near complete response to neoadjuvant therapy - skip surgery?

Jenya · August 2017

Hi all,

I was diagnosed triple positive BC on left breast in March, and just finished 6 cycles neoadjuvant therapy last month. I had MRI done this week, and result was amazingly significant with near complete response. There is no lump, no active cells from MRI.

However, breast surgeon still recommends me mastectomy to remove all tissues with calcifications, which cover half of my breast (and calcification don't go away from chemo therapy). I wonder if anyone choose to skip surgery/mastectomy? Can I ask for biopsy again? Is there anyone skip surgery after neoadjuvant therapy?

Thanks,

Jen-Ya

ElaineTherese · August 2017

Hi!

After neoadjuvant chemo, both an MRI and PET scan showed that I didn't have any active cancer left in my breast or compromised node. But, scans are imperfect, and sure enough, they missed a small pocket of high grade DCIS. So, I'm glad I had my surgery.

I was, however, able to choose a lumpectomy rather than a mastectomy, which was nice.

Are the doctors concerned about the calcifications because they indicate atypical, precancerous cells? Why wouldn't you want those out?

Congrats on your excellent response to chemo!

NotVeryBrave · August 2017

I, too, wish that no surgery was an option. My post treatment imaging looked like there was no cancer in evidence, but I was told that they would still remove the same amount of tissue with a lumpectomy and I would still need radiation afterwards.

It's a very long story, but I opted for BMX in the end because no one could explain why some areas disappeared in the good breast during chemo but one remained that needed to be "watched" every 6 months. The final pathology showed no cancer at all.

I think I would have signed up for a study (if there was one) to follow people with probable pCR and no surgery. As it is - there is no recommendation for that. All of the research shows that you do surgery for breast cancer.

I'm glad I had such a great response and you did as well. That should bode well for the future. But surgery seems unavoidable.

Jenya · August 2017

Thanks a lot, Elaine and NotSoBrave,

I only had 2 small lumps to start with, but calcification covers half of my breast. MRI before neoadjuvant chemo did show active cells on those areas though. Surgeon mentioned it may not be invasive DCIS, but we can't know for sure. In order to remove calcification area, I will end up cutting off the whole breast.

They also found an area shrunk in my RIGHT (good) breast. I need to have biopsy to confirm.

I was told that I will lose breast sensation after mastectomy (most likely), so I hope to avoid mx. However, surgeon said lumpectomy in my case is hard for reconstruction - I will end up with half boob left.

It seems that standard protocol is to remove calcification area and I can't negotiate with surgeon? I am a little desperate. Any suggestion?

Shellsatthebeach · August 2017

Honestly, I wouldn't mess with cancer. Neither my oncologist or surgeon could feel my tumor after my chemo treatments. My surgeon wants to bump up surgery as soon as possible (I do need some healing time after chemo) so cancer doesn't have a chance to come back. That sounds to me that even though it shrunk or may be gone completely, it still has a chance to grow back. The surgeon explained to me the reason they did my chemo first is to make surgery much more easy and not so much to cure the cancer.

NotVeryBrave · August 2017

I can't really speak to DCIS or calcifications and their implications. The primary concern with me was the tumor.

While they always talk about neoadjuvant chemo increasing the chance for breast conserving treatment - it seems like they still take the same amount of tissue so I'm not sure how it helps with that.

Chemo is systemic treatment so it's effects should be throughout your body.

Legomaster225 · August 2017

Scans are not perfect. Get a second opinion if that would help you bu I don't think I would feel comfortable going without surgery. I had great response in my breast with known cancer from preadjuvent chemo. I decided to have a BMX because my breasts were very cystic and I am also very small breasted and symmetry was going to be difficult if I didn't do something to both. Anyway, after mammo, a few ultrasounds and 2 MRI's cancer was still not detected in my "clean" breast. Thank God we decided to do the BMX. Who know she how long that would have gone undetected.

exbrnxgrl · August 2017

I wanted to address the sensation issue. A mx/bmx removes all underlying breast tissue, including nerves. It's like scooping out an avocado and just leaving the skin (if the surgery is skin spacing). You may regain skin sensation over time, but there is no breast tissue so anything else is quite unlikely.

A second opinion is a great idea and make sure to express these concerns. In the end, doing what is needed to prevent recurrence or metastasis trumps preserving breast sensation, for most of us. All the best

illimae · August 2017

Jen, I too had a good response to neoadjuvant chemo with some cells but no tumor remaining. A lumpectomy was recommended and I am now 1/2 my former size (was DD now D). I was diagnosed stage IV de novo and not terribly concerned about the pathology (just wanted clear margins) but it was discovered that there was some DCIS no one knew about in the removed tissue. The surgery was performed in conjunction with a reduction and lift, so I was able to keep the feeling, have a matching set and be done with surgery.

Cancer is tricky, it can hide I would share you concerns with your team and try to come up with an option you're ok with.

Kimm992 · August 2017

I agree with others who said to have the surgery.

When I finished chemo there was no cancer detected either but when they went in for the mastectomy they discovered a tiny "splatter" of cancer cells remaining.

At the end of the day, what is more important? Your life or your breast? When you think about it that way, it seems like an easy choice.

near complete response to neoadjuvant therapy - skip surgery?

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