This is a 67 year old woman with a history of abnormal screening mammogram which was worked up and biopsied. Biopsy demonstrated 0.5 cm well differentiated (Grade 1/3) invasive ductal carcinoma. Recepters were ER neg, PR neg, H2N neg. She will be taking anti-estrogen therapy for 5 years. What are the treatment options?
Post-operative radiation therapy is definitely indicated. Her small tumor size makes it reasonable to forego chemotherapy, however, an Oncotype DX assay could confirm this, albeit at significant expense. A second options is surgical: completion mastectomy. The case did not describe her general state of health and life expectancy. Before a definite answer to what treatment options are available can be offered we would need to know the full history and medical comorbidities. Further no mention of nodal status was offered. Assuming the axilla was not sampled, either by ALND or by SNB, then the options are more limited. The ACR offers the following options and appropriateness for the next reasonable step in her management:
Assume her medical history is unremarkable and there are no comorbidities. The patient elects lumpectomy. The lumpectomy demonstrates a negative margin at < 2 mm, confirms a 0.5 cm tumor (T1a) nodes are negative on SNB (0/2 nodes). What are the recommendations now?
She has good life expectancy, greater than 8 years. Many studies have demonstrated the usefulness in adjuvant radiation therapy, with a reduction in local-regional recurrence by at least 60%. Radiation therapy is recommended. Her radiation options include: