Mammogram found new mass

Hi dontwantth! I agree with Beesie on wording and the fact that want more follow-up. They likely also want to be extra careful with you since you have a history of breast cancer. Hopefully this comes back benign for you. I hope you don't have to wait too long for the follow-up... Do what you can to stay busy while you wait.... the waiting is one of the hardest things as you know ....

Since you were referred to rapid diagnosis clinic, my guess is that the plan is to do the biopsy at the same time you come in for the additional screening, unless the screening clearly shows the mass to be low risk (a complicated cyst, as an example). So I'm thinking that they want to be prepared to do the biopsy, and they want you to be mentally prepared for it, but the plan could change once they get a closer view.

This seems like a reasonable approach for a rapid diagnosis clinic - a delay between diagnostic imaging and biopsy would be inconsistent with their mandate - and with consideration to your personal history of breast cancer.

Maybe they just want to be more cautious going straight to biopsy b/c of your history - not taking chances or adding the additional step of more imaging when they may just feel they want to do the biopsy out of due diligence anyways? I'm obviously speculating though if they want you going right to biopsy it is a due diligence measure. With your history I'd hope that would offer you some peace of mind too even if initially more worry while you wait.... Keep in mind most biopsies come back benign. You've already been in that smaller percentage though so understandably are on higher alert.... Keep us posted on this all right?

dontwantthi you are understandably concerned! Anyone would be at this point.... I hope they get results back to you soon - can take from a few days to a week best case scenarios.... Do what you can to distract with enjoyable and relaxing things as hard as that will be while you wait.

Sorry but none of us are medical doctors so we could only guess. Hope you get the results next week.

I'm sorry that it's cancer again.

Whether or not you need chemo has nothing to do with the surgery you choose. Surgery, whether a MX or lumpectomy, is a localized treatment, with the goal of removing the cancer in the breast. Chemo is prescribed to reduce the risk of a metastastic recurrence, i.e. a recurrence that develops beyond the breast, in the bones or liver or some other organ. It is the pathology of the cancer that determines the aggressiveness and the risk of mets, and therefore whether chemo will be recommended or not.

Did you have radiation previously? If so, radiation cannot be given twice to the same area, so a mastectomy will be recommended. If you did not have rads last time, then you will likely have the choice of a lumpectomy + rads, or a mastectomy (most likely without rads but sometimes rads is recommended even after a MX). The recommendation on chemo will depend on the hormone status, HER2 status and pathology of the cancer, and if ER+/HER2-, probably on an Oncotype score as well.

I really feel for you dontwantthi!!!! I'm so glad you are on this site for all the info and support though info is what you seem to be craving now. Support will be important as you move through treatment as well! Please keep us updated on next steps ok? As I'm sure you know there are the surgery threads, as well as other forums and threads that could be a real help as you move forward....

The mastectomy makes sense since you can't do rads again. The "no chemo" may not be consistent with treatment protocols. How large is the tumor estimated to be? Previously you mentioned that imaging showed it to be 1cm in size. Usually with a 1cm ER-/PR-/HER2+ cancer, chemo + Herceptin will be recommended.

I'd strongly suggest that you get a second opinion. Of course the decision on chemo is up to you, but if your doctors are recommending something different than what's in the treatment guidelines, there should be a good reason. And as you say, with this being your second diagnosis one would expect your doctors to be more aggressive with the treatment recommendations, not less. So where the treatment guidelines say to "consider" a particular treatment, with a second diagnosis, I think most doctors would recommend that treatment.

Here are the NCCN treatment guidelines for ER-/HER2+ cancers. You can see that for even the tiniest cancers, 5mm or small in size, and even being node negative, it's recommended that chemo + Herceptin be considered.

I don't know if you can insist. But you can ask why they are recommending no chemo when the NCCN Guidelines (these are the gold standard used by most doctors in the U.S.) suggest that chemo and Herceptin be considered.

If they don't agree can you go somewhere else?

I agree with Beesie and Mindi! I do not know a whole lot about the medical end of these things. One thing I've seen a lot of though is chemo recommended for HER2+ I would get a 2nd opinion too - honestly even if you talked with them and they agreed to do chemo.... I wouldn't be comfortable continuing with whoever said it was ok not to undergo chemo-esp. the second time around... just me though.....