Hi, all! I met with a Surgical Oncologist Friday and will meet with a Medical Oncologist today regarding my treatment. They are different facilities, as I am in the process of deciding where to be treated. Both facilities are excellent, so it will come down to where I feel most comfortable.
I am 50 years old, premenopausal, and have multicentric, Clinical Stage I (node status, of course, verified at surgery, but no evidence on exam or ultrasound thus far) with a 7 mm IDC and a 9 mm IDC. DCIS in the mix as well. Both masses are >90% ER+/PR+ and are HER2-. Surgical Oncologist’s plan is unilateral skin and nipple sparing mastectomy with tissue expander to allow healing without pressure on healing skin and tissues. Advised Ovarian Suppression and AIs OR Tamoxifen as hormone therapy.
I was hoping that some of you may be willing to share your experiences and/or decision-making processes as you and your docs discussed your course of treatment. It’s very overwhelming, of course, and I am just trying to determine the benefit to risk ratio of the available options.
As I navigate this process, I am trying to prepare myself to have informed discussions regarding my treatment plan if it does end up involving hormonal therapy. I want to trust my care team to recommend the appropriate plan, but if given options (as I felt I was being given at my first appointment), I want to feel confident that I have the knowledge base I need in order to choose.
For the whole picture, these are the things that are making this decision difficult for me:
-Trying to determine safest path for reducing any future stroke risk. I had two small ischemic strokes when I was almost 37 years old that they found no cause for aside from the increased risk I had from high blood pressure after having severe preeclampsia 11 years prior to the stroke (there was some speculation that there is increased risk within 15 years post preeclampsia, but I don’t know if that has been confirmed with appropriate studies. I was one of a very small percentage of women who did not recover after giving birth- my BP has remained elevated and at the time, I had liver failure, etc.). I do take what I call my “stroke-repellent” which is Aggrenox -keeps platelets from sticking together and includes a low dose aspirin.
-I have been on Wellbutrin (Bupropion) for years and have done very well on it. Other mood stabilizers have not worked for me. I have also had genetic testing for medication efficacy done and this appears to be the best fit, according to my PCP. It doesn’t play well with Tamoxifen.
-My genetic testing for medication revealed that I am a CYP2D6 intermediate metabolized and that Tamoxifen “may have” reduced efficacy.
-I have only one ovary left, as I had one removed after a hemorrhagic cyst caused ovarian torsion. My paternal grandmother died from ovarian cancer. I have had blood drawn to do the BRCAplus and CancerNext genetic testing. Results will be in next week and certainly could affect treatment course if I have positive results.
“Enjoy the little things in life because one day you`ll look back and realize they were the big things.” ― Kurt Vonnegut
10/21/2021 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Tissue expander placement
10/28/2021, DCIS/IDC, Right, 5cm, Stage IB, Grade 1, 1/3 nodes, ER+/PR+, HER2- (IHC)
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