Question: I am 8 mos post left breast rads to 6700 centgrays for Stage 2b, aggressive cell type. Rads done in the prone position and some sm amt directed to the L mediastinum. Lumpectomy and no chemo. On tamox. Onset 1 week ago of sternal pain ( on pressure and at rest) ESP left but some right sternal border. Vert tired and feel unwell, but nothing else specific. No sternal swelling, and no fever. Concerned about mets vs costochondritis. Is the fact that this has extreme point tenderness along the sternal border ( and the R) more suggestive of costrochondritis? How long to wait before asking for bone scan. I refused chemo, even tho indicated, so my concerns re mets are a little over sensitized. No sternal sx until now. All else fine. Nl mammo 1 mo ago. Your opinion?

I am a XXXXXXX doctor, genetics. My oncologist saw me last week and thought I should wait it out a bit. But he did not have an opinion about what it was either. I have NOT seen my radiation oncologist. My decision not to have chemo originally is the result of the fact that I am nearly 70, have had mild SLE X 40 years, a history of cardiac arrest for recurrent myocarditis and VT, and have an implanted defibrillator with 2 sets of leads that could become infected with port insertion, and pancytopenia from my lupus. In spite of it all, I am generally well and work full time.

All calculations using standard risk calulators gave me only a 1.7% survival benefit at 5 years with any chemo combo, and after consultations at XXXXXXX it was agreed that chemo was not going to be helpful. I am ER post only at 40%, PR neg, HER2 neg. Tumor size 2.7 cm, 1 node out of 20 was barely positive. The cell type was undifferentiated, and a moderate greade Elston score. I had a quadrantectomy with subsequent total breast radiation to 4500 cgys, and a 2000 cgy boost to the L lateral tumor bed, in hte prone position, minimizing expsure to my heart and lungs. My mediastinin received some radiation. I've done Oncotype DX for tumor genetics, etc. I am very aware of all of the chemo aspects of this and the probability of recurrence and mets. Chemo is not viable under any circumstances, and I have already had the XXXXXXX radiation I can have. I took Arimidex X 6 months with disabling bone pain and was switched to tamoxifen to abate the joint problems. I had to be treated with steroids to tolerate the radiation wihtout SLE effects. I am now off sterods X 4 months. My blood work was all normal for me 1 months ago.

I have NEVER had costochondritis before and I am not having a lupus flare now.

My question was not about how to treat my original breast cancer diagnosis, but hopefully to find out from a radiation oncologist whether costochondritis occurs 7 mos after radiation rx, and if so if the manifestations I have fit it. It is acutely tender area about 10 cm along my almost all of my mid sternum and at every costochondro join on the left sternal border--and at one joint on the right. There is nothing visible but it is acutely tender. It had a sudden onset a week ago, with general malaise and acute tenderness that is very sensitive to the touch. . There is no palpable mass or swelling.

Wit regard to hurring for rx, if this is mets, there is no additional treatment for which I would be eligible. I cannot have MRI because of my ICD. BOne scan and chest film, CT, are all I can have.

But what I am asking, is does this fit a picture of costochondritis? I am not asking for management of any mets or my overall breast cancer. I think we have this well convered. Your response did alarm me.