Am I over treating my cancer?

Who cares what the doctor thinks? Go get your BMX if that's what you think is best for you! Look, you tried a lumpectomy, and you didn't like the way your breast looked afterward. How you feel about your body is important; it's not "overtreatment" if you feel better about the outcome.

I personally opted for a lumpectomy, in part because I didn't want to do reconstruction (have twins with autism who needed me to recover ASAP). I hope your surgery goes well, and that you heal well from your DIEP reconstruction.

Maybe this oncologist isn't the right one for you? I echo the rest, you get to pick the path that works for you. And you're clear on that, end of story.

I dislike dismissive comments like your doctor made, not useful in the least.

you don't have any known bc genes.

Please do whatever you are comfortable with, because in the end, you are the one who will live with the decision.

Someone mentioned earlier that there were only a few know bc genes tested for. Actually, the Ambry panel tests for 34 different genes (including BRCA 1 & 2).Not all of the genes point to a direct relationship, like BRCA, but there are links. I was BRCA 1 & 2 negative at dx, but had the full Ambry panel last summer, which was also negative.

All the best to you

It's YOUR body and YOUR life, so YOU get to decide.  

Mysoubre,

Here's the thing about having a MX (or BMX). It likely reduces your risk of a local recurrence. It certainly reduces your risk to develop a new primary breast cancer (an unrelated second breast cancer) at some point in the future. But it does virtually nothing to reduce your risk of a metastatic, i.e. distant, recurrence. Why? Because a MX is kind of like shutting the barn door after the horses have escaped.

In most cases, we've had breast in our breasts for at least 3 years and possibly much longer by the time we are diagnosed. This tiny breast cancer is too small to be felt or detected by imaging. Over the years, as the tiny cancer grows to eventually become large enough to detect, a few cancer cells might break off and move, either through the bloodstream or through the lymphatic system, into our bodies. Often that doesn't happen, but if it does happen, those are the cells that will one day develop to become metastatic breast cancer. So it all happens before you and your doctors even know that you have breast cancer. This is why a mastectomy doesn't reduce the risk of mets. By the time you have your surgery to remove the cancer from your breast, whether you have a lumpectomy or a mastectomy, breast cancer cells have either already moved into the body or they haven't. And that's the risk of mets.

It could happen that someone has a local (in the breast area) recurrence and this recurrence leads to mets - this happens rarely enough that it doesn't change the statistics that show that the survival rate is the same whether one has a lumpectomy + rads, or a mastectomy. Most mets develop without there first being a local recurrence.

Can you know if any cells escaped before you discovered your breast cancer? In most cases, no, because it's just a few cells, too small to be detected by screening or tests. So what do you do? That's where chemo and hormone therapy (Tamoxifen or an AI) come in. Both of those treatments are given to track down and kill off those rogue breast cancer cells that might be sitting somewhere in the body. And the Oncotype test is used to analyze the genetic make up of the cancer, to determine if it's a cancer that's likely to have shed off some cells as it was developing and growing. An Oncotype score of 10 says that your cancer isn't likely to have shed cells, so the risk of mets is low and chemo won't be recommended. But in all likelihood hormone therapy will be recommended, as a precaution, to lower your risk of mets.

You may decide that BMX is the right decision for you, to reduce your risk of a local recurrence and to reduce your risk to develop a new primary breast cancer. The risk of mets shouldn't factor into this decision, because it's the same either way, whether you have a lumpectomy+rads or a MX. With a 10 Oncotype score, chemo won't be recommended whichever surgery you choose. And for others who have a higher Oncotype score, or a more aggressive cancer (triple negative, HER2+), chemo will be recommended whichever surgery they choose.

Good luck with your decision. One option, given your uncertainty and the approaching surgery date, is to start with the lumpectomy, and then decide once that's done - when you have the final pathology, know the surgical margins, and see the results of the surgery - whether to move on to rads or to opt for the BMX.

Hope this helps!

Sorry, Mysoubre, I did see that you had the lumpectomy (which makes sense since you have your Oncotype score) but then I forget that when I wrote my post. A senior moment.

You are right about the Oncotype score. No question about it. Your score is specifically related to only your risk of metastatic cancer, from this diagnosis. It does not reflect your risk of a localized recurrence, and it most certainly has nothing to do with your future risk to develop a new primary breast cancer. It also says nothing about whether or not this cancer was a fluke. It simply looks at the genetic make up of this tumor, not what might have caused the cancer to develop.

What my first MO told me, and what I've seen in some studies, is that the risk to develop a new primary breast cancer, for women who've been diagnosed previously with breast cancer, is approximately double that of the average woman of the same age who has not had a previous diagnosis. This will of course be higher or lower for each individual based on personal risk factors

Here's a sample report that happens to show an Oncotype 10 score. The only risk level it mentions is the "Distant Recurrence Risk at 9 years".

Hey Beesie quick question for you--I understood that radiation is part of the killing off of stray cancer cells in the breast area (and armpit if that's also getting radiation), and that tamoxifen and the AIs are to reduce the risk of recurrence. But from your post, it sounds like you're saying tamoxifen and the AIs kill off stray cancer cells because they block estrogen. Is that what you're saying?

Mysoubre, I'm sorry to hear about your husband, I hope he's doing OK now!

Don't feel bad about cancelling, you had ample reason!!

I was originally diagnosed with a 2.7cm tumor with IDC and ILC features in the left breast. At that point in time, lumpectomy vs mastectomy was on the table.

A breast MRI showed that I had 2 tiny suspicious lumps in the right breast. I immediately said BMX. My surgeon was neither for that nor against, but she wanted to discuss before I decided.

I absolutely treasure my surgeon for not overly pushing either option.

Then one of the right side lumps was also identified as ILC via biopsy and she said BMX was a great choice.

Personally, the BMX brings me greater peace of mind. Whereas other people are more tied to their original boobs.

The end result was that my left tumor was 3cm, plus there were 2 other small tumors in there. My right just had the one tumor, but I had atypical lobular hyperplacia in the nipple, plus lots of additional sketchy stuff in both breasts that was not previously identified LCIS, DCIS, etc). For me, BMX really worked out.

My neighbor chose lumpectomy the two times she had breast cancer, and she's happy with her choice. It is such a personal choice, go with your gut!

My surgeon didn’t push me one way or the other, he presented all options with the pros and cons of each for me to decide. I was 27 at my first diagnosis and opted for a lumpectomy vs losing a breast.

19+ years later I can honestly say I wish I had gone with a mastectomy. I’ve spent the last 19 years having abnormal mammogram after abnormal mammogram, which are almost always followed by a biopsy or two. I’ve had fibroadenomas, radial scars, ADH, ALH, DCIS, and now a new IDC. The constant stress and anxiety have definitely impacted my quality of life.

This time I told my surgeon from the get go that I wanted a BMX with reconstruction (which is now scheduled for 8/5).

The bottom line is YOU are the patient, and YOU have to be comfortable with your decisions. If your MO talks down to you about it, you may want to consider a new MO.