Topic: lumpectomy vs mastectomy - why did you choose your route?

Forum: DCIS (Ductal Carcinoma In Situ) — Just diagnosed, in treatment, or finished treatment for DCIS.

Posted on: Jun 13, 2013 01:54PM

Posted on: Jun 13, 2013 01:54PM

ealga wrote:

Hi all, 

i was wondering if anyone could elaborate on this question. i have multifocal, grade 3 DCIS, and am contemplating another lumpectomy vs a mastectomy. my surgeon is confident she can clear the margins with another lumpectomy, and recommends radiation afterward.  BUT anecdotally, so many women I’ve talked to, even with a Grade 1 single foci lesion, opted for mastectomy.   I don’t want to undertreat OR overtreat but I am struggling to figure out why women would make this choice and what am I missing?  I'm at a very cutting edge cancer hospital if that matters.  I'd love any perspective on this.  Many thanks in advance. 

Dx 4/4/2013, DCIS, 5cm, Stage 0, Grade 3, 0/0 nodes, ER+/PR-, HER2- Surgery 5/15/2013 Lumpectomy: Right Surgery 7/10/2013 Lumpectomy: Right Radiation Therapy 8/28/2013 Breast Dx 9/23/2020, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER+/PR+, HER2- Surgery 11/7/2020 Lymph node removal: Right, Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Latissimus dorsi flap, Tissue expander placement Chemotherapy 1/5/2021 CMF
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Nov 19, 2019 03:17PM beesie.is.out-of-office wrote:

Yup, lumpectomy and partial mastectomy are the same. It's just a quirky thing as to which term different facilities use and why they use one versus the other. For example, some facilities will use lumpectomy if the breast tissue being removed is all in one quadrant of the breast but will call the operation a partial mastectomy if the breast tissue being removed is in two quadrants of the breast. In my mother's case, because she'd had a lumpectomy as her first surgery, when she went back for a second surgery to get wider surgical margins, her doctor called this second surgery a partial mastectomy, even though very little breast tissue was being removed. Apparently some insurance companies balk at paying for the same type of surgery twice, so this was her doctor's way of avoiding that problem. It was a small easy surgery but my mother was very concerned because the paperwork she signed said "partial mastectomy".

To complicate things further, an excisional biopsy, i.e. a surgical biopsy, is also the same surgery as a lumpectomy, although there may be less concern about surgical margins when the surgery is a biopsy versus when it is being done to remove a known cancer. Some doctors and facilities choose to call the surgery a 'lumpectomy' regardless of whether it's a biopsy or cancer surgery, and that can be really confusing because the term "lumpectomy" is associated with cancer.

A mastectomy, on the other hand, is very different from a lumpectomy/partial mastectomy because it involves the removal of the entire breast.

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Dec 15, 2019 12:30AM Cakencobbler1 wrote:

My biopsy results were “atypical papillary and cribriform duct epithelial proliferation” the Pathologist’s comments were”findings are suggestive of an encapsulated papillary carcinoma. Excision of the entire lesion is recommended to exclude the presence of invasive carcinoma.” So are atypical cells cancer? I don’t understand the difference between the Pathological Diagnosis and the Pathologists comments. Seeing a surgeon Tues. to schedule Lumpectomy. My PC said I’d ost likely have a course of radiation and one of the drugs like Femera. After reading people’s comments about side effects, I’m terrified. I’m 70 and have liver issues as well as osteopenia. Maybe I should be considering a mastectomy rather than a lumpectomy. Does everyone take these drugs

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Dec 15, 2019 05:23AM DaBahm wrote:

Cakencobbler1- my understanding from my own research is that atypical cells are not necessarily cancerous but indicate a change in the cells. Once they take the tissue out they'll know for sure. In my case a mastectomy got me a pass on the radiation but I still was given hormone therapy, which has turned out to not be that bad. There are other therapies that don’t mess with your bones so if they do suggest HR I would definitely ask about that. I took the drugs because I was had a strong estrogen reception and I was the best case scenario so maybe another thing to ask about is how strong was your estrogen receptor reaction. This is all assuming it becomes necessary:). I hope that it doesn’t, but this site is full of people not just surviving, but living, and doing it beautifully. I hope you get answers soon, waiting was the worst part to me.

“Rivers know this: there is no hurry. We shall get there some day.” —Winnie-the-Pooh Dx 9/23/2019, DCIS, Left, <1cm, Stage 0, Grade 2, 0/0 nodes, ER+/PR- Surgery 10/2/2019 Lumpectomy: Left Dx 11/7/2019, DCIS, Left, <1cm, Stage 0, Grade 3, 0/2 nodes, ER+/PR- Surgery 11/11/2019 Lymph node removal: Sentinel; Mastectomy: Left Hormonal Therapy 11/29/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 16, 2019 03:58PM TammyKh wrote:

https://www.cbc.ca/radio/whitecoat/blog/long-term-breast-cancer-survivors-face-unexpected-challenges-1.5397446?__vfz=medium%3Dsharebar

I think there is another reason not to opt lumpectomy and radiation. This article figures out heart diseases are caused by radiation treatments particularly in the breast cancer survivors whose left breast is cancerous.

Dx 10/24/2018, IDC, Left, 4cm, Stage IA, Grade 3, 0/3 nodes, ER+/PR+, HER2- Surgery 1/11/2019 Lymph node removal: Sentinel; Mastectomy: Left Hormonal Therapy 4/1/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 17, 2019 12:30PM proudtospin wrote:

i had 3 lumpies in 08, bad choice, now fighting stage 4, surgeon thought she got all but since 30 percent of all dcis returns, i got lucky.

Should have do e the mastectomy

iris Dx 6/2008, DCIS, Stage 0, ER+ Dx 2/2017, Left, Stage IV, metastasized to bone/liver, Grade 3, 1/1 nodes, ER+, HER2+
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Dec 17, 2019 03:36PM beesie.is.out-of-office wrote:

proudtospin, did you not also have a microinvasion at the time of your DCIS diagnosis? I remember that because I had a microinvasion as well. This makes the diagnosis Stage I and while the difference vs. a diagnosis of Stage 0 DCIS is very small, there is an additional small risk of mets.

Do you have a reference or link to the stat that 30% of DCIS returns? I have never seen any figure like that and if this is new information I would like to read about it. From all that I've read over the years, I believe the average recurrence rate for those with DCIS who have a lumpectomy + rads is in the range of 8% - 12%. This can vary hugely in any individual case, depending on the size of the area of DCIS, the focality (a single focus vs. two or more areas of DCIS), the grade of the DCIS, and the size of the surgical margins. I remember reading a study shortly after I was diagnosed 14 years ago which found that recurrence risk after a lumpectomy for DCIS could be as low as 4% or as high as 60%, depending on these factors.

For those who have a MX for DCIS, most studies have found the recurrence risk to be 1% - 2%. However if there are close surgical margins after a MX, a couple of studies have found that the recurrence risk might be more in the range of 12% - 15%.

On average when someone has a recurrence after surgery for DCIS, 50% of the recurrences are also DCIS, while 50% are not found until after the cells have developed to become IDC. I believe the % of recurrences that are IDC is somewhat higher after a MX than after a lumpectomy.

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Dec 17, 2019 04:19PM Gramto4 wrote:

I was diagnosed with DCIS in my right breast in February of 2018.The single focal area was 9-10 centimeters and very near the nipple area. I chose to get three opinions on which procedure (lumpectomy or mastectomy) was best for my specific situation. All three oncologist recommended removing the right breast versus a lumpectomy. I had the unilateral mastectomy in April 2018 and underwent breast reconstruction in September 2018. As much as it pained me to lose my breast, I wanted to feel that I was doing the best thing to avoid the chance of the cancer reoccurring. I read over and over again where women who chose to do a lumpectomy the first time and then were diagnosed a second time and ultimately had to undergo a mastectomy.

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Jan 8, 2020 03:08PM msphil wrote:

hello I was encouraged to get mastectomy but because we were making wedding plans our second I considered lumpectomy but my fiance now husband said which ever one would keep you here longer. I chose mastectomy with reconstruction body rejected implant expander removed wear prothesis in bras can't tell difference. Praise God I am this pass yr a 25 yr Survivor and celebrated 25 yr Wedding Anniversary. Do what you feel best for you. msphil idc 0/3nodes stage2 3mo chemo before after Lmast got married then 7wks rads 5yrs on Tamoxifen.

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Feb 20, 2020 10:08AM Dragonzfly56 wrote:

Hello from one DCIS diagnosis to another,

I just met with my surgeon status post two surgeries 1/23/20 and 2/3/20 ending with pathology diagnosis of DCIS. After the 2/3 surgery, the pathology showed another ADHIS. He assured me without mastectomies my chance of reoccurence was 11% in the next 7 years. In 2016, 2019 and 2020 I have been diagnosed with Atypical Ductal Hyperplasia in situ(ADHIS) three times.

P2016- diagnosed with ADHIS with lumpectomy. At that time I was given incredibly low reoccurance chances. (HA) 2019-2020-diagnosed ADHIS with lumpectomy1/23/20 pathology- DCIS 2/3/20- another surgery to widen margins pathology - clean margins with exception of ADHIS found on new margin.

His recommended course of treatment was radiation and tamoxifen. However after three surgeries and worsening diagnoses I was frustrated that I was not given better prognoses. He was unable to assure me that radiation and hormone therapy would give me better odds of never having to have another lumpectomy.

I have recently met with the oncology radiation doctor, was given the risk factors, because my DCIS is in left side, there are lung and heart radiation risks. Long story short choices are mastectomies with no further treatments (no radiation/ hormonal therapy tamoxifen) vs radiation and tamoxifen with side effects. I opted to have double mastectomies at 63 yrs old my breasts are just a continuing ball and chain around my neck.

Information I used to make my decision:

IE: radiation side effects

Hair loss on affected side, lung lesions, heart disease with possible heart attack.

Too much of a risk factor even at the low probabilities they quoted me.

Tamoxifen side effects

Heart disease possible, stroke, embolus to lungs.

Risk factors are more than I am willing to chance especially because with diabetes I already carry a higher risk factor for heart disease and stroke. I had not met with medical oncology doctor prior to this decision, however I did extensive research on tamoxifen.

For me deciding to have double mastectomies seems the lesser of two evils. How many more lumpectomy surgeries would I have to undergo now and or after radiation and Tamoxifen therapy. To many questions that I could not be guaranteed would not happen or would not decrease my quality of life. I felt this decision was an easy peezie no brainers for me. I hope my ramblings have helped you. I feel I chose life over more chronic life threatening choices.

Best of luck to you in making the right choices for you.

God bless.

Valerie
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Mar 4, 2020 03:01PM theworkinghour2 wrote:

Although this is not an answer to your question, I've also wondered why mastectomies are choosing over lumpectomies. From the research I've gather the results are the same. Opting for a mastectomy does not guarantee cancer will not coming back. But you can have reconstructive surgery if you do. Great question, though. I hope someone will give some insight on this matter.

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