How To Decide Next Steps After Lumpectomy.

Posted by ngguil4d @ngguil4d, Jul 26, 2021

I am 66 years old and I had a lumpectomy and oncoplastic breast reduction on June 23 after being diagnosed with IDC IA, pT1a, pN0(sn), grade 1, ER+, PR+, HER 2- breast cancer in my right breast. My breast surgeon removed 100 grams of tissue down to the chest wall from my right breast along with one sentinel lymph node. The plastic surgeon removed another 100 grams of tissue from my right breast along with skin, Then 200 grams of tissue along with skin from my left breast. The pathology on all tissue and skin from both breasts along with the sentinel lymph node came back negative.

I have seen a radiation oncologist and she did not push radiation therapy. My husband and I both felt that she thought endocrine therapy would be better. Then she told me that if I decided to do radiation she would recommend 3 weeks/5days a week of full breast radiation.

I have my appointment with a medical oncologist this Thursday and I have been trying to do some research but the more I read the more confused I get. How does one figure out what is best?

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Whatever is the best treatment for you is best. If I can help you wade through some of the choices, I would be happy to do so. There are a lot of people here have been through an enormous variety of treatments. There is a recurrence predictor called an onco DX score. That along with your particular cancer will guide your doctors recommendation. I would start now writing down questions for my oncologist, so that I don’t forget any. You do not have decide on the spot, you can have some time to research and come to a decision. I am truly hoping some other folks will chime in here with some more thoughts. Did your doctor mention any specific drug for therapy?

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I am very interested in what your oncologist recommends, and what you finally decide. I had a lumpectomy on 6/2, with 3 lymph nodes removed, which were clear. Am on Letrozole right now. Radiologist told me that based on Onco score and other indicators she did not feel that radiation would be of much benefit. Statistically, the recurrence with radiation is 1%, without radiation 4%. She also told me that this is not a time sensitive decision I have/had to make right then and there. For now I’m declining radiation treatment, but the effective window stays open for about 6 months after lumpectomy. So still an option in the next few months if I change my mind – or my oncologist changes it for me.

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@auntieoakley

Whatever is the best treatment for you is best. If I can help you wade through some of the choices, I would be happy to do so. There are a lot of people here have been through an enormous variety of treatments. There is a recurrence predictor called an onco DX score. That along with your particular cancer will guide your doctors recommendation. I would start now writing down questions for my oncologist, so that I don’t forget any. You do not have decide on the spot, you can have some time to research and come to a decision. I am truly hoping some other folks will chime in here with some more thoughts. Did your doctor mention any specific drug for therapy?

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I did not have an Onco DX test. I asked my breast surgeon about it during my last visit with her but she said it really wasn't something I needed based on my cancer. She did say that if either the radiation or medical oncologist wanted to run the test they still could. I plan on asking my medical oncologist about it at my appointment on Thursday. My breast surgeon (who is with Johns Hopkins and specializes in breast cancer) did not seem to think that radiation would be necessary. She mentioned that the chance of recurrence for me was small. When I mentioned my concerns about side effects associated with endocrine therapy she did say that if I couldn't tolerate it and had to stop it would be okay.

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@ellerbracke

I am very interested in what your oncologist recommends, and what you finally decide. I had a lumpectomy on 6/2, with 3 lymph nodes removed, which were clear. Am on Letrozole right now. Radiologist told me that based on Onco score and other indicators she did not feel that radiation would be of much benefit. Statistically, the recurrence with radiation is 1%, without radiation 4%. She also told me that this is not a time sensitive decision I have/had to make right then and there. For now I’m declining radiation treatment, but the effective window stays open for about 6 months after lumpectomy. So still an option in the next few months if I change my mind – or my oncologist changes it for me.

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My radiation oncologist told me I had time to decide about radiation. I will let you know as things develop.

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I had not heard of am Onco Dx test or score until I read information on this site. Could someone maybe explain – why do some women get the test and others don’t. Or how it is decided by surgeon decides when to do test.
I am 2 years post single mastectomy. There were no lymph nodes involved and I did not have to do radiation. How is it decided to perform an onco test? I am taking Anastrozole and am close to year two. I have not been spoken to about bone density meds, but my bone density numbers are going down and even in my last visit with my oncologist, he said I had osteoporosis and still never recommended meds. 🤷🏼‍♀️

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@sequoia

I had not heard of am Onco Dx test or score until I read information on this site. Could someone maybe explain – why do some women get the test and others don’t. Or how it is decided by surgeon decides when to do test.
I am 2 years post single mastectomy. There were no lymph nodes involved and I did not have to do radiation. How is it decided to perform an onco test? I am taking Anastrozole and am close to year two. I have not been spoken to about bone density meds, but my bone density numbers are going down and even in my last visit with my oncologist, he said I had osteoporosis and still never recommended meds. 🤷🏼‍♀️

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I cannot explain why some women get the test and some do not. That would be a question for your doctor. It was not invented yet when I started my journey. However I did find this information about it.
https://www.breastcancer.org/symptoms/testing/types/oncotype_dx
The doctor who said you had osteoporosis, did they address this issue at all? Have you asked him about the risk of fracture?

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@auntieoakley

I cannot explain why some women get the test and some do not. That would be a question for your doctor. It was not invented yet when I started my journey. However I did find this information about it.
https://www.breastcancer.org/symptoms/testing/types/oncotype_dx
The doctor who said you had osteoporosis, did they address this issue at all? Have you asked him about the risk of fracture?

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My doctor didn’t address it. When o inquired further he flippantly said ‘oh we could give you injections’ that was it No recommendation or explanation. I’m on the process of getting another oncologist. Waiting on a call today or tomorrow.

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@auntieoakley

I cannot explain why some women get the test and some do not. That would be a question for your doctor. It was not invented yet when I started my journey. However I did find this information about it.
https://www.breastcancer.org/symptoms/testing/types/oncotype_dx
The doctor who said you had osteoporosis, did they address this issue at all? Have you asked him about the risk of fracture?

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@Chris , thank you fir the link. It’s helpful.

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@sequoia

My doctor didn’t address it. When o inquired further he flippantly said ‘oh we could give you injections’ that was it No recommendation or explanation. I’m on the process of getting another oncologist. Waiting on a call today or tomorrow.

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Good for you, if your doctor isn’t responding to your questions then a second opinion or a new doctor might be better. Advocating for yourself is so important.

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@sequoia

I had not heard of am Onco Dx test or score until I read information on this site. Could someone maybe explain – why do some women get the test and others don’t. Or how it is decided by surgeon decides when to do test.
I am 2 years post single mastectomy. There were no lymph nodes involved and I did not have to do radiation. How is it decided to perform an onco test? I am taking Anastrozole and am close to year two. I have not been spoken to about bone density meds, but my bone density numbers are going down and even in my last visit with my oncologist, he said I had osteoporosis and still never recommended meds. 🤷🏼‍♀️

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Like you, I had not heard of Onco DX test till read about on this site. I had my re check appointment few weeks ago and I asked my oncologist if it was done after surgery or results were in my records. The test was not run. She explained to me this way. The test is run to help determine a treatment plan. In my case, prior to surgery I already knew I had one positive lymph node. I had a lumpectomy for tumor and two positive lymph nodes were removed. The dr said based on pre and post surgery results, the care team knew chemo and radiation was the recommended treatment plan and the Onco DX test was not needed.

This is great question for anyone to ask oncologist or surgeon about benefit of test in their situation.

Laurie Miller .

.

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Do you always have to have radiation with invasive lobular carcinoma?
First stage, 1cm tumour, no lymph nodes involved. Hormon positive, HER2-.
Non hereditary cancer.
Oncotype 24, and I am 49 years old

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@kszilvia

Do you always have to have radiation with invasive lobular carcinoma?
First stage, 1cm tumour, no lymph nodes involved. Hormon positive, HER2-.
Non hereditary cancer.
Oncotype 24, and I am 49 years old

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I would hate to pronounce a never or an always on any treatment. Especially since treatments become more individual and more tailored all the time. Because of your age, I would think that some real thought should be given to preventing recurrence. You have many years to live with the results. Do you have an appointment to discuss treatment options yet.

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