Should I undergo radiation after a mastectomy for stage one breast cancer?

I can totally feel for you. I have when through all of the treatments as well. When I first started they thought surgery and hormone blockers, then I needed chemo cause onco score was 25, then radiation was recommended cause dcis was at the margins and LVI was present in the pathology 😩

I swear they only give out the best case scenario. Then they just keep finding more..

So hard to know what is too much or not enough. Did you have genetic testing done? I am 48, premenopausal (or peri, I believe.) I was diagnosed clinically as stage 1B then after surgery pathology indicated stage 11A. I initially thought I would only need lumpectomy and radiation then endocrine therapy. However, chemo was recommended after the pathology came back. I did my own research and I did not feel that it was proven that chemo was an absolute benefit to me given my diagnosis. With any tx plan being recommended, I think it’s important to look closely at what the risks are and what the benefits are, what are the alternatives, what does your intuition tell you is right for you. There are tough choices to make on this journey….hang in there!

I would suggest getting a second opinion.

A second opinion makes sense to me. Treatment recommendations can be confusing. My sister had BC about 6 years ago. She had a double mastectomy. Don't remember the details, she was either a stage one or two and several of her lymph nodes tested positive. She however did not have radiation or chemotherapy. She is taking tamoxifen right now. There are a couple of blood work texts that can be helpful. One is the oncotype test. It tells you the probability of a reoccurrence score and the benefits of doing chemotherapy. Also, If you had a breast biopsy it is going to give you results regarding if you are estrogen and progesterone positive/negative status, your HER2 status, the Ki-67 score and the P53 score. The Ki-67 results tell you the proliferation rate of the cancer cells (but I don't know how that would relate to what the doctors are recommending, or if it does at all). There is another test, trademark name is Signatera. It tracks tumor DNA in your blood. It can detect several months before any other screens such as MRI, Cat scan but this is more for monitoring. I think the biggest would be to ask for the onctype blood work so you know the probability in percentages of chemotherapy benefits.

No you’re not crazy. You got told 1 thing and that’s what you expect. They found more than what they originally thought. It sucks but if it’s in the nodes it’s more likely to recur. So I think they’re just trying to treat it correctly.

I feel for you. I did my research and became my own advocate. I interviewed 2 oncologists and picked one in addition to a Naturopathic Oncologist who I meet with regularly. I elected for a lumpectomy and had fast trach radiation (7 doses of 60gy) and declined Letrozole as it was optional. Pathology reports supported my decision in addition to the potential side effects which could worsen my Hashimotos thyroiditis and osteopenia. Both Naturopathic doctors, traditional Oncologist and radiologist support my decision. I have a specialized diet I try to follow and mostly succeed in doing.

Laurie M I'm about to start letrozole. I'm concerned because I have osteopenia. Also concerned about other side effects. How do you find a naturopathic oncologist in your area?

Melani, I was fortunate to have one available from Seattle, WA USA who does telemed visits with me. I live rurally and travel for treatment an hour away. Your insurance provider is a great resource for coverage and care providers. And here also.

Thanks for the suggestion! That's a good idea. 😃 I do live in the DFW area so I would think there would be some resources. I'll have to do my research

Omgosh! Melani, I am from HEB!

Wow I feel like I am reading my story. I started off with stage 1 then 1b after double mastectomy. But I have had all the gray areas that the 7 (yes 7!) oncologistsz and 3 radoncs I’ve met disagree on treatment. Some say yes to chemo cuz of LVI, isolated tumor cells (technically not lymph node positive but not totally negative even though they consider it so) multi focal, bilateral and high ki67 even though my oncotype of 18 suggests not needing it (though I’m premopausal at 51). So for medonc I’ve had 4 say no 3 say yes to chemo and radiation is dependent on going back to surgery if we can get clear margins on the dcis that my surgeon would rather wait and watch and the radoncs want to radiate. Now I have to choose what to do and it’s maddening!

Laurie M. Well that's cool. If you ever want to meet up let me know. I'm really close to HEB.

I haven't lived in HEB since 1989 but when I visit my family next year, that would be amazing!

I was diagnosed June 2023 I am stage 1B grade 3. My Oncotype 24. I have a High Ki67 score.There is a calculation they use to determine if chemotherapy is needed. I went for a second and third opinion. I am high risk for recurrence, just finished chemotherapy. Waiting to find out which medication AI or Tamoxifen Both scary options.

Hi, newly dx and just reading through comments of others experience. Question for Laurie- i also live in the Seattle area could you tell me what naturopathic oncologist you see in Seattle? Thank you and god bless!

Katherine E. I know. I was concerned about the medications too. For me, the waiting, the anticipation of taking them made it worse. Once started, even though I have had some side effects from the meds (and still am having) it's not as bad as I thought it would be. I like the idea of a naturopathic doctor. I haven't looked into that yet. But I do believe they can benefit us during these these times

I recommend a 2nd opinion as well. I had all the same treatments but the latent side effects from the radiation continue to be the most troublesome and it has been 18 months since I finished.

GET A SECOND OPINION: I was Stage 3C/Grade 3 bilateral IDC estrogen + BC. I had chemo, double mastectomy with 15 lymph nodes removed, then radiation and now on Fumará for five years. My 5 year reoccurrence rate is very high and my prognosis is unknown. My surgeon said she has only had one other confirmed bilateral in 22 years of practice. I went to the doctor recommended by my OBGYN. She Dx Stage 1A and wanted a lumpectomy and radiation only and that was it. I then had a second opinion at Mayo Clinic and I was shocked! The Mayo team had four doctors examen me at once and after 2 hours and explained that my right breast “tiny tumor” was actually dumbbell shaped massive structure that spanned most of my breast. After a hunting expedition that required 4 more biopsies they found I had bilateral BC (very rare). My type of cancer is common (estrogen +) but the size and speed of growth bilateral nature was rapid and would have killed me within the year if not treated rapidly and aggressively so double mastectomy was recommended. Stage 1 requiring a double mastectomy? Get a 2nd opinion from the best cancer center in your area!

Treatment decisions after a cancer diagnosis can feel overwhelming, especially when the plan changes based on new findings. Many patients in this community have grappled with weighing the benefits and potential side effects of different treatment options, and it's completely understandable to have concerns about adding more treatments to an already intensive plan. This would be an excellent discussion to have with your oncology team, as they can explain how the lymph node findings may have influenced their recommendations and help you understand the reasoning behind each part of your treatment plan.