BRCA Test & Oncotype DX test - when???

Questions
You didn't say whether you are going to a breast oncology surgeon or if you are going to the local general surgeon in town. There can be a difference in what they recommend. Most of the time these days the standard of care is to try to do a lumpectomy followed by radiation. If margins are repeatedly dirty (that means they are not free of cancer) the surgeon may recommend a mastectomy, but usually they will do what they can to avoid taking more tissue than necessary. Even with mastectomies there are differences. A simple mastectomy takes less tissue than a modified radical mastectomy. Sometimes chemo can be done before the operation to shrink a particularly large tumor. Most surgeons will not mind if you want to go for a second opinion. You don't want to wait forever to get around to removing the tumor, but you don't have to get it done the week you find out either. Cancer can take anywhere from about a month to almost a year to double depending on the aggressiveness. So if you can get a second opinion and surgery in place within a month's time, you won't be risking much and you might be saving a lot. If nothing else, you might have the peace of mind knowing that two surgeons agreed that a mastectomy was the best course of action and that the sentinel node operation was not the best option for your mom.

You didn't say why you want the BRCA test. If you have a lot of breast cancer and/or ovarian cancer in your immediate family,you could get a referral for the test. Ask the surgeon you are going to what the procedure is for a referral where you live. They probably will recommend against it if she is the first to get breast cancer in the family. That is because only a fraction of breast cancers are BRCA positive. Most are unknowns. Young breast cancer survivors, especially those under 40, are often advised to get tested as well. Usually genetic counseling is done so that you will understand the test results and what your risk is.

While lumpectomies are just about always followed by radiation, mastectomies often aren't. However, a friend of mine had cancer right near her armpit. The surgeon did a mastectomy and recommended radiation to kill whatever she missed because of the area in question. The oncologist will decide what kind of medical followup treatment is needed based on your mom's kind of cancer. Some can be controlled with hormone treatments like the aromatase inhibitors. Some can be treated with biologicals like Herceptin. Some will respond best to chemo. The path report gives a lot of the information that those decisions are based upon. Some of the treatment decision trees in another part of this website can give you an idea of whether chemo is likely based on your mom's cancer type and size. Good luck! I will be thinking of you.

C. Abbott

Surgery
Sounds like you've really been researching all your options. The Oncotype DX is only done if the tumor is (I think) 2 cm or less. But tell your Dr. you are interested in it if it's appropriate. You might want to check with your mom's insurance to make sure the test is covered. Most do cover it.

Are they doing a sentinel Node biopsy? That's the node closest to the tumor. If not, why not? Sometimes, if they do the SNB, and don't find any cancer there, they can stop and not take any more nodes out. How do they know, before surgery, if they need to take ALL of them out, or just a few?

Good luck to your mom. Let us know how she does.

It sounds like your
It sounds like your hospital has a tumor board where they discuss the cases and decide the best way to go, amoungst the Dr.'s treating your mom.

I too had surgery scheduled on a particular date, but went for my 2nd opinion and postponed the surgery. In my case, the 2nd opinion was at a university based hospital that is a National Cancer Institute, which means they do research. I ended up having surgery about a month later, but with the 2nd opinion Dr., and have had every confidence in that decision. This is,obviously, a life changing decision (notice I didn't say "life and death" because it's all about living), and your mom has to be comfortable with the decision. Ask the Dr., if she wants to get a 2nd opinion, what a delay would mean.

I was hesitant about going for the 2nd, until I realized that I was a bit panicked, and had spent more time researching a new car than my options. Wouldn't it be nice to get 2 opinions that say the same thing, then to wonder a few weeks later? Like Cabbot said, you don't want to wait forever, but a couple of weeks usually won't change the prognosis.

Good Luck---and remember to breath.