Newbie, confused by initial consult

Hi, Autumn. I'm sorry you have to be here, but it sounds like you caught this very early. Regarding the "aggressiveness" I was actually told the same thing from one of the oncologists I saw (I went to 3 to get different opinions). I honestly think some of it comes down to the number of patients they see, since TNBC is more rare. I found the smaller practices tended to be more conservative, where the large cancer center basically said this was no big deal, we will treat it aggressively and you will be fine. This actually brought me comfort, knowing they were basing their opinion on experience. Also, TNBC is aggressive as it relates to breast cancer, but overall if you looked at other cancers the prognosis for TNBC isn't bad, and usually responds very well to chemo.

It is true your chance of reoccurance is no different if you have a lumpectomy with radiation vs masectomy. There is a lot of research to support this. What a masectomy will do is reduce your chances of getting another new breast cancer, which is why a lot of women (especially younger women) tend to go that route. This is also recommended for women who have positive genetic test results because they are at a higher risk of developing a new cancer.

I think Sam0623 response has resumed the problem very well.

I was treated in a relatively big center (for the size of my country). Both my oncologist and my BS proposed a lumpectomy but I had many doubts. I was thinking like Autum 1031 - I was 42 at diagnosis, no family cases... Maybe if I didn't have breasts it would be safer and I was considering a BMX after chemotherapy (I was stage IIA - no doubts here). My oncologist said it would be my decision but he was ok with that (and I think he actually preferred I did it). My BS insisted in lumpectomy based in those studies that show that there is no difference in the longterm concerning disease free survival or local recurrence and on the other hand there seemed to be a benefit in survival associated with radiotherapy. I went to see de plastic surgeon who was going to help in my surgery and he said: "current guidelines recommend that women seeking mastectomy when they have indication for breast conserving surgery should be discouraged". Just like that... Of course he also told me not to complain if i were to sit there five years from now with local recurrence or new primary! Its just science status at this time. It may change.

After researching I found that women with TNBC had higher risk of a second primary tumor but the most important threat to survival is the first one (mainly due to distant recurrence... not so much local recurrence). So I decided to treat this tumor as they told me: chemo, surgery and RT. Because of what BS said, because of what I read and also because I didn't feel with courage to face what seemed to me a very difficult surgery (and recovery). If I have another lump, another biopsy probably I'll be more aggressive and perform a BMX. Also I was tested for BRCA1 and 2 and they were negative.

So listen to as many opinions as you need, think of yourself and the kind of person you are and decide what brings you peace.

Hi Autum,

I was 6mm TN as well. 5 years out for me now! I went to a large teaching hospital and they seemed un-phased by my TN status. My Surgeon also said that a mastectomy would provide no more benefit than a lumpectomy for me. When I asked, she even said, "funny you should ask, I just covered this with my students."

In terms of the TN status, the statistics that I saw at the time, showed very little difference between TN and what I call "regular" BC in terms of outcomes with both chemo and radiation for the tumor size that we have. Granted that was 5 years ago, so things could have changed.

I had chemo. At the time, the cut-off between chemo and no-chemo was <5mm for no and >5mm for yes. 1mm off!! At >5mm they said chemo was considered, so I was offered it and took it figuring that I'd rather deal with chemo when I was young (I was 44 at the time) then when I was older.

Since I was younger (like you) it was also suggested that I get the genetic testing. It is scary. The counselor gave me the best advice when we were discussing whether or not to take the test. She said, "not knowing doesn't make it not there. And if you know it's there, you can do something about it." I ended up being negative (ha, when negative is a good thing.)

Try to stay positive! Definitely read the threads about the positive sides of TN.

Cindy