Can lumpectomy or mastectomy help treat my breast cancer?

Question

Hello doctor,

I am a 42-year-old woman who was just diagnosed with early-stage breast cancer in my left breast. My surgeon mentioned a lumpectomy followed by radiation.

How do I decide between lumpectomy and mastectomy?
Are there significant differences in recurrence rates?
Will I need chemotherapy as well?
How will treatment affect my fertility, and should I consider egg freezing before starting therapy?
Are there genetic tests that could help guide treatment choices?
Also, what lifestyle changes can improve my recovery and reduce the risk of recurrence?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am very sorry about your cancer diagnosis, but the good thing is that we are still in the early stages. The earlier the stage, the more treatment options we have. At this stage, it is important to do genetic testing. There are two main types of tests. The first test is for the BRCA genes BRCA1 and BRCA2, which tell us if there is a hereditary factor in the family. If the test is positive, we may prefer to do a radical or bilateral mastectomy to reduce the risk of the cancer coming back. But if you do not prefer surgery, we can consider hormonal therapy instead, which usually continues for at least ten years.

The second genetic test is the Oncotype DX. We use this test on the cancer cells themselves to know how aggressive the tumor is. If it is highly aggressive, we recommend starting chemotherapy. If the score is less than 26, meaning the risk is low, then we prefer doing surgery followed by radiotherapy. If the cancer is hormone-positive, we also give hormonal therapy, and in this case, chemotherapy is not needed. Chemotherapy is usually recommended only when the Oncotype DX score is higher than 26.

Regarding lifestyle, we prefer that you follow healthy habits, eating clean, healthy food that includes fruits, vegetables, and all essential nutrients. We also give supportive treatments during therapy to reduce any side effects. The tests and procedures we request will help us monitor anything that might be affected during treatment.

About fertility: since you are in your forties, it is better to complete any needed fertility procedures before starting chemotherapy. These procedures will not significantly affect your treatment plan, but it is recommended to do them before starting either chemotherapy or hormonal therapy.

Investigations to be done include BRCA1, BRCA2, and Oncotype DX. The treatment plan includes surgery and radiotherapy. Regarding follow-up, you will need to be checked once every seven days.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.