Expert: Claes-Gustaf Nordquist, M.D. - 5/2/2011

Question
QUESTION: At age 67 I had a lumpectomy for Stage 1 invasive ductal carcinoma. Lymph nodes were clear, margins were clear, tumor size 1.4 cm, graded 3, ER- PR- and HER2-.  I'm scheduled to start chemo soon.  My question is would my overall recurrence or survival be that much greater if I had a double mastectomy after chemo?

ANSWER: No it would not. But I would prefer that you had local radiation therapy since in my opinion a lumpectomy without postsurgical local radiation therapy is more or less malpractice. However I suppose that your chemotherapy is given as a kind of replacement for radiation therapy. Since for a stage 1 breast cancer there is otherwise no need for chemotherapy - not even in a triple negative one. However the choice is yours of course.


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---------- FOLLOW-UP ----------

QUESTION: Thank you for your quick reply to my question.  I knew if I kept my breast I would have to have radiation.  I didn't mention it is scheduled after the chemo.  I am okay with that.  Chemo scares me.  I really wasn't offered a choice about it.  It was totally prescribed as a preventive for recurrence, and now you are saying I don't need it.  I am confused.  Do you have any statistics on recurrence with or without chemo?

Answer
Well my opinion is only as good as the information I have available. Normally a stage 1 cancer is only treated with radiation therapy after surgery. In your case your tumor was rather big for just a lumpectomy and I have no access to your pathology report. It is quite possible that your tumor size in combination with your pathology report - which I have not seen - decided that the best choice for you would be to have chemotherapy too. An indication that that was the case is the fact that you mentioned that your tumor was a grade 3 which usually means that it is rather aggressive. Chemo- therapy today is not the horror you used to hear of in the past. While it is not a picnic there is no reason to be scared. So if your doctors have suggested it you should follow their advice. They have all the facts - which I do not have - so they are in the best position to give you good advice! Good luck!



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