Is Bilateral Mastectomy appropriate for DCIS/LCIS/ADH

[KB-73034]

I have been diagnosed with DCIS, LCIS, ADH in my left breast.  I have had a segmental mastectomy in which 7cm x 7cm x 4cm of tissue was removed.  After a pathology review found that the margins are positive with intermediate DCIS another surgery is mandatory.  I have had two surgical consultations, two medical oncologist consultations, a medical radiologist consultation and an MRI.  The two med onco's have given me differing guidance.  One says a second lumpectomy, with rads and tamoxifen is recommended.  The other med onco (in agreement with my primary care Dr) says "I never want to see you here for chemo treatment", and recommends bilateral mastectomy to make as sure as possible that I don't have a recurrance. Just too much bad cells/tissue in my "busy breasts".

I am confused.  My main concern, is to save my life, not my breasts.  I don't want to overtreat.  I have very dense breasts and imaging is difficult.  I have a cousin with invasive BC, and at 48 have never has children or a pregnancy.

Is a bilateral mastectomy overtreating?  Do all my risk factors make bi-lat a reasonable chioce?

Thank you in advance for your response.

Kerry

[Cleveland Clinic]

Dear Kerry:  There is no “wrong” answer when it comes to surgical options.  Certainly, many surgeons and patients opt for the smallest possible surgery or breast conserving surgeries.  Occasionally, a lumpectomy cannot be done because there is not enough remaining breast tissue to produce a good cosmetic result.  In these cases, mastectomy (with or without reconstruction) may be recommended.  Also, some women prefer one surgery over another even when both options are possible.  In other words, management of the disease in your left breast could be addressed either way and it boils down to your preference and which approach you feel more comfortable.  Bilateral mastectomy, or removing the right breast, would be considered a preventive procedure.  This may be considered in people who are “high risk.”  Having a personal history of DCIS does increase your risk of developing a cancer in the future.  The choice to do prophylactic mastectomy is generally made with careful consideration of risk versus benefit and ultimately is a very personal one.

[carme]

Every single one of us is different and so are our cancers. Do your homework, find out everything about breast cancer, the treatments, the outcomes. Be careful if you do any gene testing...we're not protected against what an insurance company could possibly do if they find out you have a gene mutation.
I paid out of pocket for testing (STRONG family history). I have BRCA2  and when my cancer showed up, I chose to have bilateral mastectomies at age 50.
My younger sister did not test, but when she presented with stage 3, she chose bilateral also.
We witnessed 3 family members with breast cancer and it's reoccurence, it was a no brainer for us. We just lost another recently at the age of 40. It took 5 years for hers to reoccur.
You might get another opinion since you have 2 that are not the same.
My prayers are with you.

[stresscase123]

WOW Kerry-

Our left boobs must have been separated @ birth!  I just had my lumpectomy- they are sending my pathology out for a second opinion, and discussing me @ tumor board this week.  My initial biopsy showed a small amount of DCIS, and the post-surgery pathology had them in disagreement whether it is more DCIS or LCIS/ADH, or a combination found in the surrounding tissue.  I may need to have one margin cleared yet (if they decide DCIS - if it's LCIS/ADH I am done).

SO confusing - though I'm tossing around the idea of a bilateral, as well...There is *way* too much abnormal cellular activity to make me comfortable with my breasts.  All I hear is "tick, tick", you know?  My surgeon seems to be very pro-breast conservation - but, like you, conserving my life is more important for *me*.  I don't like the word "overtreatment" - I mean can one really "over-treat" a potentially fatal disease??  It's more how much risk reduction does each patient need for peace of mind?

I am 40 and have 3 kids under 10.  Honestly, "overtreating" sounds really, really appealing to me right now!

Stress

[Just Turned 40]

I have 4 areas of calcifications.  Stereotactic biopsy showed all had atypical ductal and/or lobular hyperplasia, with 1 area being borderline DCIS.  MRI showed no cancer.  However, because patology showed 1 area as being borderline cancer, my surgeon recommended I have a lumpectomy on that 1 area, and watching the other 3 areas with a follow-up MRI.  I was not comfortable with that (we're going to trust the MRI for 3 areas, but not the 1?), so I went to a 2nd surgeon & she recommended either 4 lumpectomies or a mastectomy.  I am very small breasted & I can't even imagine what I'd look like after 4 lumpectomies, so I am choosing a mastectomy, and I don't even have a confirmed diagnosis of DCIS.  After reading about so many people having lumpectomies & radiation having recurrence, & having to go through it all again, I am choosing to be proactive.  I don't want to live my life worried every 6 months going in for MRI's.  

[carme]

My prayers are with you too! You go girl!

[boninclyde]

I agree with carme. You go girl. Live on.

[patmarinesmom]

I am waiting to have a second stereotactic biopsy because the 2nd opinion doc found more suspicious areas of microcalcs than the first.  so far, I know I have alh/adh but that was in one area only.  My feeling is like yours.  If they find dcis or anything "close" to it, I would want prophylactic mastectomy.  My prayers go with you.

[christine41twokiddos]

A related discussion, L Breast Stereotactic ALH and Radial Scar was started.