53 Yr Old Lady Diagnosed With B/L Breast Cancer Elsewhere. Dilemmas In Treatment!

53 yr old lady was diagnosed with bilateral breast disease elsewhere...T2N2M0 lesion right breast with multiple small BIRADS IVb lesions left breast (largest 1 x1cm) on Sonomammo. Right breast lump biopsy revealed IDC grade II, Er/PR +ve, Her 2 Neu -ve, and blind biopsy of left largest lesion revealed DCIS. PET CT had picked up only right breast lump and no uptake in left. She underwent upfront MRM with LD flap reconstruction for right breast lesion in Nov 2017.

HPE revealed T3aN2a IDC grade II NOS type, LVI +be, 10/14 nodes+ve (including 2apical nodes)..she received 4#AC --->12#Pacli ---> RT to chest wall with boost (Sept 2018). Follow up scan in Dec 2018 picked up a lesion at the site of previous largest lesion in left breast and no other lesion. Stereotactic biopsy revealed IDC grade I. Lumpectomy was done which revealed 2.2x2 cm IDC grade II, Strong bER/PR +ve, Her2Neu -ve..Fresh…