QuestionQUESTION: I an a 55 yo white female who had an excision of two breast tumors last week. The first was a mucinous carcinoma 0.4 cm (ER and PR positive) and the other was IDC 0.5 cm. Both are considered Nottingham grade 3/9. Two of three sentinel lymph nodes were completely negative. The third contained isolated tumor cells 0.012 cm ("The focus does not appear on the original frozen section slides.") There is no history of breast cancer in my family. I do not smoke, drink alcohol, or consume red meat. However, I am overweight - BMI 29 and am an inconsistent daily exerciser.
I do not want to have radiation therapy primarily because of the potential long term effects on the heart and lungs. As a past marathon runner, I highly value ever bit of lung capacity I currently have. I haven't told my surgeon this yet.
I'm willing to have a bilateral mastectomy if the cancer comes back again. What are the chances of a distant metastasis without radiation? Would the cancer appear in the breast again first or just become evident in the bone, colon, or other areas?
I am assuming I should be placed on an aromatase inhibitor also. However, I'm not sure the potential side effects of that are worth it, either.
I'm willing to live with a certain amount of uncertainty in exchange for not losing quality of life.
Are there any numbers available to help me make this decision? Am I being too short-sighted in all of this?
I thank you in advance for your help in this matter.
Marlene
ANSWER: Of course the choice is yours but you have asked me a professional question so I can only give you a professional answer. Based on your question it is obvious that one sentinel node was positive. In this situation I therefore MUST remind you that we here are dealing with a potentially deadly disease and that reality does not provide you with many choices if you desire a high probability of a cure! I therefore STRONGLY suggest that 1. You do accept postsurgical radiation therapy! 2. Also aromatase inhibitor treatment SHOULD be accepted! And 3. Postsurgical chemotherapy probably should at least be considered too! So you ARE too short-sighted when you regard this! To wait until your cancer reappears as you mention is just giving away and ruining your best advantages in this situation! I'm sorry for being so frank and blunt but you have asked me a question and I have to answer without any misleading sugarcoating! Good luck whatever you decide!
---------- FOLLOW-UP ----------
QUESTION: I've not told anyone about this.
I was started on an estrogen/progesterone patch in June of this year for management of hot flashes. I was on it a few weeks but was not having much luck getting the patches to stay in place, as I am very active during the summer, sweating quite a bit. One day, I placed the patch on my left breast, thinking it would not be able to come loose under my bra. Within 24-48 hours, I noticed my breasts and lower extremities were quite edematous. After thinking about it for a few seconds, I realized that was the only thing that had changed. I immediately removed it and did not place another patch on my body for about a week. I did read the package insert in the interim. About half way though the lengthy documentation, I found this: "____should not be applied to or near the breasts."
I had placed the patch on my left breast, above the nipple. The tumors were found in my left breast very close to this location 4 months later. Unfortunately, my previous mammogram was over 5 years prior, so not especially valuable for comparison. Is it possible that my thoughtless action could have caused the cancer? If so, what can I do to make sure other women aware of the fact these patches should not be placed on or near the breast? I'd also like to contact the company and ask that this warning be placed in a more prominent location, such as on packaging of the individual patches.
I have not mentioned this to any of my health care providers, I suppose because I feel stupid for not taking the time to read the documetation. The person who perscribed the patch probably told me not to place it near the breast, but I wasn't listening. I'm not especially compliant, either. I was suppose to have the mammogram done at the same time the prescription was written, but it was delayed due to scheduling conflicts and never re-scheduled until th eprovider would not renew the prescription without it. (I had only a 1 month supply.)
Is this something I must tell my health care providers about? WOuld it make any difference in the plan of treatment?
Thank you for giving me an opportunity to share this information with someone.
Marlene
AnswerBreast tissues are hormone dependent. That is why these patches should not be placed there as they there can give stronger hormonal side effects! But 4 months is by far a much too short time to develop any form of breast cancer! So you are NOT guilty of causing your cancers! You can tell your drs. all about this. It will not change any plans. PLEASE follow my previous advice for your own sake!
Good luck!
