How can I manage invasive breast cancer at the age of 43?

Question

Hello doctor,

I was diagnosed with invasive breast cancer, and I am overwhelmed by the treatment decisions. I am 43 and found a hard lump during a self-exam that turned out to be a 1.102-inch tumor. The biopsy showed invasive ductal carcinoma that is estrogen-positive but HER2-negative. One lymph node is involved, but there is no distant spread.

My oncologist recommends neoadjuvant chemotherapy followed by surgery and radiation over eight months. I am terrified about hair loss, nausea, and how treatment will affect my ability to care for my two young children.

The surgeon discussed lumpectomy versus mastectomy, but I am confused about the differences in survival outcomes. I have been researching online and finding conflicting information about reconstruction and fertility preservation. My aunt died from breast cancer in her 50s, so I am concerned about possible genetic mutations.

I work in healthcare and am worried about infection risks from immunosuppression. Please answer a few of my questions:

Are there newer, less toxic chemotherapy regimens?
Should I get genetic testing before surgery?
What is my realistic prognosis?
How do I explain this to my daughter?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I hope you are doing well. I truly understand the amount of fear and anxiety you are experiencing, and the moment a person is diagnosed with breast cancer, it is completely natural to have many overwhelming and scattered thoughts.

The first and most important step I recommend is doing genetic testing, because it will help us determine whether we need chemotherapy or hormonal therapy enough for your condition. Regarding surgery (mastectomy or reconstruction), this decision will also be made after the genetic test. If the results show high-risk genes, then a mastectomy would be a better option than a lumpectomy. After that, reconstruction can be done without any problem.

Concerning fertility, before starting chemotherapy, I strongly recommend egg freezing, so that if you decide to pursue fertility or pregnancy later, you’ll have that option comfortably. As for hormonal therapy, it usually lasts no less than 10 years. During the course of hormonal treatment, pregnancy can still be possible. In such cases, we temporarily stop the hormonal therapy, proceed with pregnancy, and then resume hormonal treatment afterwards as usual.

Regarding your concerns about your daughter, I believe she is still quite young and may not fully understand what cancer means. However, if she is perceptive, you can explain to her that you have an illness that requires taking some medications and treatments.

After the genetic testing, it is possible that you may not need chemotherapy at all, and therefore, you may not experience hair loss or other chemotherapy side effects. Even if chemotherapy is needed, it is not a problem; hair grows back normally afterwards. In the meantime, you can use artificial wigs or other options to help you feel comfortable until treatment is completed.

That is why genetic testing is extremely important. I hope everything is clear now. If you have any questions at any time, I am always here for you.

Thank you.

How can I manage invasive breast cancer at the age of 43?

Invasive Breast Cancer Companion