Radiation and/or Tamoxifen?

2 years ago at age 37,I underwent a bilateral mastectomy with silicone implants for a right-sided 3.2 cm "circumscribed intermediate grade (gd. 2) cribriform and solid DCIS."  There were deformed and slightly sclerosed lobular units without invasion.  The margins were negative, as were nodes on Sentinel biopsy.

Now, 2 years out, 2 tiny lumps near the scar line were discovered on exam in the right breast.  Lumpectomy was done and they were found to be infiltrating carcinoma-tubular type- involving connective tissue and skeletal muscle.  There isn't a conscensus whether this is a second primary or a recurrence.  Does this make a difference re: treatment?

It is positive for estrogen and progesterone receptors, and neg. for HER2 (0+).  CT scans and bone scans are neg.  Apparently, no nodal involvement.  

I've consulted with 2 different medical oncologists and my surgical oncologist, all of whom differ on appropriate treatment.
One says I could do nothing because it's tubular type/good prognosis or could try Tamoxifen.  Another says definitely Tamoxifen for 5 years.  The other is adamant about radiation along with Tamoxifen for 5 years.  All say chemo or more surgery is overkill.

Confused.  What do I do???

[CCF-RN,MSN-rf]

Dear DorothyW:  The first thought is that your pathology should be reviewed to be certain of the diagnosis.  This is an unusual situation and there should be pathological confirmation.  It does not matter if this is considered a recurrance or primary from the point of view of treatment.  Although tubular cancer is associated with a slightly better prognosis, it is treated according to stage, as all invasive cancers are.  Part of the decision would be based upon the pathology, size of tumors, margins etc.  If the skeletal muscle and connective tissue is involved, the tumor is a T4, which would, in many cases be consistant with a recommendation of chemotherapy.  Without more information, it is impossible to render any specific advice.  However, it is quite possible that we would also recommend radiation.  Most certainly, tamoxifen would be recommended.