Need clarification ....

Not even sure where to put this. I've been a fairly active member of BCO since my dx almost four years ago. I think I've read enough and done a lot of research on not only my dx but on breast cancer in general but still want to double check something.

My sister's mother in law is in her early 70's and had mammo and ultrasound a few weeks ago and found mass approx 10 mm. Birads 5. She was visiting in NY when she got results but lives in Puerto Rico. Someone (a nurse friend of hers) told her to go directly to an oncologist. I told her well you need a biopsy first. I said the oncologist isn't really

going to know what he's dealing with until you have the biopsy and it's confirmed cancer, type and receptors. I told her she was missing some steps. She flew back home to Puerto Rico and met with the oncologist yesterday. My sister called me today and oncologist had her schedule a biopsy for day after tomorrow but he told her some things that I thought were odd so wanted to check here in case I'm mistaken.

1) Oncologist said he wanted her on AI right away without even knowing a) if it's in fact cancer and b) not knowing HR receptor status not having any information whatsoever except a Birads 5 radiology report and not even a biopsy yet. Am I mistaken or is this way off? I just want to double check. Is there any reason an oncologist would put a patient on an AI without a firm diagnosis or pathology?

2) When I spoke to my sisters mother in law before she went back, she told me she wanted a mastectomy and she was asking about the surgery etc. So again she meets with this oncologist and he told her that 'if she's hormone receptor positive that she'd just need a lumpectomy and mastectomy is not needed for HR +.' Okay so again I hear this and it doesn't make any sense to me so just confirming here. Hormone receptor status is not a factor whatsoever in determining whether one gets a lumpectomy or a mastectomy correct? I'm second guessing myself and before I talk to my sister againI just want to make sure.

My brother in law (whose mother this is) said she loves the doctor (oncologist) and she feels so much better as he’s starting her on the medication already. I'm not a doctor nor would ever pretend to know more than one but both of these scenarios are counter to what I've learned these past four years. There's a timeline... screening, biopsy, pathology, surgery, more pathology, Oncotype if needed, treatment determination etc. I'm second guessing myself because of the info this doctor has given her. I just want to check if my interpretations are correct or am I missing something?

Thank YOU Beesie! I was hoping you would respond. I just was at a loss. I told my sister my thoughts and just said none of what she was told by this doctor makes any sense. I appreciate the validation.

2019whatayear- yes exactly. That is my concern. She hasn’t even had a biopsy yet and the oncologist is prescribing her an AI. No results, no pathology, no receptor status...all unknowns. How can he start treating her when he doesn’t know what he’s dealing with? I’m going to try and get the name of the doctor in Puerto Rico that she’s seeing. I spoke to her at length last week when she was in NY and looked at her radiology report. Showed mass and size and Birads 5. That’s it. Told her that she needs a biopsy and a breast surgeon after the biopsy and thought going straight to oncologist was jumping the gun a bit as she needs more info. But because a ‘nurse’ friend told her to go straight to oncologist and skip everything else that is what she did. And now with this latest info of what the oncologist told her I was just dumbfounded.

And if it's just 10mm, wouldn't A1s before surgery be kind of extreme? I thought that was done to try to shrink the tumor. Won't it be hard to find if it shrinks from that small of a starting size? (I could be way off on my understanding.)