Recent diagnosis HER2+ Lumpectomy or Mastectomy?

Jeanne B - I wish I could tell you that a mastectomy would spare you from chemo, but unfortunately, it won't.  The goal of the surgery is to get rid of the cancer locally - that is, in the breast.  Chemo and Herceptin will treat you from head to tow in case there are any errant cancer cells floating around in your bloodstream looking to set up camp in other parts of your body.  You said your doctor has told you taht the chances of local recurrence are the same - this is becuase even if they remove the entire breast - or both of them! - there is no way they can remove every bit of breast tissue you have.  Your breast tissue not only extends down to your muscle, but also under your arm & almost up to your collarbone.  You sound like you have a very wise doctor who is telling you to take the path of the lesser surgery as that is what he/she feels is necessary (i.e. not overkill) to give you the best outcome.  I had a lumpectomy, chemo, and rads (radiation) back in '05 and am also HER-2/neu positive.  I have not had a recurrence and am very happy I went with the lumpectomy rather than mastectomy.  One thing to keep in mind is that you can always change your mind about a lumpectomy and get a mastectomy later, but if you get a mastectomy now, there is no going back.  I hope this is helpful and wish you the best of luck.

~~Jennifer

JeanneB - my onc told me I had a 23% chance of distant recurrence (stage 1 node negative) and that having chemo/herceptin would halve that. I'm also on Arimidex for the hormone receptors and that would also reduce the chance of recurrence. If you are premenopausal, they would prescribe Tamoxifen. Arimidex is for post menopausal women. After 4 months on Arimidex, when I had my last mammo last year, my onc said you can already see a change in the density of the breast, so that was good to know.

As Jennifer said - the radiation helps prevent local recurrence. There would be no difference in distant recurrence rates based on lumpectomy or mastectomy. I was told a lumpectomy + rads = mastectomy.

The important thing is to understand just how agressive HER2+ve bc is and do everything you can to help yourself and if that means chemo/herceptin so be it. They have only made herceptin available to early bc patients 6 or so years ago I think and they are now talking about giving chemo/herceptin for even smaller than 1cm tumours. We are lucky to have it available to us.

I certainly wouldn't rush in to having a mastectomy as Jennifer said, you can't change your mind once it's done. I've avoided it so far and I'm glad.

Sue

My BS would have recommended an lumpectomy but my tumor was so big (total size 6.5 but invasive part only 5.5cm) and my small breast (large A/smallB) that there really wasn't much breast tissue left. I did a double because there was stuff in the other one too (small amount of LCIS). I believe your surgeon is giving you good advice.

Also having an MX doesn't guarantee no radiation. If your tumor is large or too close to the chest wall they might want to radiate. Not all the time. I was given a pass in spite of the size of my tumor and close margins but that was because my treatment was/is so aggressive.

I have no regrets but losing a breast is a big deal. You will lose sensation. In most cases loose your nipple. You breasts will not match… and several other issues. Granted there are pros to the MX too. It does reduce the risk since there is much less tissue but they will be watching you so closely now they will catch it early.

Wait till you get more information from you path. You can do the lumpectomy then if you change your mind do the MX. Once you do the MX there is no going back.

I was 39 at dx and went with my surgeons recommendation of a Lumpectomy and axillary node clearence due to multifocal. I only have small breasts (B cup) and I had 2 tumours 2cm and 1.5 cm and I have a very good cosmetic result

I did Chemo, Rads and Herceptin which took 8 months and I was so glad by the time I got to the end of treatment I didn't have to face any further surgery apart from getting my port removed. I was able to go back to work in the corporate world  without having further time off for reconstruction.

It's a personal descsion, but the Her2 factor isn't a contradindication to lumpectomy. 

I don't believe there is a different local recurrence rate for her2+. My understanding is that local reoccurrence rate is slightly higher for lumpectomy, but overall survival rates are similar. The choice is very individual. I chose mastectomy because my breasts are small and the lump was near my nipple so a lumpectomy would have taken most of my breast and nipple. As well I knew before surgery that because of my size and location of lump I would only have radiation if three or more lymph nodes were affected. I wanted to avoid radiation if possible. They analyzed my breast tissue after mastectomy and found a second small IDC area so in hindsight I'm glad I had the mastectomy, but everyone's choice and situation is so individual.



Christine

JeanneB - you may be eligible to receive radiation for only 5 days if they put an implant in your breast - I'm sorry, I don't know what it's called, but my gf is getting that now. I definitely would recommend a lumpectomy over a mastectomy - don't make MY mistake, thinking that I could avoid chemo if I had an MX. I was very confident this would be the case for me (my onctoype score came back in the "low-intermediate" range - a number 22) - and my oncologist was patting my on my head, sending me home with just a prescription for Arimidex (I was post-menopausal) when he realized he didn't have the results of my FISH report..........10 minutes later, the rug is pulled out from under me again, and I'm sitting in his office listening to him say I would need 4 months of chemo with a year of Herceptin! I felt then I went through the mess of the mastectomy for NOTHING! And the immediate recon I chose also turned into a nightmare (I ended up with mrsa in my abdomen - and a large hernia.)  So you can see why I am totally against mastectomies unless they are ABSOLUTELY necessary!

One question - have you had an MRI done on both breasts? If you have dense breast tissue, before any conclusions can be drawn about anything, most BS's requests MRI's to see if there's anything else going on. Also, even though you know already that you're Her2+ - be sure to ask your oncologist to send the tissue out to a second laboratory for a second reading/opinion. Labs DO make mistakes! Good luck with everything and I'm so sorry you had to join us here.

P.S. - ask your oncologist about the possibility of getting Navelbine (instead of the Taxols) with Herceptin. A new study proves it works just as well for early stage Her2+ breast cancer - and it won't cause you to become bald or damage your heart.

Hi Jeanne

I was diagnosed with BC in 2002, I am now almost 9 years since diagnosis.  I had a mastecomy, no choice of a lumpectomy as had DCIS plus Invasive, I had an immediate reconstruction as at the time the invasive part wasn't in the picture:)  I had HER2 + but ER/PR neg.

I had chemo, radiotherapy and was very fortunate to be accepted into the HERA trial at the time and had Herceptin every 3 weeks for 12 months.

I've been well and continue to have 6 monthly checks.

I hope all goes well for you with your appointment and I believe you can download a sheet on how to interpret your pathology report, or you could all the years ago I was diagnosed, I found that really helpful.

Cheers Sharon