Newly diagnosed, conflicting info... Need opinions

Hi ladies,

Before I start, I want to let you know that I am posting on behalf of my 62 y.o. computer-phobic mother.However, I've been to every appt., sat in every waiting room, and used my knowledge as a medical assistant to help her through all this. I'm the only child of a single mother, so to say we're close is an understatement. Here's her story (forgive me for being long-winded):

My mom has had a history of breast lumps since 2006, all biopsied, all benign. There was only one lump (left breast, 2008) that showed a suspicious biopsy and had to have a lumpectomy. This lumpectomy was benign. All her mammos including her latest one have been benign. Her sonos have always shown benign lesions as well (but were biopsied anyway of course) until her latest one in September 2012 which showed a small nonspecific focus in the left breast. She was told to f/u with another sono in 6 months. This one showed that the nonspecific focus had gotten a little bigger, so a biopsy was done. The biopsy was read by our hospital's chief pathologist and also was sent to a breast specialist in CA, both of whom agreed that it was ADH and recommended excision.

Lumpectomy was done 5/8/13. The surgeon (the same surgeon who has done every biopsy and lumpectomy since the beginning) removed a sizable specimen and did not do a SNB. This was read by the pathologist who was covering for the chief pathologist at the time as a"focal area of DCIS, low grade; clear surgical margins." When the chief pathologist returned, he also read the specimen and amended the path report to "MINUTE amount of DCIS, low grade; clear surgical margins (0.1 cm from nearest inked margin of resection)" with a footnote stating that "because the amount of DCIS was so minute (less than 0.05 cm) and on recuts was even smaller, breast prognostic profiling could not be performed."

She was referred to a heme/onc. During the first appt. with the onc, he told her she was very lucky, all the cancer was removed, the surgeon CURED her, and brought out the flip chart showing that she was Stage 0. No mention of rads, drugs, what to expect, nothing. He then ordered routine blood work, a chest x-ray, a CA 27.29, and told her to come back in 2 weeks. That follow-up appt. was today.

So there we are today in the office. First he asks what we talked about the last time because he doesn't remember. He looks at the chest x-ray and the blood work and says that everything looks fine. Then he says to make an appt. with the rad onc. She asked him if he really thought she needed rads. He said that if she gets it or doesn't get it, she'll be ok either way. Now what kind of answer is that?? Then he gives her a prescription and says that because they couldn't do the hormone profile on the DCIS (too small), this pill would cover them all. She has to ask him the name of the drug because he doesn't tell her. It's Evista.

All right, so WTF?? There was no risk-benefit analysis done, no information given, no nothing. Just "Take this, it's a good pill." No mention at all of the black box warning about dying from strokes or getting DVTs. My mom is an insulin-dependent diabetic, has a 50% blockage in her right carotid that is being monitored, and is a former smoker of 30 years. Her mother had several TIAs and a massive brain stem stroke that led to coma and death. Multiple aneurysms on her father's side (father, 4 AAAs; uncle, 5 brain; grandmother, ruptured in brain and caused death in her early 50s). There is no family history of breast, ovarian, uterine, or cervical cancer in either side of Mom's family. There is, though, an obvious strong family history of vascular events along with her own personal risk factors for the same.

The other issue then is about the rads. Is zapping that single minute area of low-grade DCIS that was totally and cleanly removed by lumpectomy worth the risk of exposure to the heart and lung?

Based on the above info, if this was your scenario, what would you do? We'd love to hear the opinions of those who have been on this rollercoaster before... Thanks in advance!