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|Lumpectomy with Sentinel Node Biopsy
Questions about Lumpectomy with Sentinel Node Biopsy.
|Asked||Publicly Submitted Question|
|05/27/2003||I AM A 66 YEAR OLD WOMAN WITH NO FAMILY HX OF BREAST CANCER. MY RECENT MAMMAGRAM SHOWED A CLUSTER OF MICROCALCIFICATIONS, AND A STEREOTATIC BIOPSY WAS DONE. THE REPORT WAS DCIS, LOW GRADE, NON INVASIVE, ESTIMATED SIZE 5-7MM.ESTROGEN POSITIVE. I HAVE HAD CONSULTATIONS WITH TWO BREAST SURGEONS AND DONE CONSIDERABLE RESEARCH ON MY OWN, INCLUDING READING THE 700 PAGE TEXT BY SILVERSTEIN ON DCIS. WHEN I CONSULTED WITH THE 2ND SURGEON RE WIDE MARGINS HE TOLD ME HE DISAGREED WITH SILVERSTEIN. BOTH SURGEONS HAVE RECOMMENDED LUMPECTOMY WITH RADIATION. QUESTIONS: IS THERE ANYONE ON THE EAST COAST WHO ASCRIBES TO SILVERSTEIN'S PROCEDURE OF ACHIEVING WIDE MARGINS(10 MM)USING MULTIPLE WIRES, IS RADIATION ALWAYS INDICATED, DESPITE SIDE EFFECTS, OR IS BRACHY THERAPY, ALTHOUGH IN EXPERIMENTAL STAGE, APPROPRIATE FOR THIS. MY DECEASED HUSBAND WAS A CARDIOLOGIST, AND I UNDERSTAND MOST MEDICAL PROCEDURES. HOWEVER, THE DIFFERENCE OF OPINION FROM MASTECTOMY TO LUMPECTOMY LEAVES ME BAFFLED. I WANT TO KEEP MY OPTIONS OPEN, AND IT SEEMS TO ME HAVING THE LUMPECTOMY FIRST, SEE WHAT THEY FIND,THEN DEPENDING ON MARGINS,& PATH REPORT, DECIDE ON COURSE OF TREATMENT. HAVE I MISSED SOMETHING, OR IS THE STANDARD OF TX JUST VERY CONTROVERSIAL. MY SURGERY IS SCHEDULED FOR JUNE 13, I LIVE IN RICHMOND, VA, AND COULD EASILY COME TO HOPKINS, IF I COULD OBTAIN MORE CLARIFICATION OF YOUR TREATMENT PROCEDURES. MY THANKS TO YOU IN ADVANCE!|
|Replied||JHU's Breast Center Reply|
|05/27/2003||7mm is considered a small tumor and having DCIS is good news-- noninvasive breast cancer. so though you are dealing with having to make decisions about treatment, the odds are in your favor for survival with stage 0 disease. The standard of care remains at this point in time to do lumpectomy with radiation. sometimes with DCIS being very tiny-- 4mm or smaller, very wide excision is considered and no radiation, but only done as a clinical trial. Mastectomy usually is not necessary unless there is extensive DCIS occupying a large area. Statistically mastectomy equals lumpectomy with radiation from a survival perspective, but again, survival is 99%plus for women with DCIS properly treated. You may want to check at Sloane Kettering in NY where brachytherapy is happening and see if they prescribe to various clinical trials giving more options for treatment-- ie wide excision without radiation. It's possible they might. Sometimes doctors also recommend hormonal therapy as a adjunct to prevent recurrence too.|
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