Is Bilateral Mastectomy Necessary When Another Cancer Shows up in the Opposite Breast?

Question: I had a needle core biopsy LEFT breast…under Diagnosis it states …….-invasive mammary carcinoma (crush artifact present)……diagnosis confirmation by the Dr on april 1st 2013
Speciman that was sent was labelled “core biopsy left breast” and consisted of 3 cores of tan yellow core biopsies measuring from .3cm to .6 cm…….with one needle core per cassette. Slides were reviewed Clinical history……..urgent …suspicious mass left breast I also had a cT which stated that within the outer upper quadrant of the left breast there is an irregular 1.4 x 1.7 X 2.3 cm nodule or mass. There is lymphadenopathy within the left axilla with lymph nodes measuring over a cm in size in short axis…(These findings are concerning for breast malignancy with nodal disease.) I had a mamogram that was clear.I had breast cancer 30 yrs ago/ lumpectomy in my RIGHT breast which left me with lymphoedma in my right arm The info I have given you is for my LEFT breast area.
My question is this….shold I have a double mastecomy asap and have the mass removed too or are there other tests that I should have befor I make that decision …..I am 81.7 yrs old.and very very active …..a much younger 81 year old… I am as active as a 60 year old……I have not had An ultrasound……also if its not in my breast should I have my two breasts removed or just the left ….I had radiation 30 yrs ago ( a lot of scar tissue left) … Does this mean because I had radiation befor for my right breast area and immeiately had arm swelling that left me with lymphoedma…….DOES this mean that I could not have radiation on my left side .?
The results I have written I am reading from the reports given to me by the hospital…..
I am looking forward to your suggestions Thankyou

Answer: Thank you for contacting us. I’m sorry you’re going through this especially since you had cancer on the right side 30 years ago. Regarding your current situation, given the diagnosis of invasive cancer in the left breast one thing I might ask is if an ultrasound or MRI could be performed to help determine if it’s just a solitary 2.3 cm mass or if it is more diffuse or multifocal. In addition, a sentinel node biopsy is also in order given that the diagnosis is invasive. If that is positive you may need an axillary lymph node dissection. Thus, it seems too early to determine the stage of your cancer and that affects future treatment recommendations. Do you know if the pathologist performed immunohistochemistry for estrogen and progesterone receptors and her2/neu? These also affect treatment recommendations. If it turns out to be a solitary 2.3 cm mass, and no significant lymph node involvement, the fact that you had radiation to the right breast years ago doesn’t mean you could not have a lumpectomy and radiation to the left breast. That being said, some patients don’t want to have to deal with another lumpectomy and radiation and opt for mastectomy. I think that is a reasonable choice, but until you have more information, it certainly isn’t mandatory or ASAP. I hope this helps. Please contact us again if you have further questions. I hope it’s just a small cancer and your nodes are negative.

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