DCIS in elderly (89 year old woman) with pacemaker

ellecee1974 · June 2016

Has anyone had a simple mastectomy on the breast that is on the same side as the pacemaker? If so, was the tissue / pouch containing the pacemaker left untouched by the surgeon? If not, was the pacemaker moved to a new site before the surgery? I am trying to assess the best course of action for my family member. The surgeon indicates that the mastectomy can be done without disturbing the pacemaker, however the tissue associated with the pacemaker will be left in and it can not be confirmed that this skin is cancer free until margins are analyzed. There is lower risk that the DCIS is near the tissue associated with the pacemaker yet this can not be confirmed. I want to avoid her going through the move of the pacemaker if not necessary, however we also don't want her to have the mastectomy only to find out that any tissue left in (associated with the pacemaker) has DCIS. Has anyone had this experience? Any input appreciated.

ellecee1974 · June 2016

Thanks for replying. Lumpectomy has not been deemed possible because she has already had two excisions / lumpectomies of the DCIS in the same breast. The surgeon indicates that now the DCIS is occupying approx. 50% of the breast which is too large of an area to remove with a lumpectomy. The surgeon says that the simple mastectomy is the most effective and actually straightforward way to get rid of all the DCIS.

ellecee1974 · June 2016

Understood. Yet given the grade 3 nature, we were just worried (or I am worried, the patient is rather calm considering), that grade 3 has a higher risk of becoming invasive than grades 1 and 2. I just fear that given that in a 3 year period following the first lumpectomy that it came back occupying more area, that it could come back even after a mastectomy with even a small margin, which I would not want her to have to go through... (we were hoping the DCIS would not become a problem in her remaining lifetime, yet it has). However the surgeon states that it is still better to do the mastectomy to reduce the total number of cells by a significant amount, which I agree seems the most logical. DCIS is very annoying... while they say it is not really cancer, to me it is cancer given that you still have to follow the same course of action / analysis as any other cancer and given that there are no definitive answers as to whether it will or will not spread / will or will not become invasive and when. If I could be told with certainty that in a 10 year period grade 3 DCIS does not become invasive, clearly I would not put an 89 year old through a mastectomy. Yet, where my 89 year old is full of life and very mentally competent (even more than me at 41 in many ways given more wisdom), I feel it is almost morally incorrect to not take action to correct/remove the DCIS, knowing the facts. Anyhow, thanks for your feedback Kayb.

coraleliz · June 2016

I'd check in with the cardiologist/electrophysiologist who placed the pacemaker. Pacemakers don't last forever. Is it going to need replacing soon. it can be placed on the other side.

ellecee1974 · June 2016

thanks we are - her pacemaker is only 4 yrs old but we are looking into the replacement process

hsant · June 2016

I don't understand how a surgeon could suggest a MX on an 89 year old woman with DCIS. Mastectomies aren't typically recommended for DCIS at any age, but in the case of an 89 year old woman this seems preposterous. At your relative's age, there are significant risks from anesthesia. The effects and possible complications could be detrimental, much more so than her DCIS diagnosis, which is slow growing and noninvasive. Please get another opinion from a different surgeon.

hsant · June 2016

I didn't realize that she had already underwent a lumpectomy three years prior. However, she was still diagnosed at 89 with noninvasive cancer. I'm not a doctor, but I would think that surgery would be unnecessary, given that there's a good chance that the slow growing, noninvasivecancer won't be the cause of mortality in an 89 year old woman.

As far as a doctor weighing in the patients overall health vs. the risks of surgery, all I can say is that (in my experience) there are a lot of unethical doctors out there, which is why I strongly suggest getting a second opinion, maybe from an oncologist, who specializes in breast cancer. Why should an 89 year old woman, who has a good quality of life undergo a major surgery, plus the recovery process if it isn't necessary?

I'm not someone who mistrusts the medical community, btw. My father practiced internal medicine for 45 years, my father in law was an anesthesiologist, and my sibling in laws are both MDs.

BarredOwl · June 2016

Just wanted to note that because minimally-invasive biopsies sample only a small amount of tissue, they cannot exclude the possibility that some invasive disease is present, especially with extensive, high grade DCIS. Thus, the question of whether a person actually has pure non-invasive DCIS (Stage 0) or also has invasive disease is determined from the surgical pathology.

According to ASCO, in women diagnosed with apparently pure DCIS by minimally invasive biopsy, invasive cancer is reported in 10% to 20% of cases overall, approximately half of which are limited to microinvasive cancer. So, unfortunately, to take no action incurs some risk of unidentified and untreated invasive disease, which may not be so slow growing.

Best,

BarredOwl

hsant · June 2016

I know, because I was initially diagnosed with DCIS,with a possible borderline microinvasion, but IDC was found in pathology after my BMX.

Barred, I'm not even remotely implying for ellecee's relative to take no action. I'm suggesting a second opinion. Period. That's it.

ellecee1974 · January 2017

thanks for the input - we have had two opinions from top breast cancer surgeons at two top hospitals who concur - due to the size and grade - we do not deem taking no action appropriate

DCIS in elderly (89 year old woman) with pacemaker

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