Should a mastectomy be considered with dx of breast ca with mets to bone(spine) - 1249306

Sat, 10/20/2012 - 18:57

I wasn't sure if I could ask 2 questions at the same time so I posting this second question now and look forward to your response.
I am a 54 y.o. woman, dxed with Lt breast ca in 2003, 1.5cm tumor, invasive ductal carcinoma;Er pos; her2nu neg; had lt lumpectomy,1 lymph node pos via sentinel node biopsy and then lt axillary dissection.Had chemo of adramycin,cytoxan q3wks x4 and then taxol, followed by 6 wks of radiation.5yrs of tamoxifen and 1 1/2 yrs on aromtase inhibitors. I was cancer free until 1/12 when I was dxed with breast ca again in Lt breast with mets to bone(spine) ;found 2 fx’s in spine treated with 2wks radiation & had 5 cycles of abraxine and exgeva with great response to tx. Had a break from abraxane(some neuropathy; minimal) and went on faslodex for about 2 1/2 mths and noted regrowth in my breast.(confirmed with pet scan and mri of breast, bone remains stable) I Just started xeloda 1500mg bid 1 wk on 1 wk off. I only completed one cycle so far so I am waiting to see response to this. My oncologist orginally said to me that she thought that there was a possiblity of seeing my surgeon again to consider a masectomy. Right now she wanted the disease in my breast to reduce, but in the meantime i would like to know more information about this. I have been searching the web on this topic, but have not come up with very much. I'm an RN and It is my understanding that in the past the general rule of thumb was not to have a mastectomy with metastatic disease. I have only come across one article so far that addresses this issue and was wondering if you could discuss the latest thought and/or studies on the efficacy this approach.

Revision log message
Created by FeedsNodeProcessor

Dr West

I agree that it's hard to envision a compelling biological rationale for doing a mastectomy in the setting of known metastatic disease, unless it is to palliate local symptoms from the breast mass. However, Dr. Cianfrocca is our leading expert in breast cancer, so I've asked if she can offer her thoughts here.

-Dr. West

dr cianfrocca

Hi Stacey,
This is currently a very controversial topic, so controversial that there is actually an open trial randomizing women who present with a tumor in their breast and metastatic disease to either have surgery on their breast at the time of diagnosis or to wait and only have surgery on the breast if the tumor in the breast becomes a problem. You are correct that the traditional rule of thumb was that surgery on the breast was unnecessary. However, retrospective data suggested that women with metastatic disease who had surgery on their breast lived longer. There is however a problem with those data in that a woman would never go for surgery on her breast if her metastatic disease was poorly controlled. So, perhaps the women who had surgery on their breast lived longer because their metastatic disease was more responsive to therapy prompting them to address the disease in their breast. The only way to solve this dilemna is the randomized trial which is currently open and will hopefully enroll enough women to definitively answer this important question.
All the best,
Dr Cianfrocca