Diagnosed Today - Help with Report, Please?!

Dance Smartly, I am so very sorry that you've had to join our club. Based on what you copied from your report, it also sounds to me as if you have IDC and DCIS (which isn't uncommon). The IDC being grade 1 is, as you said, a less aggressive cell. For the DCIS, grades 2 and 3 can have necrosis. For some attributes of DCIS, I've seen grades 1 and 2 grouped together and for others I've seen 2 and 3 grouped together. What you need to know is that your treatment will be driven by the IDC, not the DCIS (except for the surgical option, all of the DCIS will be removed) as what is considered appropriate treatment for your IDC will certainly be enough for the DCIS portion. Many times you won't get your receptor status right away, that may come in another day or so. My HER2 info actually came in a third addendum. No focal calcifications is part of the description of what they found, and I'm not sure that it is necessarily a good or bad prognostic indicator (although if anyone else has good info on this, I'm sure they'll chime in). The "biomarkers" that they've sent out for are things like Ki67 and HER2 (http://erc.endocrinology-journals.org/content/17/4/R245.full) Please let us know how we can help you!

Just posting to sympathize and agree with the feedback others have given you. When I saw my surgeon she was super vigilant and recommended an MRI because of a second suspicious spot, so ask about that at your appointment. Personally, I was so glad to have a "3D" mammogram, an ultrasound and an MRI pre-surgery: I wanted all the info. I could possible have. You're right that ER, PR, and HER status are important. They can come in an addendum so keep asking for that. Best of luck, It's a shock initially but you will beat this thing.

My MO at the Tom Baker got my Prosigna test which is similar to Oncotype tes

I would think that an MRI would be helpful before planning any surgery. You wouldn't want to be surprised later and confirmation is just helpful mentally as well.

I have a "patient portal" with some of my providers. Funny thing is - they don't put "sensitive" info in there. So things like pathology for cancer are not listed!

I advise everyone with a cancer diagnosis to see an MO as early as possible, definitely before committing to surgery. For some cancers (like mine) - chemo is preferred to be given first.

Sorry you've gotten this news.

I hope your appointment today goes well. Some folks above have mentioned tests like the Oncotype - it's premature to be thinking about those. They are used in early stage cancers to help guide treatment decisions, but they are not relevant for treatment decisions in other stages. You can't know what your stage is yet, so you don't know which direction you'll head on that decision tree. You've listed yourself as "1a," but the true staging is done at surgery. Everything before that is an estimate. Sometimes scans give a relatively accurate prediction of the surgical findings, but often they do not. Even MRI is far, far from perfect.

My surgery was 7 years ago, and my surgeon had a standard practice of getting a preoperative MRI. It ended up having no bearing on my treatment decisions back then (I wanted bilateral mastectomy), but if it were today I probably would have been referred for chemotherapy first (back in those days, it hadn't been proven yet that doing chemo before surgery was as good as doing it after!). NotVeryBrave had an interesting point. If your surgeon is truly a breast surgeon, he/she should likely works in an enmeshed way with the medical oncologists and should know when chemo first is an option or preferred. That's the ideal world - and where I am they would be talking to each other - but it may not be your world, so seeing a medical oncologist before surgery is something to keep in mind.

Good luck with all of this.

Glad to here a plan is coming together, for me this was the best part. lol If there is a "best" part. I wouldn't say an MRI in the states is "standard". In my expirence it depends on the doctor and your age. At 36, an MRI was my requirement when choosing a surgeon. I wasn't going to argue or fight for it, fortunatly the doctor I choose had me get the MRI before I even met him, we went over the result wich changed everything on my 2nd appointment. Are you able to get a 2nd opionion in Canada? Ya, MRI can be stresful. But whats worse, months later you find out you had more cancer lumps that are still growing in your body? I have seen more than one person in the situation on here and I would have been if I had not had an MRI.

Are you able to get genetic testing? This can be a huge insite when chooseing the best surgery for you. It takes several weeks to get the results back here.

Other than the MRI issue, it sounds like your doctor is on the "normal" path. Never heard of the age thing though, I am sure others with more expirence will chime in.

This really has nothing to do with cancer, but more out of curiosity. Why would consider Mexico???? I'm nervous just visiting for vacation let alone a serious medical issue. Maybe I am completly wrong...just was very surprised...and curious.

I'm a big fan of second opinions - had them for BS and RO. If it's an option - it can make you feel more secure in the plan of treatment even if you like the original doctors. Sometimes you just "click" with someone else.

Yes - if chemo is warranted and planned to be given after surgery then it's usually done before the radiation.

Hmmmm, Canada's socialized medicine sucks. Hope it doesn't happen here. You really don't know if it's b/c of his experience or b/c of trying to get approval.

Sticking to the MRI encouragement. It could change your choice of surgery from lumpectomy to Mastectomy that's a huge choice. It could be a life choice b/c some errant bc is still nesting in your breast even and may not be sending off little metastatic cells now but could be any day. That sounds alarming and it is, sorry. But it's your life. In the USA it's getting rare to hear of a case where an MRI isn't done.

Canada's socialized medicine kills and disables people. I have lot's of Canadian relatives. The stories aren't good, just as you described. I'd be writing for an hour or more with the stories.

I, also, agree with 2nd opinions as many here have stated.

Take or send your research about MRI's and density and missed tumors to your doc.

Push him for the MRI

sas- were is this video on toradol? Sorry if I missed it somewhere!

I definitely recommend an Oncotype as well. Typically, Grade 1 tumors are low risk and not helped by chemo. I had two Grade 1 tumors and no chemo. A breast MRI is something that varies by doctor. I had one and it found my right-side tumor (which was actually 4 foci of cancer spread throughout the breast), but statistically it's not common to find additional cancer so many doctors don't recommend it.

I thought I only had cancer in one breast, but the MRI correctly showed a more advanced cancer in the other. It did not appear on mammogram, and they could barely find it with ultrasound, even using the MRI results as a guide.

Greeneyes Several of us spent the summer of 2015 doing research on Toradol . The link is a synopsis of that work. The topic box explains how the first half dozen boxes "work". then after that they are regular posts.

One of the incredibly interesting posts is by Techtonicshift. She had pre and post Cirulating Tumor Cell (CTC's) done before and after a subsequent surgery was done and showed she had no elevation after toradol was used. I thought that exciting. I wrote to my friend Dr Retsky from our summer of 15 research. He sent back that the research is supporting CTC's being done even before first biopsy. I thought Marvelous.

Anywhooses, the video is by a co-author of what's referred to as the Retsky study. You know there's many co-authors in the publish or perish world of science. I loved Dr V's presentation. My self I had to listen 3x's b/c I have a hearing loss. But that's just me. In the video when he refers to a brilliant young anesthiologist in Brussels. that's Dr Patrice Forget. I'm prejudiced. His work and recognition of a potential simple and < 10$ injection could lead to a decreace in recurrence may get him a Noble, but time will tell.

This link is related to surgery. The topic box explains it's use.

https://community.breastcancer.org/forum/73/topics/843381?page=1#idx_23