Lumpectomy or mastectomy?
I am 70 years old and was recently diagnosed with stage 1 ductal carcinoma with mucinous features, low grade, low proliferation rate, ER & PR+, HER2-, one 10 mm tumor. Depending on what might change because of a MRI this Wednesday and what is discovered during surgery, right now my doctors are recommending lumpectomy, probably not needing radiation or chemotherapy (probably because of my age). Of course this is subject to change. But, my oncologist is recommending letrozole. Not only have I read terrible things about letrozole, but I also have osteoporosis, which letrozole can seriously damage osteoporosis. She says I can just take an osteoporosis medication. She recommends zometa. I have also researched all prescription osteoporosis meds - they are all terrible. Right now (and I seriously doubt that I will change my mind), I am thinking I will have the surgery, but totally refuse these poisonous treatments. I feel like with my age, the fact that I am now eating NO sugar, no wheat, very little dairy, no processed food, organic, keto, intermittent fasting, exercise every day, vitamin D through the sun (about 3 X wk), lots of sleep, and working on being calm (my hardest area. I don’t think I can totally cure myself, but I really think I can slow down the cancer in my body. I would rather have a quality life than to live longer and be miserable. There is a part of me that wonders since I am probably going to refuse treatment that maybe I should have a mastectomy rather than a lumpectomy, but it is a scary idea. I would so appreciate any thoughts or ideas from my community. This is the first time I have had cancer, and everything is so new and threatening to me. All I do is study, research, and read; but I find myself questioning myself at every turn.
Comments
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I am new to all of this, so cannot offer much help. Just had my biopsy today. It’s all so overwhelming. Just wanted to send you a hug! Good luck with your decision making. I am sure others will have some good advice, it’s tough knowing which way to go. I’ll be following to see what you do.
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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.
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hopematters - I am post-menopausal and was osteopenic, but had been stable for nine years, at diagnosis. I did take letrozole for 7.5 years and Prolia for 6 years, no terrible issues and my bone density improved tremendously - I am no longer osteopenic. My bone density has stayed stable even though I am no longer on Prolia, and have been off for at least 3 years. Tamoxifen can build bone in post-menopausal women - have you considered taking that instead of an aromatase inhibitor? Do you have any comorbidities that would make Tamoxifen a risk? While a mastectomy can reduce your risk of breast cancer recurrence in the breast (it does not completely eliminate it as all breast tissue can't be removed) it is roughly equal to lumpectomy with radiation as far as effectiveness. I would ask for some delineation about the potential increased risk associated with lumpectomy without radiation, and I have seen some recent studies that women over 70 may be able to skip rads in certain situations. Taking anti-hormonal medicines that are systemic rather than local can potentially prevent a new cancer or recurrence in the breast, but also provide some protection against distant spread outside the breast and a stage IV diagnosis. Of course, nothing is a guarantee, but these drugs would not be prescribed if there was not a statistically proven benefit. Whether or not you choose to take them is dependent on your risk tolerance and is a personal and individual choice each of us has to make based on many factors. You would certainly not be alone is choosing to skip some treatments but it is important to fully understand how that would affect your prognosis going forward so that you are making informed decisions rather than choices based on anecdotal info from other patients who may, or may not, have your individual risk profile and physical specifics. I would also want to hear about risk reduction percentages and treatment side effects from each specialist - systemic treatment (chemo and anti-hormonals) from the medical oncologist, types of radiation from the radiation oncologist, and surgical choices from the breast surgeon or surgical oncologist. Sometimes early in the process surgeons step outside of their lane and start discussing treatment provided by other specialists, because they are often the first doc consulted in the process - but they should not. Wishing you the best!
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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!
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Wow! I am so totally changing my mind as to my treatment options after surgery. It is true that all I have heard are negative things about the treatment options that were recommended by my doctors. It is so great to hear positive comments from some of you who have gone through what I might be going through very soon. My MRI is tomorrow, which should tell us a lot. I am meeting with my surgeon this Friday to discuss the details of the surgery. I have received a few emails from my oncologist. Actually, she stated that tamoxifen is her 2nd choice for treatment for me, but she has concerns because I am a post-menopause woman, and she is concerned about some of the rare side effects (mainly blood clots). (I have a lot of broken veins in my legs, although they have never bothered me, except cosmetically). At this point I need to keep exploring my options, but I do feel better about what my doctors are recommending. Thanks to everyone
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