Annl,

We all know the decision is yours and only yours.  I had a very aggresstive breast cancer that extensively went through the blood stream, per my patholgy report. Although i had neg. nodes. It got out through vascular invasion. I had a dbl. mast. however my Mom also died of bc some years ago and that scares me.  Now i know mast. won't save me once it gets out, i did not realize all this when i choose my mast. Kinda had to figure out my pathology on my own. Dr. was not very informative.  Would do things different if i could.  Take your time in making YOUR decision. Once they are gone that's it.

Hope all works out for you!!

Get the Mx! - you will sleep better and have nothing to regret. Your health comes first and all other things second.

It might be a good idea to consult a rad onc. You never know.

Also, delaying the mx until Dec if you decide to do it probably isn't dangerous if, as you say, it's not a particularly aggresive cancer.

Best of luck.

Leah

AnnL said her new tumor has already been removed:  "I had the tumor removed a few weeks ago."

That means the purpose of the mastectomy she is contemplating would be to remove the adjacent breast tissue that might contain residual tumor cells. It's not to take out the main tumor.  In her case, the mastectomy would serve the same function as the irradiation served in the treatment of her first cancer.  There are some things we don't know, though.  We don't know how long "a few weeks" are; we don't know what the tumor margins were; and we don't know if there was any evidence of lymphovascular invasion in the tumor.  Also, it's impossible to know whether cells from this new tumor had already spread beyond the breast, because the axillary nodes were removed during her first cancer treatment 14 years ago. (That's my impression, anyway.)

As I see it, her post contains 3 main questions.

1) Is a mastectomy really necessary, or would just a lumpectomy suffice?  In other words, what added benefit could a mastectomy provide, beyond the removal of the lump a few weeks ago?  I don't have numbers to support this answer; but I suspect the risk of local (in-breast) recurrence of this 2nd tumor would be similar to that of the first one, 14 years ago.  There is plenty of evidence that lumpectomy alone is not adequate for protecting against local recurrence of invasive BC.  So I guess I'm suggesting that if radiation was needed after her lumpectomy last time, a local treatment in addition to lumpectomy is needed this time, too.

2) Is it okay to have radiation twice in the same breast?  From what I've read, the general answer is "No."  Prior irradiation to the chest is one of the absolute contraindications to breast-conserving therapy (lumpectomy + radiation).  The key variables are, how much irradiation was given the first time; and is this new tumor (the tumor cavity) within the same "field" that was irradiated last time?  This BCO site advises that those questions can only be answered by a radiation oncologist, who would be able to determine the dosage of radiation given and the field that was treated.  Look at "Can radiation therapy be repeated to the same area again?", on this page:  http://www.breastcancer.org/treatment/radiation/when_appropriate.jsp

3) How long is it safe to wait between lumpectomy and follow-up treatment, whether that's irradiation or mastectomy?  According to that same BCO link above, women who do not need chemotherapy generally start radiation treatment 3 to 6 weeks after surgery if they're getting external beam irradiation.  If it's more focal treatment (partial-breast irradiation or intra-op), the radiation is started much sooner, if not during surgery.  The reason for the wait is to allow the tissue to heal from the surgery.  If the woman is getting chemo, radiation is usually delayed until 2 to 4 weeks after the chemo is finished (according to the BCO page).  AnnL said her lump was removed "a few weeks ago," so I'm going to speculate that it has already been 2 or 3 weeks since her surgery.  Postponing radiation therapy until December would be adding -- I'm guessing here -- another 4 or 5 weeks, at least, to the interval.  Is it safe to wait more than 2 months between lumpectomy and follow-up treatment?  I just don't know, but it would scare me to wait that long.

otter 

LindaLou, that's a great article -- thanks!

otter 

Excellent replies, and thank you so much for the articles.  Just exactly what I was looking for.  I am in Austin, Texas, there are plently of hospitals and cancer centers here.  I am looking for a doctor that will give me something other than the automatic "get a mastectomy" response.  I may end up getting one, but it annoys me that for a recurrence after 13 years, my surgeon is not displaying a little more imagination and curiosity about treatment options.  The surgeon that removed the recent tumor seems more interested in frightening me into immediate mastectomy than in considering my individual case.  I am getting a second opinion and have an appointment this week.

One of the articles above explains my situation exactly.  Apparently, an important factor is whether the tumor is a "new primary" or a true local recurrence.

Here are my 2009 pathology results:  invasive ductal carcinmona, 0.9 cm, moderately differentiated 6/9; ER/PR pos, Ki-67 pos, HER-2/NEU status neg.  Because so many lymph nodes were removed back in 1996 (negative for metastatic carcinoma in 1996), I am told that lymph node metastatis is not an issue).  The path report says positive margins, but apparently that is because the lump was just under the skin.

I did not have any treatment other than radiation in 1996 (tamoxifen was not used then like it is now), and apparently, because of my pathology, chemical treatment is not appropriate in my case now.

Dear Otter,

I re-read Ann's original post. I am not sure whether she is talking about a second remaining lump in the same breast after the recent lumpectomy or mastectomy as an alternative to radiation. It may be ok to wait for a few weeks depending upon the situation.

Thank you so much everyone.  What a smart, and at the same time, sensitive, group.   You have given me the same sort of thoughtfulness that I am seeking from a doctor.  I think there is a real problem because everyone is directing me to a surgeon for a second opinion, and what I really need is a breast cancer expert that is not so blindly focused on surgery.

I am thinking about starting a new post, maybe "Tumor recurrence after 13 years -- is mastectomy only option?".  The article Lindalou posted suggests that a second post-lumpectomy radiation is an alternative in my case.  The article also indicates that statistics are better with a mastectomy, so I will probably do a mastectomy, but I do not wanted to make this decision by being treated like an child/idiot by the doctors.

PS to unklezwife, I had a first lumpectomy/radiation in 1996.  In 2009, I had a second tumor, which has been removed by lumpectomy.  Now I am being told my only option is a mastectomy.