re margins and treatment

[Joy1121]

I am 60 years old with previous follicular thyroid cancer (1993) with two I 131 radioactive treatments in  1993 and 1996.
I am also diabetic(under control with rx) and osteoporosis, with increasing back pain in recent years.

In April, I had a mammogram that showed a 2 cm area of abnormality - spiculation- with shadow and BIRAD 4. Was told it had been there a long time. (Looking at films back to 99 the same area was there but had changed a lot in 2007-white).
The wire locator biopsy was surgical and came back with Infiltrating Ductal Carcinoma 1.2 cm, very low positivity k-67,Er positive and Pr mod. positive, and Her 2 a 2 which was not backed up by the FISH. Calcifications benign type throught both. Upper Inner area at 12:00 slightly to the right. Margin involved for IDC and DCIS. Stage 1 score 5.( 2, 2, 1), Grade 1.
A bilateral mastectomy was my choice with the right being a mod. rad. mast. with axillary and sintenel node biopsy and 4 nodes removed on the left breast.  All negative.  The margins were stated to have no obvious tumors or residual cancer with H and E stains. So clear margins.  However the gross descrition mentioned that the deep margin is .3cm from the biopsy cavity and the peripheral margin is exposed! This did not ring a bell to me until a friend had to go back because hers wasn't 1 cm.
My only treatment is Femara, with blood tests, CBC and chem. profile. I had a PET scan and it showed no distant mx, and mild activity at the site of the surgeries.
My doctor, surgeon and second opinion dr.s do not see need for radiation.
The pathologist met with me and mentioned that there is no idc left so is now DCIS and that all was clear in what she tested.  However, there is a missing section in the biopsy cavity as there was a reason the surgeon could not remove it resulting in the exposed peripheral margin, possibly skin. ON asking him, he seemed to misunderstand the question and said the hole was removed (duh) but we do know that was tested at biopsy.) and that the fascia was removed over the muscle and the skin was (reserved?) at lower edge of stewart incision for possible future reconstruction. (not interested)
The second oncologist said the radiation oncologist said not necessarily rec. radiation unless surgeon concerned.  He had a second pathologist review slides and feels this is comfortable?
Should I continue to seek more opinions or feel comfortable with just Femara? He says it's low grade so will be fine for some time even if it does spread. The surgeon said if I feel a bump then could get radiation. This feels risky to me. Am I being paranoid?

[PaulMD]

Hi there.

If the peripheral margin is positive, especially if this is through skin, then this can be labelled as a T4 tumor and would require post operative radiation treatment.  I think this is the issue that you and your doctors should resolve first (whether the skin is involved).

The deep margins of 0.3cm is also pretty close and I would also suggest a discussion about radiation.  Some would even go for a repeat surgery if they are not comfortable with the margins.

I agree with you seeking more opinions on this matter and hopefully a surgeon or radiologist with a more aggressive attitude can take this cup.

Regards and God bless.

[Joy1121]

Thank you for your thorough and professional reply.
This is very helpful.
I think they feel the margins are clear but could not test the one that is exposed.
I will pursue this. This gives me courage to do so.
THank you again!