIS has to be treated as if it was invasive because they never know if it could become invasive.  In an 80 year old, it could take 10 to 20 years before that happens, if it ever does.  Cancers in  elderly people are usually considered quite indolent and slow-growing, and I think she probably can be treated very conservatively.

Has she had a biopsy?  What grade is it?  

Maybe the Dr. thinks a Mast. would be easier on her than lump. and 35 doses of radiation.

I think I would agree with the Dr.  Will she let you go to the appt with her?  Write down questions.

Second opinion maybe.  I think radiation could be very hard on someone that age.  It is every single day

Hi Niece,

So sorry about your aunt!  Please invite her to come here and see for herself LOTS and LOTS of "whole women" with one or two or no breasts.  

There's lots of great information and support here for her and for you too - it's great that you're advocating for her and looking for information!

THere is some misinformation here, get sound medical advice

I think you should get a second opinion then trust the medical experts

Diedre, you by far, did the harder route. I understand that for some women, reconstruction can take up to 2 years. I certainly would get depressed if it took 2 years to feel normal!! But, as you remind us, her aunt already doesn't want to lose her breasts, and I personally, don't think she would have to! But that all depends on further testing, perhaps an MRI to see if there is vascular invasion and what else is going on.

Jane, I'd be interested to know what "misinformation" you see here. I read support and testimonials from women who have experienced breast cancer....what is your story?

She may also be a candidate for Mammosite radiation - 2 times a day for 5 days, which would be much easier than the full 33 day treatment plan. 

My mom is 80, and also has dementia issues.  I hope I never have to deal with this kind of decision.  But if I did, I would choose the most minimally invasive approach, regardless of what a surgeon might advise.  It is critical to consider the overall health of a senior and what other co-morbidities may exist when developing a treatment plan. 

Michelle

nieceincharge,

If the DCIS appears on the MRI to be diffuse and pretty much filling the breast, then I can understand the recommendation for the mastectomy.  That's the way my MRI looked too and it turned out that I had DCIS throughout my breast.  So a lumpectomy simply would not have been possible.  And if the DCIS is high grade, then there certainly is a risk that there could be some invasive cancer present, and for that reason, whatever appears to be cancer has to be removed.  It's an unfortunate situation since if it turns out that the cancer is all DCIS, it's very possible that it could stay in your aunt's breast and never affect her.  But since there's no way to know if it is all DCIS and since it's spread out over the whole breast, then a mastectomy does seem to be the logical choice.  

When my mother had her re-excision, she was shocked to find out that it was being called a "partial mastectomy". Since she'd already had a lumpectomy, the term "partial mastectomy" was being used for insurance purposes. That kind of freaked her out, even though she knew that the surgery really was the same as a lumpectomy.  After the surgery, she told me that her breast is a bit smaller and a big misshapen and at first she was quite bothered by this. As I mentioned in my earlier post, my mother was 80 when she had her surgery, so from her reactions I can certainly appreciate your aunt's concerns.  I don't think age matters much when it comes to how we view our bodies and our womanhood.  If your aunt sees her breasts as being part of her womanhood, this will be upsetting to her, regardless of her age.  My only suggestion is that you tell her that the surgery itself should not be difficult, and with a prothesis, there's no reason why anyone will even need to know that she's had the surgery.  

Jane, I'll second Barbe's question. I too am interested to know what "misinformation" you see here. What's your story and your background?  And are you truly a newbie here?  From your comment, it sounds as though you may be someone we know using a different name.  It would be great if you could expand on your comment and explain.   

It's certainly possible to have CT scan before surgery, in theory that is, cos I did, so i don't see why you couldn't get the other sorts. I would be hesitant about node surgery because of rehabilitation and mobility issues in an older lady, having seen what it did to me at 49! As well as the risk of developing lymphoedema. But unless the primary is very advanced, it is the chance of secondaries you need to be more worried about in the big scheme of things, so if it has spread, surgery may be pointless. That's why i think further investigations a good idea before rushing in. Just my take on it!

mollyann, at this point the diagnosis is DCIS and chemo is never warranted for DCIS, even if it's ER/PR-.  Even if a small amount of invasion is found, chemo most likely wouldn't be warranted unless there was nodal involvement. So if some invasive cancer is found, then there could be a reason to check the nodes.  And of course, an SNB is more difficult to do after a mastectomy has been done (since an SNB usually involves injections into the breast prior to the node removal); that's the reason why SNBs sometimes are done for women with high grade DCIS who have mastectomies.

If the comments that you are making about an SNB not being necessary are based on the new research that was released last week, you are completely misunderstanding the research.  What that research determined is that it is not necessary to do an axillary node dissection on those who have early stage invasive cancer who are found to be node positive (no more than 2 nodes) through their SNBs. Having the SNB is crucial to this finding and there is nothing to suggest that those who have invasive cancer should not be having SNBs.  

nieceincharge, the question of the SNB is an interesting one in your aunt's case.  Normally with high risk DCIS such as she has, an SNB would be done along with the mastectomy. But in her case, given her age and given how unlikely it is that she might have positive nodes, it could be reasonable to pass on the SNB.  It's a tough call. This is one place where getting at least a couple of opinions from doctors would be very helpful. I found that my SNB was a lot more painful and more difficult to recover from than my mastectomy surgery so there's reason to avoid that if you can.  On the other hand, if invasive cancer is found, then there will be the question as to whether the nodes were positive and if they are, whether chemo might be necessary.  But then if doctors would be relucant to recommend chemo to someone your aunt's age, that might be a reason to not bother with the SNB.  Lots of arguments to support either decision...  

mollyann, I said that "if the comments that you are making about an SNB not being necessary are based on the new research that was released last week...."  Okay, you're saying that this isn't the source of your comment.  

I don't dispute that removing nodes does not lead to increases in survival.  I haven't reviewed much research on this but I have read lots of studies that show that having a mastectomy doesn't increase survival and I would expect that removing nodes would be pretty much the same thing. If cancer cells have already moved into the body prior to the discovery of the cancer in the breast (and to my understanding this is what happens in most cases where mets eventually develops), then removing the breast and/or removing the nodes isn't going to affect survival.  That makes sense to me.

What removing the nodes does is help determine staging and treatment. And it's getting the right and appropriate treatment that saves lives.  For someone initially diagnosed with DCIS who is then found to have a small invasive cancer, understanding the nodal status can be crucial to their treatment decisions and long-term prognosis.  

I don't want to hijack this thread so I won't ask you to post your previous research. I will do a search on your name and this topic and see what you've posted about this before.  Given the breakthrough nature of the study that was released last week, and the fact that this study still recommends SNBs, I am very interested to see the studies that you are referring to that suggest that checking the nodes simply isn't necessary for those with invasive cancer, either for staging, treatment or survival (and as I said, I understand the survival part). 

It is very confusing Neice and I think what people are saying is, get another opinion or two if you can. Things like the risks of anaesthesia figure highly for someone this age. We here don't know if she's a young 80 or an old 80 if you know what i mean by that, what else she has going medically, socially eg will she have to cook for herself etc when she goes home or is there already carers package in place (in addition to all the help i'm sure you give!) that's when Lymphoedema can become so disabling and push her into being unable to cope and maybe have to go into a home if she currently manages alone or with minimal help. Things like that matter so much more IMHO than living on from 87 to 93, we are talking enjoy living from 80 to 85 - and then maybe 93 why not! and also if investigations will change or decide a treatment option that's one thing, but if they already decided she's too frail for chemo then finding she might have benefitted from it, is pretty futile. Thirty-year survival isn't really such an issue....

It all puts you in a tough position too, I'm guessing you are probably her nearest relative if you are handling her affairs, that's really stresssful on you as well and the extra opinions can help you get your head round it a bit better. Wishing you well in the tough choices in finding the best care for your aunt and that she tolerates well and responds to whatever treatment is thought best. And that you yourself can end with least regrets, you are doing everything you can for the best with the information you could get at the time and nobody can do more than that.

Hi Mollyann

You said,

" Niece, There is zero reason to take a sentinel node except to stage her for chemotherapy. If she is ER-/PR- from the biopsy information, that is already an indicator for chemotherapy which she can refuse. So it is redundant to take a node to stage her twice. If there is cancer in the nodes, removing them will not improve her survival and only risk crippling lymphedema. Please PM me if you want the evidence for this."

How can you presume to know whether there is zero reason for SNB in this particular person's situation?  Or what reasons her doctors may have for recommending specific treatments?  It's one thing to mention other options, but to make these kinds of assumptions about a stranger and her doctor is just plain irresponsible.  Why imply that her doctor is an idiot who would knowingly endanger his patient?  Yikes!

And why would you ask someone to PM you privately for evidence?  If you have evidence or new research, I'm sure we'd all be interested in it - why not start a new thread to discuss it?  

I can't help you with a mastectomy, but I thought I would share with you the story of my great aunt.  She was diagnosed with BC about 10 years ago.  She had a lumpectomy and did chemotherapy.  She is now 93 and is in great health.  Age does not prohibit proper treatment as long as you aunt's health will allow it.

Good luck!

Mollyann, I have heard of cases where patients who are unable to get general anethesia instead get some kind of spinal block and twilight sedation, but I thought this was very rare. Are there other reasons a patient might make this choice? I'm just curious. I never considered anything but general anesthesia and other options were not given to me, but I was 33 at the time of my mastectomy and otherwise in good health. For older women, maybe this is something they can talk to their surgeons about?



But the last part or your post-- a mastectomy that only takes half an hour? How in the world is that possible? I'm trying to keep an open mind here, but the the thought of a 30-minute mastectomy just makes me think it would be some kind of hack job! My surgeon took almost 5 hours to remove my breast and do a SNB (all mapping was done the day before, so the SNB would have been a very small part of the operation). I didn't have any reconstruction or anything else done, just the unilateral mastectomy.



How would a breast surgeon remove all the breast tissue in such a short amount of time? Is this a different procedure than the typical modified radical mastectomy?