Lumpectomy radiation therapy vs. mastectomy

I was diagnosed with stage 1 breast cancer in November 2000.  The pathology showed infiltrating ductal carcinoma.  Also uncovered was LCIS which is probably where the cancer came from.  The cell type was class I (described as a Lazy cancer), ERPR positive, Her2Nu[something] negative.  I had complained of  this lump for 18 months, had gone to 2 obgyns, one surgeon and had a mammogram, complaining of this lump to the radiologist.  ALL of them passed me off saying that the lump was "nothing".  Noone ever sent me for or suggested a simple ultrasound, something I now find incredible!!  I have learned that in all probability, I had the lump for up to 5 years.  
I went to Memorial Sloan Kettering for a 2nd opinion where they suggested CMF Chemotherapy (which I just finished), lumpectomy (which I had on Dec. 4, 2000)and radiation therapy.  I have maintained that the best course for me was chemotherapy and mastectomy, largely because of the LCIS.  After talking to a radiation therapist last week, he agreed that, if I could handle it psychologically, a simple mastectomy was in my best interest.  My question is: What is the course of treatment at Cleveland Clinic for my situation?  I have found no support from the oncology community here in Hartford for mastectomy.  They maintain that Lumpectomy + Radiation = Mastectomy.  I do not understand how that can be in light of the fact that several of my friends who have gone through this protocal have had recurrence and then had to face modified radical mastectomy and extensive chemo.  Am I missing something??  I am scheduled to have a simple mastectomy Aug 6 and will then avoid radiation therapy.  Am I off base in my thinking?   Thank you in advance for your response. It is not too late to change my mind.    Wanda Carmon

[CCF-RN,MSN-JS]

Dear Wanda, The general recommendation for treatment of stage one infiltrating ductal carcinoma is lumpectomy + radiation therapy or mastectomy.  It has been shown that the results of these treatments, in terms of recurrence and survival, are close to equivalent.  Thus the decision regarding which procedure to use also takes into account the patient preference.  These are a more extensive operation (probably without radiation therapy), or breast preservation with a more limited procedure and definite radiation therapy.

LCIS (lobular carcinoma in situ) is a less common finding and is thought by some to be less malignant, but patients with this have an increased risk of developing some form of invasive cancer in either breast over many years.  You have already had cancer and are receiving treatment.  The concern would be in terms of developing cancer in the other breast.  The standard treatment of LCIS can be more frequent periodic examinations (physical examination every 4-6 months plus mammogram annually).  An alternative is total mastectomy to both sides.  

The decision is not an easy one.  The mastectomy would allow you to avoid radiation, however your risk for developing cancer in the other breast remains, and close follow-up is important.  Your oncologist may also recommend tamoxifen as your tumor was estrogen receptor positive.