Chemo first or surgery first?????

Hi CanuckMom, and welcome to Breastcancer.org. We're sorry you had to find us, but glad you did!

In the main Breastcancer.org site you'll find reliable information that may also help you decide, such as the article Treatment for Triple-Negative Breast Cancer.

Also, we recommend you to visit the section Breast Cancer 101 of the main Breastcancer.org site. It is place designed for those newly diagnosed that will help you learn more about what to expect now.

Hope this helps!

The Mods

hi, sorry you got this awful diagnosis.  I wasn't informed until i came here about getting chemo first and i think it would have been nice to know if it was working.  My tumour was 1.5 in june and the same size at surgery 2 months later.  Triple neg as well but they are all different. I think because i had huge breasts and a fairly small tumour they knew they could get it all with Mastectomy. If you are small breasted with a larger tumour i think they like to shrink it a bit first to get clear margins. 

Go with the one you are most comfortable with and discuss again with MO.  Best wishes for a smooth journey.

sorry. I meant discuss with your surgeon.  I think they probably won't know either whether it will work so it is a crap shoot either way. I had sentinel node done at time of surgery as well.

It is really hard to deal with all the unknowns.

What part of canada are you? Do you like the hospital and surgeon?  Hopefully you have some support.

Canuck: In my experience, the most empowering thing about this journey is also the most anxiety-provoking: having to make decisions. Some women feel comfortable having doctors direct all decision-making, and some (I'm one of them) don't. I believe firmly that we can all make the right decisions for us when armed with good information... and conversely, when we feel anxious, it's because we don't have all the information we need to act. I think that's where you're at now -- and it's perfectly natural. I would urge you to get in to see an oncologist as soon as possible, and have a really good discussion about the pro's and cons of treatment order (bearing in mind that oncologists and surgeons may each have their professional biases). 

I didn't even know I was TN until after Lx and SNB, nor was the option of doing chemo first ever presented to me. But a lot has changed in 5 years. I wish you well.  

Hi CanuckMom, I'm in Ontario and was treated at Sunnybrook. As Luah explained so well, your in the hardest part right now. As soon as you have a plan you will feel much better, but you need to make sure you get as much information as you can from your team of doctors. At my hospital they work together, but initially after a birads 5 mammogram, and having a fight with my PCP about where  I wanted to be treated (first time I really had to fight for what I felt was right) I was seen by the rapid diagnostic unit at Sunnybrook. I was asked if I had a BS I  would like to be referred to-and an apt. was set up for a core biopsy, diagnostic mammogram and ultrasound. I met with my preferred BS one week later along with her choice of MO and RO. It was at that time I learned I was TN and that thankfully the one node that looked 'murkey' in US and had fluid tested-showed no involvement. Because of where my tumour was located, the size of it, lack of node involvement they all felt that I would benefit from chemo first to shrink it, and get better margins with LX. The benefit for me was also that if any cells had spread microscopically chemo would take care of it. I felt very satisfied with the information given to me and all I remember is that when describing my diagnosis, this was what they felt was the best plan for me-I agreed and had a Muga scan and clip placement that day! Chemo started 2 days later-which made me feel very empowered. I had high dose (versus dose dense ) FEC-D and my breast surgeon could feel the tumour softening at my first check up 3 weeks later, so I knew the chemo was working. 

As far as MX vs. LX my breast surgeon flatly felt that I was a good candidate for LX and gave me lots of information to read. At that time the latest study had just been released showing that LX with rads had a slight edge over MX. She was willing to do MX if that's what I wanted ( which is what I initially wanted) but was glad I had the time during chemo to weigh all my options. 

My initial diagnostic mammogram done 2 weeks earlier measured my tumour at 2.3 and the last one before chemo measured it at 3.1 so that beastie was growing-fast. 

I had a SNB done at time of LX (I had 4 nodes out) and 3 weeks later I was thrilled to learn I had PCR good margins on surgery and nodes were clean! 

If you feel you are not being given enough information now is the time for you to fight for yourself. I would demand to see a MO and get their opinion as well. Wishing you lots of strength, but trust me you will feel better once a plan is in place-just make sure you are comfortable with those who are involved in your care/health because your worth the best you can get!

Hi Canuckmom,

I was diagnosed 5 years ago, and my team here in the US thought chemo first was the way to go.  The large size of the tumor was a factor, in addition to the TN diagnosis.  

I consulted with 2 additional oncologists and 2 additional breast surgeons.  In this case, it was unanimous.  Chemo first. 

Wishing you good health and strength.  

Hugs.