Expert: Claes-Gustaf Nordquist, M.D. - 10/12/2010

Question
Stereotactic bx of left breast showed DCIS.   MRI showed extensive disease throughout breast, so chose left total mastectomy which was done 12 days ago with a sentinel node biopsy of four nodes - all negative.   There was DCIS which was estrogen positive at 90%, progesterone positive at 5%.  There was ALSO 0.5cm of invasive duct carcinoma which was estrogen negative, progesterone negative, HER2 negative.  Local oncologist is sending me to an oncologist who specializes in breast cancer at a tertiary center.  Does this mean I will likely get "two" types of treatment - treatment directed at suppressing the estrogen, as well as chemo to address the ER neg, PR neg, HER2 neg invasive cancer, or just focus on the invasive cancer and not the ER+, PR+ DCIS?

Answer
Well you will probably be recommended to accept chemotherapy for your triple negative invasive cancer. That is what I would do anyway. Since your whole affected breast has been removed I see no reason for hormonal therapy for that breast. However you have another one. Hormone treatment can reduce the risk of cancer there. But since it seems your lesions in the affected breast were extensive a profylactic mastectomy of the other side should I think at least be discussed. After such a bilateral (double sided) mastectomy your breasts can be surgically reconstructed if that is your wish. Good luck!



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