Breast cancer treatment options

[hapster1]

Just got back from oncologist with wife. She had lumpectomy 2 weeks ago. Doctor recommended radiation and hormone therapy. She said chemo was up to my wife. She had a 1.1cm tumor removed with negative lymph nodes. She said at 1.5 she would push for chemo but at 1.1 left it up to us. Does this sound right? My wife is 54 and otherwise in good shape. Doctor did say that it was 2 to 3% better not to recur with chemo but only 2 to 3%. Is it worth going through chemo and its negative side effects for 2 to 3%?

[Avidhiker]

I researched that same question until I was exhausted. Yes, unfortunately, it is only about a 3% decrease in the risk of recurrence.  My tumor was 2.4 with negative nodes.  I did chose to take chemo only after I had the ONCOtype DX test performed.  Genomic Labs in California is the only lab currently in the world that performs this genomic test that quantifies the risk of recurrence in node negative, ER+, early stage breast cancer.  It assigns a number 1-18 low; 19-30 intermediate; over 30 high. Most oncologists will let you skip the chemo if your percentage is 10 or under.  My number was 26 with a 16% chance of recurrence in ten years (taking into account that I will be on Tamoxifen).  If you are really into stats, this means that I reduced my risk from 16 to 13 because of chemo. I am also taking weekly infusions of Herceptin (my HER2 was overexpressed). This will further reduce recurrence by about 50% (50% of 13=6.5--6.5). In my opinion, you do whatever it takes to not have this rotten thing come back. You only want to go through this once.

I assume you know the results of the tumor markers, whether she is ER and PR+ or -, how aggressive the tumor was, whether she was HER2 overexpressed.

The Oncotype DX test is getting a lot of attention now.  In one year, their cases went from about 600 to 14,000.  It is becoming a tool for oncologists to help determine whether chemo will provide benefit.  One caveat:  Trials are now underway to determine whether those women who fall in the gray (intermediate) zone will benefit.  As you know, this taks about 5 years.  I was not in a position to wait.  Hopefully, my oncologist is right about the benefit outweighing the toxic side effects.

[hapster1]

Thank you for your responce. Oncotype Dx test was not mentioned but we will be questioning the oncologist now. The doctor did say if she thought it was necessary(chemo) she certainly would recommend it but where tumor was 1.5 and negative nodes with clear margin she left it up to my wife. Looks like more research before final decision. Once again thank-you for the insight.

[boninclyde]

I had right breast masectomy for wide spread calcifications, 0.09 invasive cancer, er+. PR+, HER2-, no lymph node involvement, oncotype test 20 1/2. I do not need chemo or radiation. I will now have to have tamoxifen or ovaries removed. By looking at her results and studying my on cancer it does not look like she would need chome. I am not a doctor. Go to breastcancer.org and look at info there.

[rkmsim]

My second bc in 2003 had the same characteristics as your wife.  In 1998, my tumor was 2cm, 1 positive lymph node and I chose chemo as well as radiation.  In 2003, I had a new primary on the other side.  It was 1.1cm, negative nodes, ER+, PR+ and Her2Neu negative.  I decided not to have chemo based on the pathology and statistics despite the fact that 2 out of the 3 oncologists that I went to recommended chemo.  However, the important thing is that you make a decision based on the facts and ultimately what you feel most comfortable with.  You have to say to yourself - if the cancer comes back, will I say I should have had chemo.  If you know that in your mind you did what was right for you, then that is what is important.  I know that if I get bc again, I still feel that I made the right decision both times, in 1998 and 2003 based on the information I had.

[hapster1]

Thanks to all for the responses. We just got back from the radiologist yesterday and my wife has decided to go with just the radiation and hormone therapy. Both radiologist and oncologist are very comfortable with that along with my wife. They tell us everything looks good and was caught very early. This was actually found by mistake. She was sent in for a breast mri which showed all was well but this 1.1cm on the other breast was picked up by the mri. Lucky us. She is comfortable with her decision and we are both going to be positive about this. Thank-you and good luck to all.

[Avidhiker]

Thanks for your well wishes and best of luck to your wife.  I am midway through radiation which is a piece of cake, a daily inconvenience.