lumpectomy or mastectomy?? Two Opinions?

[angelaone]

Hi, I was diagnosed on 2/14/08 with IDC - I quickly had a lumpectomy and 12 lymphnodes removed during surgery. I was told after that they found two nodes that were cancerous, and two very small additonal tumors (1mm & 4mm) near the orginal tumor - of 1.5cm - they removed all with clean margins. I am er pos. 10% and Her2neu pos - I was told by my first surgeon that due to my two add'l. tumors found, that now I should have my breast removed because it is "multi-focal."  I am presently undergoing dose-dense chemo (AC, Abraxane/herceptin) and am finishing 7/10. During this chemo, I went for a 2nd opinion. This hospital agreed with the treatment plan but disagreed with the Mastecomy. They told me they were not sure it was multi-focal and if it was multi-centrix, that would require a mastectomy. They think that I can keep my breast since I got clear margins.

I am confused as what to do. I really want to keep my breast badly but do not want to be stupid.  What do you think?


This discussion is related to Lumpectomy as good as Mascectomy on Agressive tumor with cancer lymph nodes ?.

[japdip]

It is accepted practice that if we get a second opinion that doesn't agree with the first then we should seek a third. It is a difficult decision in your case and I certainly don't envy you having to make it. I'd go for one more opinion just to be sure.

[Fernando Roque, MD]

Hi.  The National Comprehensive Cancer Network (NCCN) guidelines for the treatment of breast cancer state that an absolute contraindication for lumpectomy is "widespread disease which cannot be incorporated by a single local excision which achieves negative margins".  Since the lumpectomy was able to remove the two additional lesions with clean margins, the smaller lesions were in effect, "incorporated by a single local excision which achieves negative margins". Lumpectomy is therefore adequate and there is no need to resort to mastectomy.  There is no evidence that mastectomy plus axillary lymph node dissection is superior to lumpectomy, axillary dissection plus whole breast irradiation in stage 2 disease (which you have).  In fact, the studies indicate that the two procedures are equivalent in terms of efficacy for early breast cancer.  My assumption here is that you're still going to have whole breast irradiation after the chemotherapy.

I hope this helps clarify matters.

[angelaone]

Thank you so very  much for your comment. I am leaning heavily for keeping it. I am due for a MRI after I finish chemo and if nothing else is found, I think I am keeping it. Thank you for your sort of "third opinion" :) as I know you must be so busy. You made my day!

[angelaone]

PS. Yes, am due to have 7 weeks of Rad. to start after chemo. (forgot to mention that) also, the first hospital was Beverly Hospital in MA (mastectomy) 2nd hospital was Beth Israel in Boston, MA. (keep it!) :)