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Breast Cancer (Expert Forum)
Medullary and Chemo
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
Medullary and Chemo
by ahubby, Jan 10, 2004 12:00AM
Thanks. My wife (37 years old) was diagnosed with invasive breast cancer recently.
she had a lumpectomy with Sentinel lymph nodes procedure. The pathology report showed: typical medullary carcinoma, 0.9cm w/negative margin, grade 3, ER/PR-, Her-2 negative. All five lymph nodes were negative.
We have our second opinion done in a famous institute in Boston yesterday, they agreed with the pathology report.
The tricky part is Medullary. All the information we got before we saw our Oncologist stated that Medullary Carcinoma had a better prognosis, and our radiation doctor said no chemo was needed (2002 NCCN guidelines). He said just doing radiation without chemo, the 10 year survival rate for such a small size medullary cancer was around 90%, the chemo may boost it to 91% 0r 92%. Our oncologist showed us the 2003 NCCN guidelines, which stated that medullary was not considered as a milder kind of cancer, for two reasons:1)the risk of metastases equal that of other high grade carcinoma, 2)easy to be misclassified.Her data: 10 year survival rate was 80% and 88% without/with chemo,and she recommended the chemo. Our second opinion doctor confirmed that it was medullary carcinoma, but it was not considered as a more favorable type. chemo or not? up to us. My question:
1)what have changed recently that lets the NCCN reconsider medullary carcinoma?
2)In your practice, did you see any difference in prognosis between the typical breast cancer and the medullary breast cancer?
3)what is the 10 year survival rate for stage I medullary carcinoma with and without Chemo?
4)chemo or not chemo?
she had a lumpectomy with Sentinel lymph nodes procedure. The pathology report showed: typical medullary carcinoma, 0.9cm w/negative margin, grade 3, ER/PR-, Her-2 negative. All five lymph nodes were negative.
We have our second opinion done in a famous institute in Boston yesterday, they agreed with the pathology report.
The tricky part is Medullary. All the information we got before we saw our Oncologist stated that Medullary Carcinoma had a better prognosis, and our radiation doctor said no chemo was needed (2002 NCCN guidelines). He said just doing radiation without chemo, the 10 year survival rate for such a small size medullary cancer was around 90%, the chemo may boost it to 91% 0r 92%. Our oncologist showed us the 2003 NCCN guidelines, which stated that medullary was not considered as a milder kind of cancer, for two reasons:1)the risk of metastases equal that of other high grade carcinoma, 2)easy to be misclassified.Her data: 10 year survival rate was 80% and 88% without/with chemo,and she recommended the chemo. Our second opinion doctor confirmed that it was medullary carcinoma, but it was not considered as a more favorable type. chemo or not? up to us. My question:
1)what have changed recently that lets the NCCN reconsider medullary carcinoma?
2)In your practice, did you see any difference in prognosis between the typical breast cancer and the medullary breast cancer?
3)what is the 10 year survival rate for stage I medullary carcinoma with and without Chemo?
4)chemo or not chemo?
Doctor's Answer
by CCF-RN,MSN-rf, Jan 12, 2004 12:00AM
Dear ahubby: It's not that anything has changed other than more data being available to be analyzed. The NCCN is a group that strives to reach a consensus on what should be the standard of care. They base their discussions on research that is available and determine what, as a group, they believe will benefit the largest numbers of people. Remember, data is based on large groups - never on individuals. The biggest reason to not consider medullary carcinoma more favorable is its risk of metastasis. The survival rates in the AJCC staging manual site 5 year survival rates (observed 87%, relative 98%) for stage one breast cancer - it does not differentiate types. However, there are other factors that may make one more prone to consider additional therapy [e.g. Bloom Richardson score, ER/PR status (negative tumors tend to be more aggressive), angiolymphatic invasion, and age of the patient]. The key to deciding upon chemotherapy is considering one's risk and the potential benefits. Dr. Susan Love's Breast Book has a good discussion of this. If your wife's tumor were larger than one centimeter - chemo would be recommended. Given that medical oncologists are the most familiar with the current literature regarding chemotheray, I would be partial to their recommendations rather than those of the radiation oncologist (his job is to be most current with principles of radiation therapy). Ultimately, this decision will be hers. We recommend a thorough discussion with the oncologists (less about the medullary aspect) more about her specific risks versus benefits.
