Mastetomy for 93 year old

My goodness. I would get a second opinion. There is a field called geriatric oncology, and it would be great to consult someone in that sub-specialty. I would want to know how aggressive this cancer appears to be, whether there could be a trial of a new drug with monitoring, whether a second lumpectomy is an option. Do women in your mom's family generally live to be 99? How is her health overall? What does your mom think about it all?

Sandy,

I'd have a serious heart-to-heart with your sibs, an anesthesiologist & your mom. I really believe your mom's cancer is irrelevant in this circumstance. It is her brain that is the problem. She may physically recover from the surgery but her brain might not recover. I have seen this far too many times.

Jane

You and your mom could probably do a second-opinion consultation by telehealth, especially with an oncologist in the same state as you. (I am guessing you are in the USA. If you want to post here or private massage me your state I will see if I can get you started with a couple resources.)

jhl, I'm not sure I understood what you were saying re: dementia. Did you mean that existing (early) dementia can be exacerbated by the surgery? Thanks.

Sandy,

Can you recall what your Mother indicated at the time of her lumpectomy? Did you ever discuss what her choices were? Is she cognitively intact enough to express her desires? Please, do not worry about choices in the past. AI's probably would not have made a significant difference and chemotherapy/radiation might have been far more than she was willing to do and perhaps not indicated. The last 3 years have been 3% of her life. Hopefully, she'll have lots more happy and fulfilling years ahead with you, your sibs & the grands. But, really, ask her what she wants. It would be best if her surgeon gives her a complete disclosure of all the pros and cons. Let her make her choice of what she wants done. Even with a bit of dementia, she may still have agency with which to express her own desires.

Best of luck,

Jane

jhl and sbelizabeth, thank you for responding. I had no idea.

My 99 year old grandmother recently had a 2nd lumpectomy. She was originally diagnosed at 90 - lumpectomy & radiation but no pills taken due to her age. Unfortunately the cancer came back around 95 and due to her age & non-aggressive cancer it was decided to skip surgery and just take anti-hormone therapy. Unfortunately the tumor ended up being 2 tumors which slowly grew (she tried all the variations of AI’s, tamoxifen, and faslodex). We were concerned it would break through her skin so had to do surgery. The surgeon did a lumpectomy as quickly as she could - no real concern for margins or aesthetics - just get the cancer out quickand close. I do think the anesthesia affected her brain unfortunately - she was very confused afterwards and hasn’t been the same since. She aged a lot between 93 and 99 though, thinking back 6 years ago I think she could have handled a 2nd lumpectomy just fine back then. Good luck with your family’s decision- I know it’s not easy.

bcincolorado, I'm sorry to hear of your diagnosis. My SIL also has early dementia but is not on meds. Have you noticed that they are helpful?

As a side note, you make an excellent point regarding medical POA and HIPAA. I'm mostly retired but I still do data extraction for prehospital cardiac arrest incidents. It happens distressingly often that an elderly individual, or someone with an end-stage terminal disease, collapses at home and the family has no idea what their wishes would have been. There's no written documentation anywhere. Paramedics are obligated to provide resuscitation attempts (CPR, sometimes intubation, IV starts, meds) that are almost always futile. Cardiac arrest resuscitation care for the very ill or elderly is undignified, very invasive, distressing for the onlookers, and unnecessarily interrupts what should have been a peaceful transition from life.

Everyone, everywhere should have an advanced directive and a medical power of attorney (POA). Young, old, big family, no family...everyone should have written directions as to what medical care should be provided if they're unable to decide for themselves.

Those who are elderly or in frail health should also have a POLST (Physicians Orders for Life Sustaining Treatment) https://deathwithdignity.org/polst/. This document takes the place of a Do Not Resuscitate (DNR) order, although both are valid. A POLST provides more detailed information as to an individual's wishes for end-of-life care. These documents vary from state to state, so look it up online for your own state's requirements.

A second opinion would make sense, especially from a general doctor. Also, mastectomy may be helpful as cancer goes however, a bigger picture of overall health is as important. I would never think estrogen-positive cancer can start in a woman her age where estrogen is already less than most of us who take anti-estrogen medications.

I just wanted to add my grandmother's story to this conversation. She was 93 when she was diagnosed with breast cancer. Overall, she was in fairly good health and thrived in her environment. The surgeon felt that a lumpectomy would suffice. She was put under a general anesthesia and did wonderfully well, living another 6 years. She passed from old age/heart failure. Grammy never showed signs of dementia both before and after surgery, but then again it doesn't seem to run in the family. Her b.c. was hormone positive. Hard to believe as she had a complete hysterectomy 60 years before. I, too had hormone positive b.c., even though I had a complete hysterectomy 30 years before my diagnosis. She never rec'd hormone replacement therapy. I did, low dose climara patch for 15 years.

Given the choice of dying of breast cancer or old age/heart failure, we both picked the latter.

i am not hormonal bc meds at this point and my MO stopped mine early because of side effects of bone loss for me was getting to point I needed Prolia regularly. Hormonal meds did not cause my dementia issues at all.

trishlove I'm glad the famly was there for her and supported her.