What to do? Synchronous bilateral breast cancer, multiple types
I have been diagnosed with synchronous bilateral breast cancer, multifocal on the left site.
Right breast IDC, 4mm, pT1aNxM0, ER 30% weak-strong, PR 90% weak-strong, HER2 1+, Ki-67<5%. DCIS present. Atypical lobular hyperplasia found.
Left breast multifocal, Stage IA pT1cN0M0. a) IDC, 1.1 cm, ER+PR+HER2-;Ki-67 5-10%. b) ILC,6 mm,ER+PR+HER2-,Ki-67<10-20%, margin focally positive for the IDC (although surgeon claims that in reality margins are negative, as per pathologist's note "tumor abuts the false 3 o'clock anterior margin, however, re-excision of margin of this 3 o'clock site is negative for tumor). DCIS present. Atypical ductal hyperplasia found.
Sentinel nodes on the left side were clear.
The right side cancer was found thanks to surgery. A preliminary ultrasound guided biopsy must have missed the cancer cells and was determined to be benign tissue, but the surgeon decided to remove it. Since the cancer was found after surgery, the sentinel nodes on the right side were not removed.
I consulted both with my surgeon and with a second surgeon at UCSF and I am not getting a clear indication on what to do next. I have three options. 1) no other surgery; only radiation+tamoxifen, 2) removal of possible cells left on left side+sentinel nodes on right side, followed by radiation and tamoxifen, 3) DMX + sentinel nodes on right side, followed by tamoxifen.
I really don't know what to do next. My surgeon claims that mastectomy and radiation have the same recurrence rate so she is steering me towards options 1 or 2. Surgeon from UCSF says that this is true for recurrences from the same tumors, but mastectomy is more effective in preventing new tumors (and yet, he is leaving completely up to me the decision). Should I ask for a third opinion? If so, where should I go? I really hoped UCSF would help me figure out what the next best step would be.