Lumpectomy + radiation vs MX with probable multifocal IDC/DCIS

Options
labmama56
labmama56 Member Posts: 27
edited October 2021 in IDC (Invasive Ductal Carcinoma)

So happy to have found this community and am doing a lot of reading right now. I have been diagnosed with right breast 1.8 cm IDC/DCIS, currently Stage 1A, ER/PgR+, HER2-. Met with my BS yesterday for the first time. We planned a lumpectomy, radiation, and hormonal therapy. Had an MRI today and found out there's another suspicious mass in the same breast, thankfully smaller, around 8mm.. Radiologist recommends another diagnostic MMG & US, followed by biopsy. So I've been reading about multifocal and multi centric BC while waiting to hear back from my nurse navigator and/or BS. Things seemed so manageable and now it's thrown me for a bit of a tizzy. It did help to read various opinions about how much a smaller, second mass raises risks vs means the same treatment. Anyone with similar experiences? Anyone with a Stage 1 BC get referred to a tumor board for treatment planning when a second mass showed up?

Thanks in advance for any input. It really does help to see so much experience and wisdom in this community.

· Share on FacebookShare on Twitter

Comments

  • 1982M
    1982M Member Posts: 300
    edited October 2021

    Good morning!

    Im stage 1A. I’m in a similar situation although my DCIS was discovered after my lumpectomy. My tumour initially looked to be about 1.5cm but once removed the invasive tumour was only 8mm/0.8cm. However they found multifocal DCIS that was not visualized previously. 7 out of 25 slides had DCIS. All of them on the inferior part of the tumour. I now have to decide between re-excision vs unilateral mastectomy vs bilateral. I’m meeting with radiation oncology via telephone on the 19th.

    We don’t have a tumour board where I’m from. My surgeon is recommending mastectomy, but mostly bc my tumour and my DCIS was hard to find on screening. She did say we could try a re-excision. My breast are medium sized so I think I could do an oncoplastic reduction and get away with it- but honestly I waver so much.

    Im 39, so I feel like I have lots and lots of years where I could face a recurrence. Im not sure if I choose lumpectomy I could handle it if I had a local recurrence and had to do all this again. I know the survival is the same/distal metastasis, but I do think local is more with lumpectomy. Im triple positive so Im doing chemotherapy right now.

    Sorry- not much help really. Just saying your not alone!

    · Share on FacebookShare on Twitter
  • labmama56
    labmama56 Member Posts: 27
    edited October 2021

    Hi 1982M,

    Sorry we’re in similar situations but it’s nice to hear from someone thinking through the same things. I’m 56 and feel I’m right on that edge of years to deal with recurrence worries decision point. At 39, I can totally understand your wavering! My BS estimated somewhere around 10% potential recurrence with lumpectomy and 2% potential recurrence to the chest wall with mastectomy. Still a very hard decision IMO. And throwing in triple positive, I can see your dilemma. Tumor boards here are made up of BS, MO, RO and their teams who all come together and recommend treatment. I wonder if you could ask your team to have a joint discussion with you? Sending you all good thoughts!

    Hoping to talk with my surgeon today. It would be nice to go into the weekend with some idea of how she views the MRI results from yesterday.

    · Share on FacebookShare on Twitter
  • Salamandra
    Salamandra Member Posts: 1,444
    edited October 2021

    MRIs are super sensitive and known for more false positives than other forms of screening. I wouldn't assume multi focal cancer before a biopsy.

    · Share on FacebookShare on Twitter
  • 1982M
    1982M Member Posts: 300
    edited October 2021

    Labmama56:

    Wow- 10% vs 2%. I wish someone would tell me what there recurrence estimates would be. I haven't really gotten a good %. I waiver by the minute about what to do. 10% chance of local recurrence feels really high. I never want to interrupt my life with chemo again….

    I know my surgeon called the radiation oncologist so hopefully the had some sort of discussion and I can get some answers when I chat with the RO.

    Honestly healthcare here right now is a mess due to Covid. The fourth wave has hit us hard where I am so I think that complicated all the choice right now.

    · Share on FacebookShare on Twitter
  • labmama56
    labmama56 Member Posts: 27
    edited October 2021

    1982M:

    I hope you can get some answers soon too. Where are you located? I worry about COVID messing up healthcare where I’m at in Colorado too—our ICUs are 98% full. Seems like my clinic however is pretty separate, thank goodness. It is taking me longer to get to this next diagnostic mammogram and US, then assuming biopsy for this second mass. That part is pretty frustrating, but I’ll just have to be patient.

    Wishing you all the best as you make the decisions for your treatment.

    · Share on FacebookShare on Twitter
  • 1982M
    1982M Member Posts: 300
    edited October 2021

    I’m in one of the prairie provinces in Canada. A real cluster of a mess here.

    I’m currently taking chemo so I don’t have to decide for a month or so. Im leaning towards re-excision.

    · Share on FacebookShare on Twitter
  • labmama56
    labmama56 Member Posts: 27
    edited October 2021

    1982M,

    Wishing you all the best up there. And hoping chemo is going well. I’m still waiting for the biopsy of the newly identified mass, but expecting it to be malignant (spiculated, hypoechoic). I thought I was really comfortable with lumpectomy + radiation, but if I have two masses in two quadrants, I’m wavering. Researching MX with Diep flap reconstruction….

    So many decisions. Take care

    · Share on FacebookShare on Twitter
  • muska
    muska Member Posts: 1,195
    edited October 2021

    With tumors in different quadrants, lumpectomy even if possible would likely result in a significantly disfigured breast. Also, keep in mind you would need to continue frequent regular screenings in that breast. I would ask what the monitoring schedule would be like and factor this into your decision making.

    I had two small tumours - .9 and .3 - in two different quadrants of the same breast. Was assessed stage 1a before surgery, upgraded to 3a after surgery. Glad I chose BMX.

    Good luck with your decision

    · Share on FacebookShare on Twitter
  • 1982M
    1982M Member Posts: 300
    edited October 2021

    good luck Labmama!

    Mine is multifocal so same quadrant and it's only the DCIS left, I think in your case mastectomy and reconstruction makes sense. If they don’t get good margins I won’t try again- straight to mastectomy (not enough tissue. I don’t have DIEP as a option so I’ll do implant based reconstruction.

    Good luck to you

    · Share on FacebookShare on Twitter
  • labmama56
    labmama56 Member Posts: 27
    edited October 2021

    Thanks for your input, muska. I can imagine how glad you were when post-op pathology came back! Yes, disfigurement with two quadrants has me leaning MX now. Monitoring schedule is an excellent topic to ask at my next appointment, thanks for that! Wishing you all the best.

    1982M, your thoughts on margins, etc make perfect sense. Good luck!

    · Share on FacebookShare on Twitter
  • Pink1976
    Pink1976 Member Posts: 1
    edited October 2021

    Sorry we are all dealing with this.

    I also was recently diagnosed Sept, stage 1, grade 2, ER+/PR+ HER2-. First appt with BS seemed like a plan, lumpectomy radiation and hopefully done. Then the MRI. Recommended for 3 additional biopsies. Further images determined one not needed and the other 2 were negative. Now the decision lumpectomy + radiation or Mx. After 5 biopsies in a month, the decision seems more complicated.

    Hopeful your tests have good outcomes as well.

    · Share on FacebookShare on Twitter
  • Moderators
    Moderators Member Posts: 25,912
    edited October 2021

    Welcome, Pink1976. We're so sorry you find yourself here, but we hope this community can be a source of support and encouragement for you. You are definitely not alone!

    The Mods

    · Share on FacebookShare on Twitter
  • labmama56
    labmama56 Member Posts: 27
    edited October 2021

    Hi Pink1976--so sorry to hear about the additional worries and biopsies. Such a tough decision.

    I got my results from my second biopsy--another IDC/DCIS, stage 1, low grade, ER/PR+, HER2-. Given the 2 tumors are in 2 different quadrants, MX is now required, no more option for lumpectomy + rads. Which is ok, I had already decided if the 2nd tumor was cancer, I wanted MX.

    The decision I'm now sitting with is choosing bilateral vs unilateral. There isn't much research on multi centric BC and recurrence in the other breast, but along with lobular carcinoma, multi centric shows elevated recurrence in at least one large study from M.D. Anderson. I've had a family member end up with a 30 year battle of recurrences (different kind of cancer) and watching that process unfold leads me to want to lessen my chances of recurrence as low as possible. My breast surgeon really pushed me about that desire and by the time I broke down crying, she said she was convinced that I had really thought this through and was making this decision as a result of weighing all the pros and cons. Wasn't a fun experience in many ways, but I feel better that she really asked me to look at all the angles. My cancer is in my right breast but I've had two biopsies required for the left before any of this came up. My gut is definitely speaking loudly that saving that breast likely isn't worth the risk nor the anxiety that comes with imaging dense breasts and having more "suspicious" areas referred for further investigation.

    I'm meeting with my plastic surgeon today to discuss DIEP reconstruction, etc, etc,. Looking forward to having more input.

    Wishing you all the best!

    · Share on FacebookShare on Twitter
  • 1982M
    1982M Member Posts: 300
    edited October 2021

    Thanks for the update Labmama56. It’s so hard to make all these decisions. I sometimes wish someone would just make them for me.

    I hope your surgeries go well!

    · Share on FacebookShare on Twitter

Categories