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Breast Cancer (Expert Forum)
Treatment after bilateral mastectomy
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
Treatment after bilateral mastectomy
by Lillie02465, Nov 11, 2006 12:00AM
I'm 70 yrs. old in excellent health and had a 6 cm left breast biopsy in Jul 06. The pathology report, based on 28 slides, showed 2 areas of DCIS separated by 2-3 cm. The 1st (Mamm detected) DCIS about 1 cm. had clean margins: solid, cribiform, intermediate grade, central necrosis with calcifications, ER/PR(+)& HER2(-). The 2nd (MRI detected) DCIS at least 1.5 cm (very close margins): solid, cribiform, clinging, intermediate/high grade, apocrine features, central necrosis, no clacifications, ER/PR(-) & HER2 (3+). I elected bilateral mastectomy with a SNL biopsy on each side, no reconstruction. Analysis of 12 pathology slides showed no malignancy in either breast or in the nodes. ADH was found in the right breast which also showed up on that side 6 mos earlier in an excisional biopsy. Gladly, no maglinancies were found, but I was surprised that only 12 slides were used to analyze both breasts and the nodes. Seems like a very small % of total tissue removed was examined which makes me question the validity of the results. Q1: How confident can I be in the results even if confirmed by a 2nd opinion? Q2: The surgeon said I will need no further treatment (i.e., no chemo, radiation, or adjuvant therapy). I assume this is the recommended approach per NCCN and other guidelines but would like to know which circumstances dictate additional treatment, and, if so, what it would entail. Is my age a factor?
Doctor's Answer
by CCF-RN,MSN-rf, Nov 13, 2006 12:00AM
Dear Lillie02465: The most important pathological review is that of the known abnormalities (where there are 28 slides). When the remaining "healthy" tissue is removed, the pathologist takes larger cuts for evaluation. If anything questionable is noted, they would look at that area more carefully. You might benefit from meeting with an oncologist who is best equipped for making recommendations for adjuvant therapy based on the literature. An oncologist would review everything about your case, offer some meaningful statistics and make recommendations for additional therapy if appropriate. Tamoxifen is frequently given after breast conserving surgery for DCIS but is not clearly indicated for most patients who have undergone mastectomy for DCIS. If any invasive cancer were found, recommendations would be different.
Member Comments (2)
by boninclyde, Nov 11, 2006 12:00AM
To: Lillie02465
It does seem like a small amount of slides. Which you can send for a second opinion. Have them send the whole breast. Your insurance should pay for it. I had 38 slides sent for a second opinion. As far as treatment is concerned visit breastcancer.org and post questions there. Great site.
