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Medical Forum / Diseases and Disorders / Breast Cancer / July 2005How best to prevent recurrence?
Hi, All Last month I had microcalcifications and a biopsy diagnosing DCIS, high grade, non-invasive. I opted for a simple mastectomy on the left breast (done the 23rd ) and the final path report showed 'another' site, independent of the original biopsy site and showing extensive cancerization of the tissues, comedo type, much bigger area, etc. In other words, I was fortunate to have elected the mastectomy instead of the offered lumpectomy and radiation. Lymph nodes were clear. My main motive for choosing the mastectomy over the lumpectomy was that the chance of recurrence was 15% in the affected breast, and that was too high a risk, plus I have small breasts. Now, my BC surgeon says I am 'high risk' because of the multi-focal cancers in the left side and have a 15% chance ( one in six in over all statistics ) of the right side going bad. Since the bigger, nastier area did not show up on the mammogram or the MRI, should I elect a prophylactic removal of the right side? I've not been able to get in to see an oncologist yet, but hope I can by the end of the month. I really, really do not want to undergo chemo or take any of the drugs I've read about here. So.. main questions: 1. Can you still get breast cancer if you have all the breast tissue removed? 2. The type of cancer I had was not estrogen responsive, so will that mean that future cancers will be that type, too? 3. Is multi-focal BC somehow worse in the sense of predicting bi-lateral involvement than a single site incidence? 4. Are there individual risk factors that would affect the 1 in 6 odds, either to raise or lower? I'm guessing that the people on this NG have heard the answers to my questions somewhere. To complicate matters, I'm being forced to change insurance Sept.1 and the surgeon (whom I really like) will not be available to me after that. So, a wait and see strategy is not an option. TIA SC PS- after reading about all the struggles people here are having with chemo and other drugs as well as metastized cancer, I 'do' realize how lucky I am to have my relatively simple problem. I wish you all well. > Hi, All > [quoted text clipped - 9 lines] > chance of recurrence was 15% in the affected breast, and that was too high a > risk, plus I have small breasts. The overall statistical outcomes of lumpectomy and mastectomy are about the same. The higher risk of recurrence with lumpectomy refers to local recurrences which require additional surgery but are still curable. However in your case it seems your decision was fortunate, you would probably wound up with a mastectomy whatever option you originally took. > Now, my BC surgeon says I am 'high risk' > because of the multi-focal cancers in the left side and have a 15% chance [quoted text clipped - 8 lines] > 1. Can you still get breast cancer if you have all the breast tissue > removed? Yes, you can, but the chances are considerably less. Firstly, there are bound to be traces of breast tissue left, and secondly there is always the possibility of a stray cancer cell or two remaining from the original tumours. > 2. The type of cancer I had was not estrogen responsive, so will that mean > that future cancers will be that type, too? No, not necessarily. Even a single tumour can sometimes change its status during its lifetime. > 3. Is multi-focal BC somehow worse in the sense of predicting bi-lateral > involvement than a single site incidence? Multi-focal is generally worse in overall outcome. I don't know if there is any greater risk of contralateral recurrence or new occurrence, or whether it is entirely down to a higher risk of metastasis. > 4. Are there individual risk factors that would affect the 1 in 6 odds, > either to raise or lower? Most of the known risk factors are already established and beyond your control (genes, timing of menarche, previous cancer, childbearing, etc.) The main "lifestyle" risk factors are obesity and poor general health. When saying that your risk is one in six, this compares with the lifetime risk for the population in general of about one in eight, it isn't that much increase. Tim Jackson > Hi, All > [quoted text clipped - 5 lines] > fortunate to have elected the mastectomy instead of the offered lumpectomy > and radiation. Lymph nodes were clear. > My main motive for choosing the mastectomy over the lumpectomy was that the > chance of recurrence was 15% in the affected breast, and that was too high a [quoted text clipped - 6 lines] > really, really do not want to undergo chemo or take any of the drugs I've > read about here. Chemo was a rotten hobby, but it beats the <bleep> out of dying. (I know it's no guarantee against dying from BC, BTW. All one can do is play the odds!) > So.. main questions: > 1. Can you still get breast cancer if you have all the breast tissue > removed? It should dramatically reduce your chances of another primary tumor to near zero. Sources I've seen seem ambiguous about whether it reduces the chance to zero, literally. IF one has/had invasive BC, and IF there were undetectable micro-metastases, and IF they grow later, one could still get metastatic BC. > 2. The type of cancer I had was not estrogen responsive, so will that mean > that future cancers will be that type, too? Not necessarily. > 3. Is multi-focal BC somehow worse in the sense of predicting bi-lateral > involvement than a single site incidence? Don't know. My personal data point is that I had 5 tumors in one breast, and one in the other. > 4. Are there individual risk factors that would affect the 1 in 6 odds, > either to raise or lower? Sure. All the normal risk factors: Alcohol consumption, obesity, etc. And, while it isn't proven, it's starting to look to me like research suggests that regular moderate exercise may reduce risk. Other comments: I am very satisfied with my bilateral mastectomies, with no reconstruction. I don't have to have mammograms. Physical breast exams (self or doctor) are very easy, and new local lumps would be easy to detect. Having bilateral mastectomies avoids the (small percentage) potential for postural problems caused by unequal weight distribution. One minimizes future surgeries (surgical biopsies, reconstruction, etc.). I can wear protheses, or go without. Not only do people not commonly stare, but many don't even register that I'm flat (well, slightly concave). I've had people express sincere surprise when I say I'm a BC survivor, even as I stand before them completely flat, wearing a t-shirt. Go figure! My surgeon didn't want to do a bilateral, with one side prophylactic, which is what I wanted after initial malignancy was discovered in one breast. However, a suspicious area in the contralateral breast was identified on my mammograms before my initial surgery. We agreed that he would have it biopsied while I was in surgery, and do a bilateral if it was malignant. It was. Fooled him, got what I wanted <grin>! Good luck making your decision -- keep us posted on how things are going with you, OK? Ann T. Remove 'dontsendspam' from address to reply by email |
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