Triple Negative, BRCA-1, Bilateral Mastectomy, Radiaiont

[JKim2009]

Hi, I'm a 36 year old, new mom with a 10 month old baby boy.  I was diagnosed with triple negative breast cancer (IDC with mass of 3cm) in July and I immediately started chemotherapy.  I went through 4 rounds of Adriamyican/Cytoxan and currently doing 12 more rounds of Taxol.  I am also BRCA-1 (feels like I won the lottery).  I am scheduled for a bilateral mastectomy at the end of the year.

My radiation oncology is conservative and would like me to do radiation therapy after my surgery.  My initial PET and MRI show some lymph node involvement but since I did chemo first (instead of surgery) the doctors do not have a clear picture of my initial diagnosis pathology.  Consequently, the rad onc says my case is not textbook and so he wants to be on the safe side and go ahead and recommend the radiation.

I am concern about radiation therapy because (i) I worry about secondary cancer in the future due to radiation compounded by the chemo regime (Adriamycin is not good for the heart and risk of leukemia), also my age (the longer I live, the more chance of new cancer), also more compounding of future cancer risk of having my ovaries removed in the near future because I am BRCA1 (which increase my chances of lung cancer) and I would like to avoid complications with my reconstruction and more surgery if that happens.  

My chemo treatment is going well.  If after my surgery, the lymph nodes are clear and my pathology report is clear (no sign of cancer), is it reasonable for me to consider not getting radiation?  Also, is there differing levels of pathology report that I can request (i.e., more samples taken or more detailed analysis)?  My med oncologist says my case is on the fence, but she also thinks that there is low risk associated with radiation.

Any thoughts would be appreciated.

[SueYoung55]

Well, you do have a full plate there. As BRCA 1 you have a higher risk for ovarian cancer so having an ooph is a good choice though I hate to see it on a woman your age.

As for surgery, bilateral mastectomies would be recommended and I'm sure you're looking at reconstruction. If you're going to have radiation you will want to stay away from expanders and implants as the risks associated with that and radiation aren't worth it. Tissue transfer would be the best route and you can have bilateral mastectomies with either DIEP flap reconstruction (best choice as it leaves muscles in tact) or Tram Flap (which does take your stomach muscles) or Latissimus Flap with takes your latissimus dorsi flap from your back and moves it forward under your arm.

Triple negative cancers can be very aggressive. Your choice in this is to consider how agressive you are going to be. That's what I'd be researching since you have some time to do this. Radiation if it made it to your nodes is very much the way to go and really, only surgery is going to find that out. You didn't mention Herceptin... are they not putting you on a round of that too?

I will also send you a private message.

Best wishes.