Decisions....

On Friday, I learned that the mammogram still showed calcifications. (Calcifications are dead cells that have calcified and indicate that cancer could be in the area. However, I'm not sure how these calcified dead cells would ever go away with chemo... They are dead.)

This morning, while I was waiting to have my echocardiogram to check the condition of my heart, I wrote the following email to my surgeon:

Hi, again. I got my mammogram on Friday. And, I still have calcifications. However, I want to understand if calcifications ever disapear? They are dead cells that calcified, right? They were an indicator to check for cancer cells. We can't be sure from the mammogram that I still have cancer cells that the MRI isn't showing. Is that correct? Can we tell if I have new calcifications?

When you discuss my case, I not only hope to hear your recommendation but am also interested in learning what you think my future treatment should be if I choose to not have a mastectomy. I'm curious in what treatment could entail. Furthermore, is there evidence that when cancer comes back that it is more likely to be more aggressive? What are my chances that it will come back without a mastectomy? What are my chances of it coming back with a mastectomy?

If I have a mastectomy now, do you still believe I should lose my nipple? What are the pros and cons of nipple saving?

I just want to undestand and weigh my options as well as hear the team's recommendation. I'm finding myself extremely confused again. Thanks for your help.

Thank you!
Lara

My surgeon responded with the following:

It is important to realize that only 1/3 of patients who have a complete clinical response actually have a complete pathologic response. Calcifications usually do not disappear and are an indicator of disease. That is why when I first met you I had said that I did not think that you would ever be a breast conservation candidate. When a patient starts out with diffuse calicifications they hardly ever go away, and it is important to remove all signs of disease. There is no way of knowing until we get the pathology report whether the tumor was killed by the chemotherapy, but the recommended treatment is to remove all signs of the tumor. I definitely do not recommend a nipple sparing mastectomy, that is experimental and only being considered in patients with very small tumors far away from the nipple, definitely not for someone with a locally advanced breast cancer. I will sit down with you on Wednesday and we can go through all of the recurance rates. See you then.

I've got so much to consider and decide... I'll report more after my appointment on Wednesday. Please pray that I make the right decisions!