Lumpectomy or mastectomy?

hopematter, I am sorry you have to join us. It seems you have good prognoses. When I was in your position, I didn't want to take letrozole however, cancer was found in 2 lymph nodes and this changed my decision on being in letrozole and zometa. Wait for the after-surgery biopsy and if the cancer is small, no lymph nodes, I would skip letrozole. If you have to take it, I heard that letrozole doesn't have severe side effects on older women.

Hi, hopematters - so sorry that you have had to join us! Regarding the lumpectomy vs mastectomy question, there are a lot of factors that go into it, and your upcoming MRI should give you more information to use in your decision-making process. Neither surgery will completely prevent local recurrence or distant metastasis. I chose to do a BMX because I had 4 tiny tumors (1 IDC, 2 DCIS, 1 mixed DCIS/IDC) spread over both breasts, and would have needed reconstruction anyway if I'd gone the lumpectomy route. I also wanted to avoid radiation, if possible. My oncotype score was very low, so chemo was not recommended for me.

As far as follow-on systemic treatment goes, of course your personal preferences and comfort level are the driving factors in that decision. As SpecialK noted, it would be helpful to have all the information on risk mitigation to inform your choice. I would just say that the possible side effects from the recommended AI and zometa don't necessarily affect all (or even most) bc patients. I have been taking anastrozole (an AI similar to letrozole) for almost 6 months, and do not have any of the side effects that are most commonly mentioned. Like you, I have osteoporosis, so am also on zometa, with infusions every six months. Other than the expected reaction to the first infusion (about 24 hours of flu-like symptoms) I have had no side effects from the zometa, either; I do get my teeth cleaned and checked every 3 months in deference to the very remote chance of ONJ. My oncologist believes that the zometa will, in addition to countering the impact of the anastrozole and offering some protection against bone mets, improve my bone density significantly. I should add that I'm 60, walk at least 5 miles a day, work out with weights at least twice a week, practice moderation in all things diet-related, work full-time at a very busy job, and am looking forward to getting back to regular international travel as the world opens back up. In short, neither of these medications has had any impact whatsoever on my quality of life. I mention my own experience only because people who suffer from significant side effects of these medications are understandably a lot more vocal than the many of us who are fortunate enough to have few (if any) side effects, so the conversation tends to be dominated by the negative effects.

The bottom line is that we all want to get rid of the cancer, and to do what we can - consistent with our individual values, beliefs, and comfort levels - to prevent it from spreading or recurring. You are very wise to seek information on the choices others have made, and their reasons for making those choices, as you go through the process yourself. It's not an easy process, and I wish you all the best!