Giuliana Rancic early stage BC

LtK wrote

"Voracious, that is a good quote.  I think it's largely fear driving us now, who wants to look in the face of mammography potentially being less effective than we'd hoped. " ...

in regards to me, it was very effective-

 of course we need more screening techniques, but for some, mammograms can save a life. Even with dense breasts and a non-palpable tumor. It's a fact. Unless of course there is some proof that early stage breast cancer is somehow not dangerous and it does not matter whether or not is it discovered? I missed that news somewhere.

(I removed a section here where I was basically whining and stompin my feet...:) We are all on the same focus, just coming at it from a number of directions.

The latest news is that she is now having a BMX, after having the lumps. It doesn't say in the reports, but I guess we can assume her margins weren't great. I think she is very petite, so that doesn't help. She doesn't seem to want rads, so I am hoping this works out for her. She also doesn't want to take Tamoxifen and put off her fertility treatments. So I guess she is thinking she can have the BMX and get right back to making a baby. I read in one report that she hopes to be fully revovered by New Year's Eve, which I find incredibly optimisitc for a BMX. But, best of luck to her!

She made the announcement on the Today show this morning.

Here's a link:

http://scoop.today.msnbc.msn.com/_news/2011/12/05/9221432-giuliana-rancic-to-have-double-mastectomy

 I think we all wish her the best.

I just finished a bone scan which clearly they had seen something suspicious. They sent me to another room for a 3d scan.  I am needless to say scared.  Has anyone else had a suspicious bone scan?

Tori, I'd say that it depends on what the margins are after surgery and the pathology of the cancer.  Right now she has positive margins after her lumpectomy so her recurrence risk is probably extremely high.  If she had a re-excision the objective would be to get clear margins and with clear margins - and with radiation and hormone therapy - it's unlikely that her recurrence risk would be as high as 40%.  Maybe 20% if the margins aren't great and the pathology is aggressive but that's probably on the high side too.

However I will say that overall I thought that her interview was a lot more realistic and accurate than many of the interviews I've seen from other public figures who've had BC.  At least with the BMX she indicated that she still had a 1% chance of getting BC - she didn't say, as so many others have, that "I never have to worry about BC again". And she and her husband stressed that this is a very personal decision and everyone has to do what's right for them.  

The one thing she didn't address is her risk of mets, which of course is unchanged regardless of whether she has a BMX or not, and which probably is somewhat greater than 1%, assuming that she has invasive cancer and assuming that she doesn't take hormone therapy (one of her goals is to get pregnant sooner rather than later).  I have to admit that I don't blame her a bit for not raising that one.

She might have multifocal DCIS. As Beesie pointed out, she probably has positive margins if she is willing to undergo more surgery,and perhaps re-excision may not be feasible, for cosmetic reasons.

I was also confused about the 1% comment.  Maybe she is talking about local recurrence.  At 37 with bilateral disease, I can't imagine how her risk of recurrence is 1% without tamoxifen.  I hope she is listening to good advice.  I think it can be easy to be overwhelmed with grief over the loss of one's breasts and not understand the lifetime risk of estrogen positive BC recurrence. 

While the info is still a jumble, the tone is definitely sober, and geared towards simply saving her life.  And for that, I'm really very sorry.  It's still an unreal experience for me, looking at breast cancer in the face.

Wouldn't the SNB have been done at the time of the lumpectomy?  It would have been part of this same report.

you know I wonder how many women go in for a lumpectomy and end up with BMX. When I was first DX I was told and believed  a lumpectomy 5 day SAVI radiation  and done, but until they get in there and get back reports any thing can happen. My heart goes out to her, so many memories this story brings back. Cancer Sucks...

Nancy

I am confused, she did not have radiation, right. I read conflicting reports.

My guess is that she is fairly early stage - probably Stage I since they did check her nodes at the time of her lumpectomy.  Assuming she was node negative, then unless she was HER2+ or triple negative, chemo would in most cases not be recommended.

She came out of the bilateral lumpectomies without clean margins in one breast.  Next step therefore was either a re-excision followed by radiation, or a mastectomy.  By having the BMX, she should be able to avoid radiation (unless it turns out that she has positive margins even after the mastectomy).  As for Tamoxifen, it would be used to reduce the risk of both local recurrence and mets. With the BMX her risk of local recurrence is only about 1% so she wouldn't really need the Tamox for that.  Nobody knows what her risk of mets might be - nothing has been said to give any indication of this.  The risk of mets depends on many factors - the nodal status (which I'm guessing is negative), the size of the tumor (maybe not that large given that re-excision was an option, but on the other hand she had two separate cancers, one in each breast), the aggressiveness of the tumor and the Oncotype score (if she had the test done). I'm guessing that her risk is low enough that she feels that it's okay to skip the Tamox. 

In the Los Angeles Times her husband said that after not getting clear margins on one side she is not having additional surgery for clear margins, NOT having radiation, and going straight to BMX.

I'm going to go back and watch the Today Show episode she and Bill was on. Because I thought she had just had the double lumpectomy and didn't get a good outcome on the test, so she was opting for the double mastectomy.

I'm thinking it must be DCIS with such a low chance of recurrence and no strong recommendation for tamoxifen. Sounds similar to my experience a number of years back. I had two lumpectomies to get clear margins, we thought we were in the clear (no radiation needed), then found some more DCIS in a different part of the breast. Finally decided on the mastectomy and no further treatment was needed. Should have gone for the double as 10 years later IDC was found in the other breast.