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Newbie - Diagnosed IDC T1N0 HER+, PgR+, HER2- and DCIS

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Hello, I'm 57 and was diagnosed in July. I had a lumpectomy which removed the .4mm tumor and tissue with DCIS, the margins were clear, then had a sentinel biopsy which came out negative. I will be seeing my docs for followup and to discuss treatment however since they removed everything I don't see why I should pursue radiation or immunotherapy. I would prefer to be very conservative and be monitored frequently and if there's a reoccurrence treat that. Does this sound reasonable? Has anyone taken this approach. Is there any reason to pursue treatment for a hypothetical future reoccurrence? Thank you and wishing everyone the best and much good health. Tricia

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  • maggie15
    maggie15 Member Posts: 924
    edited August 2023
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    @chapterfive , If cancer is invasive there is the chance malignant cells remain after the tumor is removed. Radiation kills any cells locally (in the radiation field) and hormonal therapy helps prevent any cells which escape to another part of the body from growing. That is why the standard of care (accepted medically appropriate treatment) is both radiation and HT. There have been clinical trials done which show that for patients over 65 with small low-grade tumors like yours HT alone is sufficient. While clinical trials have not yet been completed, there are studies suggesting the age for this option might be lowered to 55.

    https://www.health.harvard.edu/blog/when-can-women-with-early-stage-breast-cancer-skip-radiation-after-lumpectomy-202209152816

    Frequent monitoring instead of surgery is accepted practice for some DCIS patients but not for those with IDC. Insurance will only pay for frequent monitoring if it is prescribed by a doctor.

    You have the choice whether or not to follow your doctors' recommendations. There may have been more research done within the past year that would put you in the group that can skip radiation. You should discuss this at your upcoming appointment and get answers to the questions suggested in the article.

    For the record, I had radiation but declined HT. It is against my MO's recommendation but he agrees my reasons are valid and I understand the extra risk I am taking. Talk to your doctors and decide what is right for you. All the best!

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,830
    edited August 2023
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    maggie15’s comment is spot on. I would also like to emphasize that any treatment recommendations are based on the IDC. DCIS becomes less important when you also have an invasive component. Treating the IDC will take care of the DCIS but again, it’s the IDC which is of greater concern. Breast cancer cells travel through the bloodstream as well as the lymphatic system so while negative nodes are good, that doesn’t mean bc cells have no path to spread.
    You mention simply treating a recurrence should it happen. You may be thinking of a local recurrence (confined to the breast) but the greater concern is a metastatic recurrence, spread to organs/tissue beyond the breast, which is incurable.
    Watch and wait monitoring is very reasonable for pure DCIS but the game changes once IDC is part of the dx. I know that you want to take a conservative approach but you already have an invasive cancer. All treatment decisions are ultimately up to you but IDC trumps DCIS and treatment decisions should be made based on that. Take care