Lumpectomy or Mastectomy - 76 year old

Really, she should discuss this in depth with her breast surgeon, and possibly a radiation oncologist. And her internist should also be consulted due to the other conditions.

I had a lumpectomy & radiation. They used general anesthesia for the lumpectomy, and they also took 5 sentinel nodes for biopsy. Because 4 of those were positive for cancer, I had to have another surgery to take more lymph nodes. The 2nd surgery took a lot longer (3 hours) because it's very difficult to get those lymph nodes out without damaging muscle & nerves. Healing from the surgery was fairly quick. 

I had no side effects from the radiation, except for some slight skin "burns" towards the end of the course of treatment. The radiologist applied a special waterproof bandage over that area. I was 58 at the time, and had no heart or lung problems from the radiation.

Will she also have chemotherapy? If so, whichever type of surgery she chooses, she should talk to her doctor prior to it about installing a port for chemo. My doctor didn't mention it, and I didn't know until my first chemo session that there was such a thing. The port goes directly into a chest vein, and looks like a bottle cap under the skin after it's healed. Nurses can directly access it for chemotherapy infusion, usually with much less difficulty that accessing an arm vein. It also saves the arm veins from damage from the chemo drugs. Once the incision is healed, no care is needed (except that the medical team will flush it before & after each infusion). They gave me a prescription for a numbing cream to apply 1/2 hour before treatment so I didn't feel a thing.

Hope this helps. Of course, what is seems right & good for one person is not for another. 

A lumpectomy is a much easier surgery to go through and much easier to recover from. If she has other health problems, a lumpectomy very well might be the way to go for those reasons. Radiation is very targeted now days and rarely causes collateral damage. Due to her age, she may be able to skip anyway.....something to ask about.

Here is a very recent article from BCO research pages. I am pasting the whole thing over for you to look at.

Some Older Women With Hormone-Receptor-Positive Disease May Be Able to Skip Radiation After Lumpectomy. 

Published on January 28, 2014 at 5:22 am

• Topic: Radiation Therapy
• Tags: Standard (most typical), Breast, After surgery, and External

In most cases, the usual treatment for early-stage, hormone-receptor-positive breast cancer is lumpectomy to remove the cancer followed by about 6 weeks of radiation therapy (you receive treatment 5 days per week) to destroy any cancer cells that may have been left behind after surgery. This two-step approach reduces the risk of breast cancer recurrence (the cancer coming back).

But in 2004, this treatment approach changed for older women. Large studies showed that while lumpectomy plus radiation did reduce the rate of recurrence among older women, it didn’t improve overall survival. Overall survival is how long the women lived, whether or not the cancer came back. So the National Comprehensive Cancer Network modified its treatment guidelines: radiation therapy became optional for women ages 70 and older diagnosed with early-stage, estrogen-receptor-positive breast cancer who take hormonal therapy medicine for 5 years or more after lumpectomy.

Doctors then wondered if certain postmenopausal women younger than 70 also might be able to skip radiation after lumpectomy. They also wondered what the rate of recurrence was among these women who skipped radiation.

New research suggests that the rate of recurrence among women 65 and older diagnosed with early-stage, hormone-receptor-positive disease who are taking hormonal therapy is low; these women may be able to skip radiation after lumpectomy.

The study, “The PRIME II trial: Wide local excision and adjuvant hormonal therapy ± postoperative whole breast irradiation in women ≥ 65 years with early breast cancer managed by breast conservation,” was presented on Dec. 11, 2013 at the 2013 San Antonio Breast Cancer Symposium.

The PRIME II study included more than 1,300 women who joined the study between 2003 and 2009. All the women were ages 65 or older and all had been diagnosed with early-stage, hormone-receptor-positive breast cancer that hadn’t spread to the lymph nodes. All the women also were taking or were going to take 5 or more years of hormonal therapy medicine.

After lumpectomy to remove the cancer, the women were randomly assigned to get radiation therapy (658 women) or not (668 women).

After 5 years of follow-up, there was little difference between women who received radiation therapy and women who didn’t:

• 1.3% of women who got radiation therapy and 4.1% of women who didn’t had breast cancer come back in the same breast
• 0.5% of women who got radiation therapy and 0.7% of women who didn’t were diagnosed with breast cancer in the opposite breast
• 0.5% of women who got radiation therapy and 0.8% of women who didn’t had breast cancer come back in the lymph nodes near the site of the original cancer
• 97% of women who got radiation therapy and 96.4% of women who didn’t were alive whether or not the cancer had come back (overall survival)
• 97.3% of women who got radiation therapy and 94.6% of women who didn’t were alive without the cancer coming back (disease-free survival)

Thirty-five of the women who didn’t get radiation therapy and 29 women who got radiation therapy died during the study. Most of these deaths were not because of breast cancer or its treatment.

This study and others suggest that some women ages 65 and older diagnosed with early-stage, hormone-receptor-positive breast cancer who are taking 5 years or more of hormonal therapy medicine may be able to skip radiation after lumpectomy.

If you’re a postmenopausal woman and have been diagnosed with early-stage, hormone-receptor-positive breast cancer, you and your doctor will consider the characteristics of the cancer, your unique situation, your surgical options, your treatment options after surgery, and your personal preferences when creating your treatment plan. If you’ll be having lumpectomy, talk to your doctor about why radiation therapy is or isn’t recommended for you after surgery and how that decision was made.

I was 71 when diagnosed. I had a lumpectomy and planned to have rads. The margins weren't good, so my surgeon went back to take more. That turned up another tumor which hadn't showed on the mammo or ultrasound. I sort of freaked and decided I wanted a mastectomy. It took about a month to recover from the mastectomy versus a few weeks for the lumpectomy. I didn't need rads after the mastectomy. I believe they did the lumpectomy under lighter anesthesia than with the mastectomy. I would definitely make sure they're looking at the whole picture with your Mom. Her other physical problems may lead the doctor to think one alternative is much better than the other. If you live where you could go with her to the appointment that would be helpful. If not, perhaps another family member or good friend could go. Extra ears are very welcome when all that information comes fast. We recorded the meeting with the surgeon in case we needed to go back to clarify something.