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Jul 21, 2007 06:31 AM Beesie wrote:
Looking at your MIL's pathology, what she has is IDC - "Intraductal and infiltrating ductal mammary carcinoma", not DCIS. There is a component of DCIS in her pathology, but DCIS is Stage 0 breast cancer whereas IDC is Stage 1 (or it could be higher). In diagnosing BC, the more aggressive cancer always trumps anything lower. So someone with DCIS and IDC is considered to be an IDC patient.
Because your MIL has IDC, an important piece of information will be her lymph node status. From her pathology report, it doesn't appear that her lymph nodes have been tested yet, so this will have to take place during her next surgery. Her lymph node status, along with the overall size of her tumor, will determine the stage of her breast cancer. It will also determine what other treatments - chemo, hormone therapy - may be necessary.
All of this doesn't necessarily affect your MIL's surgery decision. Lumpectomy or mastectomy.... always a difficult decision. Sometimes, if the tumor is large or in more than one quadrant of the breast, there is no choice and a mastectomy is the only option. The rest of the time, it's a matter of personal choice based on a number of considerations. As nash mentioned, the survival rate between lumpectomy w/ radiation and mastectomy is the same, however the recurrence rate for lumpectomies is higher. This higher recurrence risk can be reduced by taking hormone therapy drugs such as Tamoxifen.
Some of the considerations in the decision:
- How will your MIL feel about losing her breast? Some women want to avoid this, while other women feel better "just taking the whole thing off".
- How will your MIL deal with recurrence risk? If your MIL's cancer has not moved beyond the breast, a mastectomy would probably reduce her recurrence risk to 1% - 2%. (Note that this wouldn't be the case if it turns out that there is some lymph node invasion). With a lumpectomy w/ radiation, and if she adds hormone therapy, her recurrence risk may be in the range of 5% -10% (my numbers are estimates; her actual risk depends on her final pathology and only her doctor can give her the correct numbers). Would your MIL continually panic if her risk is 10%, or is this something she could easily live with?
- How does your MIL feel about radiation and hormone therapy? With a mastectomy, radiation often can be avoided, although there is no guarantee. If there is lymph node involvement or if the tumor is close to the chest wall or skin, even with a mastectomy, radiation might be required. But often it's not required whereas with a lumpectomy, radiation is pretty much the norm. As for drug therapy, after a mastectomy, if there is no lymph node involvement, hormone therapy is usually considered optional. Since the recurrence risk is so low (unless there is lymph node involvement), the main benefit would be protection of the remaining breast. However after a lumpectomy, because there is a higher recurrence risk, hormone therapy is a more important part of the treatment plan.
Those are just some of the considerations. The important thing to keep in mind is that this is a very personal decision. Having participated on this board for about 1 1/2 years now, I think I can safely say that no one should ever try to convince someone who wants a mastectomy to not have one, and to have a lumpectomy instead. They likely will live in fear of a recurrence, and regret not having had the mastectomy. On the other hand, if a lumpectomy is a viable option based on the size of the tumor, and if this is the surgical choice that the patient is most comfortable with (understanding all the implications with regard to recurrence risk, radiation, hormone therapy), then it is wrong to try to convince the patient to have a mastectomy. A mastectomy can be a relief for someone who wants this surgery; for someone who doesn't want this surgery, a mastectomy can be traumatic and live-changing. It's not something that you want to push someone into if it's not their choice.
Sorry for being so long in my response, but I hope this helps.