Do You Have to Remove the Breast After Breast Cancer Recurrence?

Is surgery necessary for breast cancer recurrence?

Hello: In 2012, I was diagnosed with ductal carcinoma in situ and underwent a partial mastectomy, along with radiation therapy and hormonal treatment.
I did not adhere strictly to the medication regimen, taking it for about a year and a half, but I have consistently attended follow-up appointments.
I completed the radiation therapy.
In 2016, a new tumor developed near the site of the original carcinoma, and the doctor diagnosed it as stage IA invasive carcinoma, measuring 0.6 cm.
It is still uncertain whether there is lymph node involvement.
I underwent blood tests, ultrasound, and imaging, which revealed multiple bright spots.
I had an MRI yesterday, and the report has not yet been released.
However, the doctor has repeatedly told me that preserving my breast is not an option.
I would like to ask the doctor: 1.
Did my lack of adherence to the medication lead to the recurrence? 2.
Is it true that recurrence in the breast means it cannot be preserved? 3.
If I have previously undergone radiation therapy, can I not receive radiation treatment again? 4.
After surgical removal, is there no chance of recurrence? Thank you for your answers, doctor.

Wang Xiuyun, 40~49 year old female. Ask Date: 2016/07/23

Dr. Wu Jianting reply Breast and Thyroid

Dear Ms.
Wang,
Here are the responses to your questions; however, please make the final treatment decision after discussing it with your attending physician.
1.
Patients who do not take their medication regularly or who discontinue treatment prematurely indeed have a statistically higher rate of recurrence.
2.
Regarding points 2 and 3: The amount of radiation that tissue can tolerate is limited.
If radiation therapy has been administered previously, a second round cannot deliver an adequate dose, which is why most recurrences lead to a choice of total mastectomy.
4.
After surgery, various adjuvant therapies may be required depending on the situation.
There remains a possibility of recurrence or metastasis after surgery, so please adhere to regular treatment and follow-up.
Wishing you all the best, and thank you for your questions.

Reply Date: 2016/07/23

More Info

Breast cancer recurrence is a complex issue that raises many questions regarding treatment options, especially concerning the necessity of breast removal. In your case, having had a previous diagnosis of ductal carcinoma in situ (DCIS) followed by partial mastectomy, radiation therapy, and hormone therapy, it is understandable to be concerned about the recurrence of cancer and the implications for your treatment moving forward.

1. Adherence to Hormonal Therapy: It is important to note that adherence to prescribed hormonal therapy can significantly impact the risk of recurrence. Hormonal therapies, such as tamoxifen or aromatase inhibitors, are designed to reduce the risk of cancer returning by blocking the effects of estrogen on breast tissue. Incomplete adherence to these medications can potentially increase the risk of recurrence. However, it is not solely the lack of medication that leads to recurrence; other factors such as tumor biology, genetics, and overall health also play critical roles.

2. Breast Conservation After Recurrence: The decision to remove the breast after a recurrence depends on several factors, including the size and location of the new tumor, the extent of the disease, and previous treatments. In some cases, if the cancer is localized and has not spread significantly, breast-conserving surgery (lumpectomy) may still be an option. However, if the cancer is invasive and there are concerns about clear margins or if there are multiple areas of concern, a mastectomy may be recommended. Your healthcare team will consider all these factors when discussing your treatment options.

3. Radiation Therapy Limitations: If you have previously received radiation therapy to the same breast, there are limitations on the amount of radiation that can be safely administered again. This is due to the risk of damaging healthy tissue and increasing the risk of complications. However, in some cases, alternative radiation techniques or targeted therapies may be considered. It is essential to discuss these options with your oncologist, who can provide guidance based on your specific situation.

4. Risk of Recurrence After Surgery: While surgery can effectively remove the visible cancer, it does not guarantee that the cancer will not recur. The risk of recurrence depends on various factors, including the biology of the tumor, the effectiveness of adjuvant therapies (like chemotherapy or hormonal therapy), and individual patient factors. Regular follow-up appointments and imaging studies are crucial for monitoring any signs of recurrence.

In summary, the decision to remove the breast after a recurrence of breast cancer is not straightforward and depends on multiple factors, including the characteristics of the tumor and previous treatments. It is essential to have an open dialogue with your healthcare team about your concerns and treatment options. They can provide personalized recommendations based on your medical history and current condition. Additionally, adhering to prescribed therapies and attending regular follow-ups can significantly influence your prognosis and overall health.

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