Conflicting pathology reports AND Femara or Tamoxifem?

Hi Everyone,

My 53-year-old sister, who resides in the Philippines, was recently diagnosed with Stage 1 cancer on her left breast (papillary carcinoma) with a tumor size of 1.9 cm (microscopic).

Pathologist number 1 report: excision margins, negative for tumor (distance from excision margin: 1mm). Estrogen receptor assay "positive staining in >90% of tumor with 3+ intensity with an Allred score 8. Progesterone receptor assay "positive staining in 5-10% of tumor with 2+ intensity with san Allred score . HER2 - negative - complete strong membranous staining in >90% of tumor cells. She took the specimen slides to another pathologist.

Pathologist 2 report: "There is an early invasion outside the capsule in focal areas. There are also two areas of vascular invasion by tumor outside the capsule. " Estrogen receptor assay: "+++ in 95% of the tumor; progesterone receptor assay - negative; her2neu - negative.

There seem to be conflicting findings in the excision margins, one saying negative and the other saying there is invasion outside the focal areas. The progesterone r.a. are also conflicting. What to do?

Her oncologist also prescribed Femara but she's afraid of hair loss. Doc said alternative would be Tamoxifem, with possible long-term effect of thickening of the uterus. What are your experiences with both meds?

She's planning to have a mastectomy over lumpectomy. thinking that nothing else needs to be done after the surgery. But I heard that some patients have undergone radiation or chemo even after a mastectomy.  

Any thoughts would be appreciated.

Thank you very much. 

egr