Question: I had in 1989, on the left breast, a modified radical mastectomy, removal of left breast, under arm lymph nodes and lining over the chest muscles. In 1990, I had a simple mastectomy - removal of entire right breast.. A couple weeks ago, I had surgery to remove a lump above the left implant. Today I learned that is an "infiltrating carcinoma with lobular features". The pathology report reads that the specimen was bisected to reveal an ill-defined tan-yellow and tan-white area of firm soft tissue located in the center of the specimen measuring 1 x 0.9 cm and located 0.2 cm from the closest inked resection margin of the specimen. I have an appointment with the surgeon next Tuesday - but I am stressed out; and would like to learn what I can now as to the likelihood of a full eradication of the cancers.

Dear Dr. Kannepalli, Thank you for your timely response. • I did not receive chemotherapy or postoperative radiotherapy after the surgery on my left breast in 1989. • I have just asked a doctor to review my medical record to answer 2 other questions you posed: o The stage of my disease in 1989 when I had the modified radical mastectomy of my left breast; and o the kind of mastectomy I had on my right breast in 1990: a prophylactic mastectomy or a DCIS (in-situ cancer). As soon as I get the answers, I will get back to you. Once again, thank you for addressing the matter. XXXX Dear Dr. Kannepalli, I have yet to receive answers to the questions you raised. From my own Internet research, however, I conclude that the mastectomy on my right breast in 1990 was a prophylactic mastectomy and not for DCIS. I am still waiting to learn the stage of my disease in 1989 when I had the modified radical mastectomy on my left breast. But I am pretty certain that it was an early stage. Recap: • infiltrating carcinoma with lobular features • Estrogen receptors: positive • Progesterone receptors: negative • HER-2 protein: negative • In 1989, I did not receive chemotherapy nor postoperative radiotherapy following a modified radical mastectomy of my left breast. Left underarm lymph nodes were removed. • In 1990, the right mastectomy was prophylactic and not for DCIS. • Pending: confirmation that my disease in 1989 was in an early stage Once again thank you for your assistance in this matter. XXXX

Dear Dr. XXXXXXX My disease in 1989 was in fact in an early stage. Is there any other reply that you are waiting for from me? Francoise

Thank you Dr. Kannepalli, Yesterday, my husband and I saw the oncologist surgeon who operated on me. He and you agree that additional surgery is in order due to the fact that the tumor was extending to the margin. I will be undergoing a full-body PET scan this Saturday and an MRI of the breasts on Tuesday. He has not yet ruled out radiation or chemotherapy. That will be decided upon after the surgery and tests. If either of the two treatments are in order, radiation, he said, would probably be considered before chemotherapy would. He is also sending the tissue to a lab for an oncotype DX breast cancer test. Your findings and his are a great relief to me. Thank you for your timely and detailed attention to this matter. XXXX