IDC in 40 yo, have a date for lumpectomy/SNL biopsy

Also, I'm reading the HER status can change the approach - whether to do chemo first, before surgery. My HER status is pending. I have so little time to decide if I should back out of the surgery. Help!

Thank you, Elaine.

I'm just trying to make sure I don't jeopardize my treatment by rushing into surgery.

Mucki, do you mind telling how old you were when diagnosed? My tumor wasn't seen on mammogram, so I'm thinking I need an MRI too. My surgeon says it may not be approved by my insurance. I'm heavily leaning towards postponing my lumpectomy until I understand the process. It's hard - I'm worried that my cancer is growing while I'm sitting on this, but I don't want to make an incorrect decision.

Also, I got some recommendation and got an appointment on September 13th for a second opinion at a large university hospital about an hour away. The oncologist I'm going to see is the same one who treated my friend when she got BC at 40. They also have breast surgeon, imaging, pathology all within the same clinic.

Can you, wonderful ladies, help me with an approximate timeline of treatment? Core biopsy was 8/28, DX on 8/31, if I see oncologist on the 9/13 and who knows when I do get the surgery - is it not too long of a wait? I see in the histories here there is often about a month's time between diagnosis and start of treatment.

I know my current surgeon can probably get me in a little sooner, but I honestly may have more trust in the doctors at the university hospital. I'm thinking about starting genetic testing process here, through my surgeon, but waiting until 13th for the rest. Does this sound like a good plan?

Hi MTwoman, thanks so much for your reply!

I talked to a friend of mine who recently went through a horrific experience of her husband being diagnosed with stage 3 colon cancer at the age of 36. (He is actually doing really good, had neoadjuvant chemo and complete pathologic response, and currently considered in remission). She gave me this: you are 40 years old, you want to think about treatment that will not only be good for you short term, but long term as well. That made me think: if I do lumpectomy, I will need radiation, I was told that was for sure. If do mx, I may not need rads.

I decided to not do anything invasive until I see the oncologist on the 13th. If that appt was 2-3 weeks out, I may be doing something different. But with it being pretty much a week away, I think I should wait and get all my info.

I'm seeing my current (1st?) surgeon today, with my husband. Mainly to talk about options, not for an exam. I will tell him I've got this appt on the 13th, and try to push for MRI. I pretty much decided I want MRI before surgery, even if it's not within my standard of care based on the fact that I'm stage 1 clinically. My friend told me it was also a good "test" for your doctor's office. If they don't fight for the tests your insurance thinks are optional, drop them. She says for us, we will need follow up imaging our entire life. Some results will come back equivocal. We will need our doctor's help to get approval for more follow up imaging. If they are not willing to help at this early stage, we need another office/doctor.

Thanks, moderators, but I'm pretty sure I'm not doing the lumpectomy tomorrow.

A few other question: has anyone done SNL biopsy before mx or lx? I will ask the surgeon today, just in case, although I still think I need to talk to MO first.

Also, what are the ways (beside SNL biopsy) they figure out lymph node involvement? Is it seen on MRI? Mammogram (again, my mammogram was clear and here I am with a 2 cm cancerous tumor in my breast)? Ultrasound?

The surgeon did clinical exam and confirmed my lymph nodes on both sides were normal size. He also did US under my arm, although it was super quick. I'm assuming he didn't see anything alarming. I completely understand this doesn't rule out lymph node involvement, but I'm puzzled as to how they stage cancer in those who don't do surgery first.

Thanks again, MTwomen. I'm a very impatient person by nature. I always want to "do something", often without thinking through all the options. I think even for me, rushing into surgery 5 days after diagnosis, with some info still pending, is too much. I know I will be freaked out every day, thinking my tumor is growing, but I need to fight this urge to rush into "doing something" and gather my info.

We had a great chat with the surgeon today, I took my husband to the appointment. We quickly realize how much cancer is changing our life already.

I was total emotional wreck over the weekend, agonizing whether or not to go ahead with the lumpectomy, and ultimately told my husband we need to make this decision together. That's not how we usually operate - we have our areas of influence, and "medical stuff" is usually mine, whether it comes to our kids' health, mine or even his own. I make appointments for him and read his results.

But here, it's too big of a decision, I need him on board and can't be shielding him - I just don't have enough of emotional strength right now. He has a crazy intense job (engineering start up), but he will have to take time off to go with me to the appointments and take me to surgery. He told his boss about the situation, and I think they will be fine with him taking time off (he really has no set hours, he usually works ~10-12 hour days. So, it may be 6 hours some days, and 10 hours some others). I also had a great conversation with my boss about my availability over the next few weeks. I have the best boss in the world! This may seem unrelated, but for me, emotionally, having the right expectations set at our work is very important. So much weight off my shoulders! I feel almost happy now, despite still being in the same place - cancer, who knows how advanced, being angry about "why me", "I'm too young for this" etc.

As a result of our conversation with the surgeon, I will be doing genetic testing and, hopefully, an MRI. All the while waiting for my HER2 status to come back (although the surgeon said it won't really change my treatment plan, because my tumor is not large enough to do neoadjuvant chemo) and for an appointment with an oncologist at the university clinic. He completely understands I may even go with the university clinic surgeon. I will probably "feel bad" after all this time he spent with me, but ultimately, I need to have a team I'm comfortable with. I haven't decided if I'm going to wait until genetic testing comes back to go ahead with surgery. It may take up to 21 days. I'm not sure I want to wait that long. I realize a week or two won't matter, but I want the lump out by the end of September.

But here is where I will have a second opinion (or first) from the oncologist. I feel like doing surgery without talking to an oncologist first, is like rushing into battle without a general.

Thank you all, wonderful ladies, for your support. Got genetic test done today and my surgeon is working on my MRI preauthorization, There seemed to be a bureaucratic bump with my insurance, but I hope it will be resolved.

My insurance, I'm sure, is freaking out . We are a very healthy family on a high deductible plan. In the past 1.5 years we barely visited doctors: a few physicals, annual check up at OBGYN, and dermatologist (I have melanoma in the family and myself have abnormal moles so see derm every 6 months). Now in the past months we've been to ER 3 times (unrelated to my breast), I've seen a few doctors, biopsy, imaging whole works. I'm sure somebody there will figure out soon they are in for a treat.

Gina, I totally agree with you on work obligations. Even though I have a family, work defines my life a lot. I'm an information system consultant, and this job is my dream job. I've been at it for 18 months. It kills me that I can no longer pay attention 100%, at least not right now. If I get called to an appointment at the same time when I have a work call - I will reschedule the work call. That's just a question of priorities, and I have to put myself first.

Mucki, thank you so much - I will PM you! It feels like an odd age to be 40-something here. We are definitely young for this, but then you look at 30-somethings with little kids going through this, and your heart breaks for them.

So glad I waited and did additional testing. Turns out I have DCIS in my other breast. BMX for me, but first chemo.

I'm pretty sad today: never felt so betrayed by my own body. I liked my beasts, had no idea they were not to be trusted.

My oncologist, when delivering the news about results of the biopsy on my left side, said that it would take 5-10 years to turn into cancer. But said they would do SNLB on the left now as well, when doing mastectomy. I was a little surprised about that. The DCIS is grade 1, but she said they do it on all DCIS surgeries, to make sure there is no invasive cancer hiding somewhere. 

Basically, I'm and was high risk all these years, t have both invasive and in situ BC in both breasts by age 40. I just didn't know.

I'm trying to figure out my next step with genetic counseling. What mutations I should be tested for. I have family history of melanoma and zero BC history. Just feel so screwed up and broken right now