First Doctor appt now questions and wondering what to do?

Shellbell, 

Invasive ductal carcinoma is the most common type of breast cancer.  So no, IDC is not really a terrible diagnosis.  But IDC is a very broad umbrella - there are all sorts of different diagnoses within IDC.  Some are not aggressive at all, and others are very aggressive.

With a 0.7cm tumor, the good news is that you have a small tumor.  But your cancer is also grade 3 and HER2+.  Those two factors mean that it is highly likely that you will require chemo, whatever surgery choice you make.  That's the thing about chemo.  The need for chemo doesn't change if you have a lumpectomy or if you have a mastectomy or if you have a bilateral mastectomy.   So when you make your surgery choice, it's important to understand that.  If it's determined that you would benefit from chemo, that's not going to change if you choose to have a MX or BMX instead of a lumpectomy.

In fact, current treatment guidelines suggest that chemo and Herceptin be given to patients who have ER+/PR+/HER2+ cancer that is 0.5cm or larger in size. The NCCN guidelines are the ones used by most doctors in the U.S.; see page 76 for the treatment guidelines for your type of diagnosis:   NCCN Guidelines for Patients / Breast Cancer

At this point, have you only talked to your surgeon?  It might beneficial to also talk to a Medical Oncologist.  Sometimes this discussion doesn't take place until after surgery, but sometimes the initial discussion with the MO takes place prior to surgery.  Your surgeon can advise you on the surgery options, but everything else should come from the MO.  It's the MO who will recommend what, if any, additional treatments will be recommended after surgery, be it radiation, chemo, Herceptin or hormone therapy.  The MO might also be able to advise you about the surgery choice - sometimes if chemo and Herceptin are required, MOs will suggest that the patient not undergo a MX or BMX, at least not initially, because it is a harder surgery with a longer recovery time, and it's important to keep your strength for the chemo and Herceptin treatments.  On the other hand, the MO might agree that a MX or BMX is the best choice for you. So it might be helpful to you to have a first discussion with the MO prior to making your surgery decision. 

When you are diagnosed with breast cancer, you are thrown into a whole new world, a world that you really don't want to be part of.  It's scary and it's hard.  But you will figure it out, as you learn more about your diagnosis and understand more about the treatment options..  

(((Hugs)))

Hi Shellbell, 

Lumpectomy or mastectomy, either single or bilateral is a personal choice. I feel the same way about it as your nurse friend, probably for the same reason. In the job I worked at all my life, I saw many women who had a new cancer in the "good boob" several years after dealing with the original breast cancer diagnosis in the other breast. That meant having to go through this all over again. I couldn't stand the thought of that so I chose a bilateral mastectomy, even though it was a small, low grade cancer. I knew for me, that was the right choice. Worry and he thoughts of yet another surgery would have driven me crazy. My best to you as you make your decision. Another lady in my neighborhood had a bilateral mastectomy the day before mine who was her2 + and did chemo and herceptin. She did fine too. That was 4 years ago and she's still good.