Why No Surgery for MBC?

Hello @pbnew i don’t k ow about could sand should but this was the answer I received when I asked.
Because it isn’t curative it won’t make a difference in what the cancer does, his exact words were “it will trowel it around a bit, but you will still have the same cancer”.
I had a hard time accepting it, but it did make sense. I also read in a book called dance with the devil (I think, I read a lot of books during that time), that cancer tumors compete with each other, and when you take out the big ones it allows the smaller ones to grow faster, therefore better to treat them all at the same time with systemic therapy.
How are you feeling with all of this?

Thanks for looking into it. It still doesn’t make sense to me. So it’s ok if the tumors in the breast are still active after the metastasis has been cleared? I’m not aware of any treatment that is curative.

It seems like there are varying approaches. My team is on the no surgery side. My oncologist said, since it has already spread, removing the breast tumor(s) will not eliminate the disease at other locations. My surgeon said, mastectomy is a big surgery and "you will go through all that for what" (ouch!).
There are research which say mastectomies in MBC have no effect on overall survival, and there are others which says it is beneficial to do it.
An integrative oncologist I consulted with said "less disease is less disease" and is for removal. And if it is very small (say, after some time of systemic therapy), interventional radiation methods could be used. But as @auntieoakley said, there should be curative intent for MBC, which -sadly- there isn't (for many oncologists).

It also depends on the site(s) of mets, I believe. I friend of mine had liver mets and the systemic therapy made them disappear (yay!). Now in my mind, if they removed the tumor in the breast, she'd be cured. But that's just me. Bone mets, on the other hand, is another story.

And finally, I guess it is very easy to be denied by the insurance since saying "I'm trying to *cure* this MBC patient" will not be taken very seriously. 🙁

I understand, believe me.
@eku fleshed this out really well.
This is a tough place to be and we are right there with you. Have you gotten a second opinion or gone to a large cancer center, where you might get more than one option of care?

Thanks for your response. I’m not in the U.S.

I m stage 4 breast cancer. After 4.5 years in herceptin and tamoxifen, recent CT scan shown tumour enlarged. Oncologist told to do mastectomy.
My surgery will be in July.

I was diagnosed July 2020 with BC with Mets to Liver and Bones, I was given 2 years of life. The surgeon would not do surgery. Many, many and more chemo treatments later (80 as of now) as well as changes to my eating and environmental toxins, the cancer no longer showed in my liver, just scar tissue, and the Mets to bones was stable. In Jan 2023 surgeon agreed to a unilateral mastectomy because breast tumor started growing again. He said with new research this surgery could be done and research is showing more years added to life. He also told me that he didn’t think I would be here today as I lay on operating table, that was March 2023. I did do 25 rounds of radiation but radiation Dr said there wasn’t enough studies as of now to see if the radiation would help. As I told him, my name will be in the medical books one day with success! I will say, having the surgery does put my mind at ease that at least a chunk of the cancer has been removed and I will try to also promote a healthy body with the continued plant based eating and getting toxins out of my life. So, check with different surgeons because mine was totally against surgery until they are now saying, even with metastatic cancer, it can double your life expectancy with surgery. I may be on drugs the rest of my life but hopefully we can stop the chemo soon. Good luck!

@jpnnobx

That’s amazing! Thanks for sharing your story.

In October 2022, my oncologist said I'd be dead in 1-2 years without chemo (which I did not do, due to kidney disease and preference). Both she & I assumed that microscopic metastasis was already underway from a rare aggressive NET in breast. I did want a lumpectomy because the tumor was troublesome and what if I lived a little longer...I didn't want an ulcerated breast and emergency mastectomy towards the end of my life. The pathology report was somewhat better than expected--the oncologist "revised life expectancy upward." I then had 15 radiation treatments for two reasons: my husband was very pro and I wanted to show him his opinion counted and I didn't want to be completely nihilistic but have a bit of hope. Of course surgeon & radiation oncologist were optimistic that their treatments would help extend life and precent local recurrence, but I have no hard facts on this. I've had to navigate many conflicting opinions. So this discussion has been very helpful to me--and I thank you all.
I feel my life is in G-d's hands anyway, which is fine with me! I feel like all my effort to find balance and not over treat has actually been a positive experience in terms of personal growth and even in terms of relationships. The Mayo chat has been hugely helpful and grounding. Love to you all. Couldn't manage without you.

I have had MBC for 4 yrs-in bones,skull some radiation-I was told there was a study that said surgery did not extend your life.I am looking at proton therapy for the skull as it is extensive.Has anyone had it? I am on Orserdu for the
ESR1 variation and might be on Enhertu for Her 2 status. There are so many
decisions to make and my best to everyone going through this.Lois