I'll just comment that MRIs are really reliable--in fact, my BS told me they have a 30% false positive rate. Also--my first lumpectomy was a large area--8cm x 6cm x 3cm, and certainly that side is smaller than the other (with the smaller lumpectomy) but I figured women are always lopsided anyway. You absolutely cannot tell with clothes on.

If the biopsy pathology is correct and it is Grade 1, then it is a relatively slow growing type. (grade 3 is the fastest growing, grade 1 the slowest). So at least you can relax a bit about this. This is urgent but not an emergency - you have time to get proper assessments and think about treatment and surgical choices. Tumor boards are a great resource for this type of situation. You might find you're a candidate for lumpectomy but with those, there is a possibility for a need for a re-excision. Otoh, it's way smaller surgery & faster recovery.

Re chemo, your MO will recommend it or not, based on final post surgical size and pathology, and the lymph node status. There is a genomic test called Oncotype (done on tumor tissue) which might further help your oncologist regarding a recommendation for chemo. Oncotype tries to assess the risk of a tumor recurrence and whether chemotherapy has more benefits than risk for a particular pt. Some tumors are very highly hormone responsive and the recommendation might be for hormone therapy only.

best wishes

Jen it isn't uncommon for the different imaging modalities to show varying sizes of the tumor. I had dense breasts so my mass wasn't "seen" on mammography and ultrasound until we could pinpoint it with the MRI. Then MRI indicated my mass was about 50% larger than it wound up being on final pathology. So you truly won't know until the surgeon is in there.

Wishing you well on your surgery and outcome, hoping the pathology continues to correlate with your grade 1 (slow growing) biopsy diagnosis. Typically chemo is more effective if your cancer is quicker growing.

I have pretty much the same diagnosis, just diagnosed in mid December. I'm electing to do lumpectomy with IORT which involves travelling out of state. I'm sure I will be advised to do hormonal therapy. I currently am taking a CBD FECO (full extract cannabis oil) I purchase from a dispensary, as there has been studies that CBD can help shut down the tumor hormone receptors. I'm also taking Turkey Tail and another mushroom supplement.

Hi Jen,

Pretty similar case here. I didn't have additional imaging. I had a "conglomorate" of tumors located behind my nipple. It showed in the mammogram and the dx USN. My BS recommended mastectomy, given the location and size of the tumor. He said I would be very unhappy with the results and reconstruction would be more difficult. I did lose my nipple and quite a bit of skin in the process to ensure wide margins.

Moth mentioned Oncotype. This test will be beneficial to help you and your MO decide the best course of treatment with regards to chemo. My score was only 4, so it was a definitive chemo Not Beneficial conclusion. Here is some information: About the Oncotype DX Breast Recurrence Test

I also had a hysterectomy, but they left my ovaries. Because I am still premenopausal at 51, I am taking Tamoxifen. AI is in my future, but how soon is still up in the air. I have handled T really well. /E are minimal and manageable. I am a crying angry mess right now, as I had to stop it for surgery end of January, I restarted about a week ago. I seem to recall this being an issue when I first started taking T, and it eventually calmed down.

Hi Jen,

I saw my oncologist after surgery. I, too, chose unilateral mastectomy. I'm a pros and cons list person. It is such an emotional journey, I needed to work from facts.

Best of luck on your upcoming tests. Keep us posted on your surgery date.

I chose and met with an MO immediately after the Mammo & ULS - even though it looked like my diagnosis was DCIS. He was the oncologist for my BFF who died of pancreatic cancer and he was marvelous. So I wanted him on board from the beginning - even though I did not have chemo or rads the first time.

Well, but then I had a local recurrence in a lymph node, And it had morphed into HER2+. And was SO glad he had been following me all along and advocating for me with the tumor boards - because I trusted him totally.

But then I also do lots of research before picking all my docs, so...

I also saw the MO (and the RO) before surgery. But that's the way my care team operates--they have you come in and meet them all one at a time and each one shares what will probably happen, assuming the pathology confirms their initial dx.

So it all depends on how your team works

Is it true a PET scan is not normally done for early stage cancer? I've had two people ask me why the doctor is recommending chemo prior to doing a PET scan to see if it detects any cancer. I guess i'm interested to know why. Why would it not be done for early stage cancer?

muffet, take a read again through your original thread. The answer to the question you've been asked "I've had two people ask me why the doctor is recommending chemo prior to doing a PET scan to see if it detects any cancer" is there.

Topic: Should I get Chemo? https://community.breastcancer.org/forum/5/topics/...

Several of us explained to you why chemo is recommended for those who have aggressive diagnoses such as your own, even if there is no evidence that the cancer has spread. The reason for giving chemo to someone who is early stage is so that any rogue breast cancer cells in the body can be killed off before they become large enough to be found by a CT or PET scan. Once a full body scan finds something, the patient is already metastatic, i.e. Stage IV. Chemo is given to reduce the risk of that happening. So a PET scan finding isn't relevant to the chemo decision - and the hope is always that the PET scan finds nothing. But that won't change whether chemo is recommended. If the cancer is aggressive (and yours is) and therefore presents a significant enough risk that some rogue cancer cells might be hiding out in the body, then chemo is recommended.

"My current BS says that because genetic testing was negative, my non-cancer breast remains average risk for breast cancer. Do y'all agree?"

No, unfortunately I don't believe that to be true. The risk of a second cancer is higher for those who had a first cancer that is hormone negative, but for any of us diagnosed one time, our risk of a second primary is higher than average.

Second Primary Breast Cancer Occurrence According to Hormone Receptor Status https://www.ncbi.nlm.nih.gov/pmc/articles/PMC27209...

The analysis was based on 4927 women with contralateral second primary breast cancer. Of these, 3701 had a first HR-positive tumor and 1226 had a first HR-negative tumor. The risk of a new contralateral primary breast cancer among women who had a breast cancer of any HR status was more than two fold (SIR = 2.46, 95% CI = 2.40 to 2.52) that of the general population.

For women with a first HR-positive breast cancer, risks of an HR-positive and an HR-negative second tumor were similar, and the average risk of developing a second tumor was approximately double the risk of a first primary breast cancer in an unaffected woman.

.

Contralateral breast cancer risk according to first breast cancer characteristics among United States women from 1992 to 2015. https://ascopubs.org/doi/abs/10.1200/JCO.2019.37.1...

Although CBC risk is declining in the US from 1992-2015, survivors have approximately twice the risk of an incident breast cancer (in the contralateral breast) compared to the general population.

Of course, the risk of not developing a second/contralateral breast cancer is still a lot higher than the risk of being diagnosed again.

I can confirm what Beesie said. In 2010 I had a small ER-PR-HER2+ and ER+PR+HER2- invasion. The oncologist described it as a sheet of cancerous cells.

I don't think you really know what you are dealing with until after the surgery. Pre-MX, I was told I had a small DCIS. Oops!

Because the preliminary diagnosis was so benign (relatively), I elected a single MX. Because of the HER2+ factor, which was not discovered until after surgery, I had chemo with Herceptin (for the HER2+ bits) and Tamoxifin (for the ER+ bits). Beesie talked me into it so listen to her. I kept my hair with cold caps -- SO worth it.

You probably have guessed where this is headed . . .

In 2020, I was diagnosed with cancer in my contralateral breast. Because it actually was DCIS, they did no ER/PR/HER2 analysis. Makes no sense to me but what are you going to do?

My genetic testing came back negative, twice.

Over 2020, I had four surgeries to remove the offending breast and reconstruct both of them so they looked like they are supposed to match (FAIL). Because I am ten years older, the recovery was substantially harder.

When I was diagnosed in 2010, my oncologist *guaranteed* me I wouldn't get it in the other breast. Ha.

Turns out your chances of getting it in the other one are much higher than I was told. This caused me to blow off the mammogram for the remaining breast for a few years. Don't do that.

Net/net -- you aren't going to really know what you have until after the surgery and if it were me, I'd go for the BMX. Also, make sure you understand how your pathology report will be handled -- will only one pathologist look at it or do all cases get several looks? i wanted to hire a pathologist to do further analysis on the second cancer but apparently that's not a thing.

Hugs to you. This is hard. It is a lot. Listen to Beesie.

I tolerated Tamoxifen no problem. People are all over the board on this. Some can’t tolerate it at all. You might want to try it and see if it bothers you.

I understand about the UMX — I had to be talked into even doing that. Make sure you like your surgeon. I didn’t like mine (although she was “the best”) so I didn’t trust her 100% when she said chemotherapy. I LOVED my oncologist but feel she lead me astray. Flip that for the second round. Plastic surgeons were fine if you don’t consider the outcome — which may be as good as it gets. I have no way to know.

I should have taken the time to make sure I trusted my team but there’s a good bit of panic involved in a cancer diagnosis and I had to consider the schedules of my post surgical care team plus I’m a “get it over with” kind of chick.

Hugs. This is hard. You’ll do good.