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Mastectomy or lumpectomy

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Topic: Mastectomy or lumpectomy
Posted By: monimay01
Subject: Mastectomy or lumpectomy
Date Posted: Feb 20 2019 at 2:55pm
I had my mind set this morning during a follow up before I meet with plastic surgeons about reconstruction options. I had my mind set on a mastectomy of my left breast. My MO and SO want me to reconsider saying the outcome will be the same with a lumpectomy and radiation or a mastectomy. I understand this, even if my thoughts still go with "get rid of the breast and there's less chance of recurrence" . 
If any of you were candidates for either surgery, how did you choose? What were deciding factors? Is anyone concerned about radiation induced sarcoma later on? Anyone have a lumpectomy and still need reconstruction? 
I was finally getting okay with my decision of removing my breast and now I'm being asked to reconsider. 
I was diagnosed 1/21/19. I'm 34 years old with a 9 month old daughter. Negative for brca 1 and 2 mutations, but I have an "unknown variant" on brca2 that they say not to worry about. Tumor is 1.5x1.5 cm, tnbc, stage 1, grade 3.


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Dx IDC 1/21/19 (age 34), TNBC, BRCA 1&2 negative; 1.5x1.5 cm, Left breast



Replies:
Posted By: 123Donna
Date Posted: Feb 20 2019 at 10:57pm
This is a hard and very personal decision for you.  I'd say go with what you feel is best for you.  I know you say you've been tested for the BRCA gene, but there are many more genes associated with an increased breast cancer risk.  Before you make your decision, I'd consider getting tested for the other breast cancer genes.  There is a simple test if your doctor's office won't do it.  If you test positive for one of the genes, you may want to consider a mastectomy over a lumpectomy.

Updated chart on the BROCA Cancer Risk Panel test and new genes they are including in the test.

http://tests.labmed.washington.edu/BROCA" rel="nofollow - http://tests.labmed.washington.edu/BROCA


Color 30 Gene Test for Hereditary Cancer

https://www.color.com/product/hereditary-cancer-genetic-test" rel="nofollow - https://www.color.com/product/hereditary-cancer-genetic-test






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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: monimay01
Date Posted: Feb 20 2019 at 11:38pm
thank you for your reply. I think I was tested for something like 23 Genes with the only thing that came back was the unknown variant on the brca2 gene. They are saying this is nothing to worry about, at least right now. I've been reading other survivor stories, studies, statistics and other material, and I'm now leaning towards the lumpectomy plus radiation. My MO Saud there is now data that shows a benefit for lumpectomy plus radiation because the radiation "touches" so much tissue, where as with the mastectomy it would not be touched by radiation... Such a difficult decision to make and I'm terrified. I will roll with what ever I decide and start my fight!! 

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Dx IDC 1/21/19 (age 34), TNBC, BRCA 1&2 negative; 1.5x1.5 cm, Left breast


Posted By: 123Donna
Date Posted: Feb 21 2019 at 7:55am
I found this Chinese study from 2017.  I agree with your doctor that radiation may add a benefit as seen with these results.

The different outcomes between breast-conserving surgery and mastectomy in triple-negative breast cancer: a population-based study from the SEER 18 database

Breast-conserving surgery (BCS) including radiotherapy (RT) has been demonstrated to provide at least equivalent prognosis to mastectomy in early-stage breast cancer. However, studies on triple-negative breast cancer (TNBC) patients are relatively scarce. The current population-based study aimed to investigate the distinct outcomes between BCS+RT and mastectomy in patients with TNBC. Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, we enrolled 11,514 female TNBC cases diagnosed during the years 20102013. Those patients were subdivided into BCS+RT (5,469) and mastectomy groups (6,045), and we conducted a survival comparison between the two groups. The endpoints were breast cancer-specific survival (BCSS) and overall survival (OS). In the overall cohort, patients with BCS+RT exhibited distinctly better breast cancer-specific survival (BCSS) (log-rank, p < 0.001) and overall survival (OS) (log-rank, p < 0.001) than did mastectomy patients. When stratifying the TNBC patients according to age, histology grade, TNM stage, tumor size, and lymph node (LN) status, most patients in the BCS+RT group presented with better survival than did the patients in the mastectomy group, except for the grade I (log-rank, p = 0.830, both BCSS and OS) and stage I (log-rank, BCSS, p = 0.127; OS, p = 0.093) patients. In addition, after adjusting for confounding variables by multivariable Cox proportional hazard analysis, BCS+RT still tended to present with higher BCSS and OS. In conclusion, from our study on SEER data, BCS+RT displayed elevated BCSS and OS in TNBC patients compared to mastectomy, at least equally. Our study provided further evidence for surgeons that BCS with RT is available for TNBC patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354870/" rel="nofollow - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354870/


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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: barrycarrot
Date Posted: Feb 23 2019 at 3:49pm
I had a similar diagnosis to yours and was 37 at the time. I also had a hard time making a decision as I too was given the choice or either lumpectomy or mastectomy. I ultimately decided with the lumpectomy and do not regret my decision. I also had 2 young girls and was a single mom at the time. I knew my healing time would be quicker with the lumpectomy and to me, the studies did not show enough proof one way or the other that one was better than the other as far as reoccurrence.  It really is a personal choice though. Go with what you feel is right.
 
To keep your head up - know that it's been 3 years now since my diagnosis and I'm healthy and enjoying life again. You will get there too. :)
 
All the best,
Carrie


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Age 40, DX: 12/10/15 Stage 1 TNBC, BRCA-, 7mm tumor in left breast, no nodes, ACT Chemo 1/4/16 - 4/15/16, Lumpectomy 5/16/16, PCR (Praise God!), radiation 6/22/16 -8/3/2016


Posted By: L.Jo
Date Posted: Feb 25 2019 at 2:34am
Hi Monimay01, 
I stumbled across your message while googling TNBC. I have completed 20 weeks chemotherapy and spoke to my surgeon last week. Although i was kind of mentally prepared for a mastectomy i broke down in her office once discussing my options. I am booked in next month for a lumpectomy as my surgeon said im not ready for a mastectomy & she said at the moment we dont know what we are dealing with. My scans were clear from cancer anywhere else but like my doctor said until a lymph node is in the bucket and under a microscope we wont know. I am also 34 but i do not have the brca gene (no ones actually checked) & the only history i have of breast cancer is my great grandma & 2 of my grandmas sisters-all were over 80 years old.


Posted By: monimay01
Date Posted: Feb 27 2019 at 11:17pm
I wanted to give an update. I had surgery this morning. I went with the lumpectomy plus radiation. I'll be starting chemo after I heal from surgery and then start radiation. My SO said he bad clear margins in the end and that my sentinel node biopsy came back negative for cancer on the 3 nodes he removed! I'll have a final pathology report in 10 days. 
I'm comfortable with my surgery decision as of right now and eager to continue and finish this fight! 
Thank you all who read my post and offered some insight to me on this topic! 
Monica


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Dx IDC 1/21/19 (age 34), TNBC, BRCA 1&2 negative; 1.5x1.5 cm, Left breast


Posted By: L.Jo
Date Posted: Mar 01 2019 at 9:29pm
ive gone through the chemo already & the only advice i can give is listen to your body. If you want to sleep then sleep, if your hungry then eat what ever you are craving. (mine was hot chips with lots of salt & vinegar) Tell the oncologist if yourgetting the numbness/tingling in your fingers & feet. Try different pain medication to see what works best for you. And most importantly dont be afraid. Chemo is a long road & im still getting over it but there is an end to it 💪🏼💪🏼💪🏼💪🏼


Posted By: Tamara
Date Posted: Mar 02 2019 at 3:26pm
Monica,
My diagnosis was very similar to yours in March of 2014. I was 48 with children in high school and a busy life. I opted for the lumpectomy, then had chemo and radiation. Most important is that you feel comfortable with your decision as it is such a personal one to make.
Here I am 5 years later with a clean bill of health but monitored closely due to the TNBC diagnosis, I am pleased with my decision.
Best wishes to you,
Tamara



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