Multicentric / Multifocal--impact on treatment?

I had mutifocal tumors (3) id'd in initial mammogram, and biopsy showed both ductal and lobular features. Pathology after Mx ended up identifying IDC, ILC, DCIS and cribiform. There *was* another thread not too long ago that discussed this general subject, and it seemed like a lot of women had similar stories. It did not affect my doctors' recommended treatment plans at all.

However, I too wonder if I should have had a BMX even though the other breast was "clear"...may still elect to do so when I have reconstruction. I have heard too many stories about cancer that went undetected by mammography being found in pathology of prophylactic BMX...But my surgeon says this is purely anecdotal info...Personally, I think it may come down to peace of mind for me, as far as getting other breast removed... Best wishes to you! 

Certainly studies of outcome suggest that multifocal sisters have similar outcome to univocal sisters with same stage disease years down the line. Regarding what to do about the "healthy" breast, I think it is reasonable to insist on MRI in this situation, especially if any of the original tumours went undetected on mammo. However the decision on BMX when MR looks ok depends on how much anxiety is going to torture you even knowing that MR looks ok. I have had same dilemma about whethere to have mx on my "healthy" breast. For the time being I am going for yearly MR but if there is any concern at all I will go for mx and immediate recon

BW

I also had multifocal areas (one IDC embedded in DCIS, all others DCIS).  Because I had a mastectomy, the oncologist told me the only tumor that was taken into consideration for treatment was the IDC.  It's size and characteristics was what was used for staging and treatment.

I was told it is common for there to be multiple sites of undetected DCIS in a breast.  It is why radiation is used to clean up the breast after a lumpectomy.

Because none of the DCIS was anywhere near the chest wall and my nodes were clear, I did not have radiation.  Four AC and herceptin were my treatment. 

I ended up having my other breast removed 6 months after the first because of a BIRADs 5 classified mammogram.  All the slicing and dicing of that breast did not find any cancer.  Only typical benign changes of an aging breast.

Another one here.

I had 3 different size IDCs in the middle of 14 cm DCIS. My onc. went by the largest IDC to determine treatment plan, but I don't think there would be any other choice. My cancer is hormone negative and HER2+, plus relatively young age = the most aggressive chemo and Herceptin. I really like to keep my other breast but as ladies said - it depends on your anxiety level.

Good luck.

Hi Kadia

I had at least 3 IDC lesions in different quadrants so required a mastectomy. A had an MRI on the good side prior to surgery, which then led to a biopsy….results were good. BS recommended mastectomy on both sides regardless, but I decided to only do the cancer side. So I went ahead with a uni mx. My onc said that only the largest lesion determines treatment (and not a combination of all tumours). So I didn't need chemo or rads. One year later, I had the 'good side' removed and had reconstruction on both sides. I'm more than 2 years out from initial diagnosis and feel good about my choices.

I had two IDC tumors, in the my right breast.  Both were in different quadrants.  I also had two tumors that were DCIS.  All four tumors had different pathologies:

1) IDC tumor  #1, 0.8 cm, lower left quadrant, 48% er +, 46% pr +, HER2-. oncotype score = 16

2) IDC tumor #2, 1.2 ccm, upper left quadrant, 99% er +, 98 % er +, HER2-, oncotype score = 8

3) DCIS tumor #1, in upper right quadrant was high grade, with possible  microinvasion

4) DSIC tumor #2, in upper left quadrant, low to medium grade.

There were also two small areas with LCIS (2mm and 3mm). 

My diagnosis was three staged.  I had a mammogram and biopsy of DCIS #1.  That led to surgery. I thought I was having a lumpectomy and SNB, but woke up with an additional scar.  It turns out my surgeon felt a dimple and decided to remove what ever was causing the retraction.  That turned out to be IDC #1.  My onc ordered the oncotype test and chemo was not recommended.  The radiation onc I saw asked me to have an MRI before beginning radiation.  That led to another round of biopsies and the discovery of IDC #2.  The final pathology report after my BMX showed DCIS #2.  There were areas of atypical cells (ADH and ALH) in the left breast.

My onc recommended chemo, based on the size on IDC #2.  I insisted on oncotype test even though my onc said he had never heard of this being done.  When we received the score, he said I didn't need chemo.  I agreed after I figured out the odds that either tumor would recur.    It never made sense to me to base treatment on the largest tumor, as the smaller one was more aggressive.  I think you do have to look at the total picture - my onc said that made more sense.

I went into my UMX knowing of one IDC tumor and an "Area of Concern".  I had been offered a lumpectomy but opted for removal.  The path came back with 9 other tumors/tumorlets, one near my chest wall.  It was a mix of IDC and I had micromets in 2 of the 3 nodes removed.  My onctype came back a 7 for the largest and 10 in general.  I finish rads on Monday.  I will argue forever with my BS re: the usefullness of MRIs for dense breasts women.  He still says too many false positives and I say not in my case!

I am not sure my 2 tumors were still classified as multifocal after pathology confirmed the were 2 totally separate tumors they were multicentric. My tumor board agreed I should have a mastectomy. As far as my oncologist he is treating me with hormone therapy no difference between idc and ilc.

Susan99, thank you so much for your words and encouragement! We're so glad you've joined our community, and we hope you find this to be a supportive place!

The Mods

and thank you, Meow! I thought multifocal was located in same quadrant and multicentric in different quadrants.....maybe there’s more to it. And I’m reading that ILC can be different. It doesn’t respond to tamo as well. And it chooses gastric, ureter, ovaries instead of lung liver bones... (gross generalizations).