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Radiation Questions

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I’m a seasoned 71-year-old 2X survivor who is going for #3 & #4!!! Each cancer has been new. Except for the 1st, they were all small. I was notified today that 2 recent biopsies of the same breast indicate cancer. I have questions while waiting for the referral to a surgeon. Has anyone had the full course of daily radiation & then targeted radiation on the same breast years later? Has anyone had 2 targeted radiations in the same breast during the same excision surgery?

I’m a little antsy because I was told “no more radiation” 20 years ago with my 2nd cancer. However, they did not have targeted radiation at the time. Not wanting chemo!!! Thank you!!!!

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  • moderators
    moderators Posts: 8,089
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    Hi @jes_2007 and welcome to Breastcancer.org.

    We're so very sorry for the 2 new reasons that bring you here, but we're really glad you've found us. You're sure to find our community a wonderful source of advice, information, encouragement, and support — we are all here for you!

    We don't have any information regarding targeted radiation after already completing radiation therapy. Have you talked about this with your doctor? Could mastectomy be considered this time vs. lumpectomy and radiation? Likely, once you have more information about the type and diagnostics of the biopsy you'll get a good plan in place.

    Please let us know what you decide and how else we can help!

    —The Mods

  • jes_2007
    jes_2007 Member Posts: 7
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    Thank you!! The radiologist who did my biopsies said either a cat scan or mri (don't remember which one) is done after mastectomies, but not annually - only if there is a problem. I've always discounted a mastectomy because I didn't think they'd regularly test for cancer in the breast wall after that procedure. If this is the case, I will likely continue having lumpectomies as long as possible.

    To answer your question: My primary referred me today to a quality surgeon whose office is ready to schedule an appointment ASAP as soon as they receive an approved referral. I expect him to recommend a mastectomy. I need to do more research, namely my insurance coverage for annual testing!

    I love this site. It helped me get through my treatments in 1992-93 & 2002-03. I've recommended it to many through the years.

  • thora902
    thora902 Member Posts: 3
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    I thought they could still do ultrasounds of the chest wall and lymph nodes after mastectomy.

  • jes_2007
    jes_2007 Member Posts: 7
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    Thanks thora902!!!! I will ask about ultrasounds of the chest wall & if they are done annually like mammograms. I'm sure they will recommend a mastectomy again. So far I've never had lymph node involvement because the cancers have been caught early, thank goodness. I hope you are doing well!

  • lb13
    lb13 Member Posts: 48
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    @jes_2007 I have had breast cancer twice. Each time a lumpectomy - 1st time 30 whole breast radiation treatments - this time 25 targeted partial breast radiation treatments. I am on #18 today with 7 to go.

  • jes_2007
    jes_2007 Member Posts: 7
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    Where did you find the information on the first line of each diagnosis? Is there a place to help us understand these? Today I received info from my doctor, but it has no stage, no ER + or -, PR + or -, or HER. He mentioned Estrogen positive. Will I get that info with the future MRI? We covered so much during the appointment. I hope you don't mind all the questions. Thank you!

  • jes_2007
    jes_2007 Member Posts: 7
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    thora902, I found out that after a mastectomy that pimples along the incision need to be investigated as cancer. The surgeon then runs a specific test to confirm or rule out cancer.

  • moderators
    moderators Posts: 8,089
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    Hi @jes_2007,

    Here are two articles that you will likely find helpful in understanding hormone status (ER+/-, PR+/- and HER2-/low/+).

    Your doctor won't be able to give you accurate staging until after surgery (lumpectomy or mastectomy) is completed to see whether or not there is lymph node involvement. After that, they will generate your pathology report, which is when you should receive more comprehensive information on your cancer, and will inform the treatment approach that your doctor takes.

  • lb13
    lb13 Member Posts: 48
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    @jes_2007 Your final diagnosis/staging does not come through until after surgery and pathology results. No two breast cancers are the same and I learned there are so many factors that go into a diagnosis (unfortunately with lots of waiting in between!) My diagnosis/staging was listed on my final pathology reports.

  • jes_2007
    jes_2007 Member Posts: 7
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    Ib13 & Moderators, thank you!!! I just received a little more info through the physician's Patient Portal that I will include on my profile. I'm in the waiting mode (1 month out) for a breast MRI that is needed before the team can decide the best approach & schedule surgery which he said would probably be around 30 days after the MRI. Calling daily to see if there are cancellations. Have to stop eating comfort foods to calm my innards!! Gained 4 lbs last month!! Everyone says I seem so calm. My insides are going crazy!!! Glad they can't see it!! I've started going through some research & will read the articles suggested in the above post. Thanks again!!!

  • tigglewinkle
    tigglewinkle Member Posts: 20
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    Hi. I met with my breast surgeon last week who seemed pretty emphatic that I do radiation, and maybe I have to, but I am concerned about the fact that my tumor (IDC, 1cm+) is close to my chest wall. She didn't seem worried about it, but I am nervous about the possible effects on my heart and lungs. I have seen some studies that suggest that early stage lumpectomies without subsequent radiation fared as well as those with, and those stats were something like 2.5 % recurrence. But the surgeon said 20% chance of recurrence, if not radiation, which is obviously not great. I know preventing recurrence is the purpose, but if the radiation causes lung cancer in the meantime….what good would that do? How do you weight those benefits and risks? I'm a former smoker and would like to know what I'm getting into. Also wonder about Proton therapy, but I don't think insurance will pay for it. I am meeting with the radiation oncologist in about a week, and would appreciate any information before my appointment. Thank you.

  • tigglewinkle
    tigglewinkle Member Posts: 20
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    moving the above comment to a different section

  • maggie15
    maggie15 Member Posts: 953
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    @tigglewinkle , Studies show that women 65 and older with tumors <1.4 cm can skip radiation if they commit to finishing 5 years of hormonal therapy. Another study showed that women 50 - 59 with small tumors and an Oncotype DX score of 18 or lower can do the same. HT sometimes causes side effects which make sticking with it difficult. If you are concerned about your heart and lungs you could resolve to put up with any SEs from HT you might have. Some people have hardly any but you never know.

    Insurance generally does not cover proton therapy. There are breathing patterns which can be used during radiation to help protect the heart and lungs.

    You can also ask the RO to show you where your radiation field would be and estimate the exposure to your lungs. The location and size of the tumor does affect this.

    Good luck with your decision.

  • tigglewinkle
    tigglewinkle Member Posts: 20
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    @maggie15 Thank you. I too have seen those studies. Am I correct in assuming that they push radiation no matter what? It just seems to be a given and I feel like I’m jeopardizing my health if I say that I am worried about it and want to consider other options.

  • maggie15
    maggie15 Member Posts: 953
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    They push radiation because many people don’t use HT for the full five years due to side effects. If you choose radiation you have the 20% less chance of a recurrence covered and whatever extra benefit you get from HT. Your MO will tell you what that is if you ask since that varies depending on individual circumstances. A recurrence is not necessarily just another tumor in the breast; it could be metastatic.