Chemo and radiation for invasive cancer that has not spread?

[crazy2kayak]

I'm 38 years old, recently diagnosed with invasive ductal carcinoma. My tumor is 1.7 cm, her2 neg, estrogen / progesterone pos; no evidence of spread (lymph nodes negative; MRI negative for additional tumors). Margins at surgery are clear. I take very good care of myself--I exercise, and I am not overweight. I also have become a vegetarian (with fish) since diagnosis. Several questions with similar connotations: Why (or Do I?) need chemo and radiation? Tamoxifen?  I

What are my chances for recurrence with / without?  Is it just as effective to treat recurrences when they arrive?

If I have chemo / radiation, what are the chances I will get another cancer as a result while curing breast cancer?

If there is no tumor left behind, how will Tamoxifen benefit me?

These are difficult decisions. If you can also direct me to some studies, I'd be grateful.

[CCF-RN,MSN-rf]

Dear crazy2kayak:  There are basically two surgical procedures for breast cancer, mastectomy (removal of the whole breast) and lumpectomy (removing the tumor only - with a margin of tissue).  If a lumpectomy is done radiation therapy is generally recommended.  Radiation is occassionally recommended after mastectomy in some circumstances.  Chemotherapy is often recommended in tumors greater than 1.0 centimeters.  The amount of benefit will vary according to other risk factors.  Your oncologist should be able to discuss these statistics with you.  Through the years, research has shown that women who receive adjuvant therapy do have improvement in survival.  Early treatment with chemotherapy and/or antiestrogen therapy is aimed at improving the chances of cure.  While disease that recurs outside of the breast and local lymph nodes is treatable, it is unlikely to be cured.  As you have been diagnosed with breast cancer, your risk is higher than average that you could get a second breast cancer or even an unrelated cancer but recurrent breast cancer is generally felt to be the greater concern.

Some types of chemotherapy can contribute to the development a secondary cancer (such as leukemia).  This is extremely rare and if it were to occur, would most likely happen many years after the chemotherapy. Similary, radiation therapy has rarely been associated with other cancers in the radiation field and tamoxifen has been associated with endometrial cancer.  Again, for most patients for whom treatment is recommended, these risks are much smaller than the potential benefit in terms of preventing metastatic breast cancer.

The purpose of tamoxifen is to reduce the amount of estrogen (which "feeds" estrogen positive breast cancer).  The purpose of removing the estrogen is two-fold, one is to "starve" any remaining cancer cells which could possibly be anywhere in your body.  The other is to remove estrogen from exposing any remaining breast tissue where the "conditions" could be right for forming a new cancer.  Studies have shown that tamoxifen is very effective in preventing breast cancers.

You ask very good questions and a thourough discussion with your oncologist will, hopefully, help you to reach a decision about how to proceed moving forward.

[LauriS]

You might want to check out this website:

   http://www.adjuvantonline.com

Your oncologist can go there, enter your pathology info and then show you the risks and benefits of the different treatment types.  I believe it also shows the survival rates based on the treatment types (I haven't seen it yet - just found it).

This can help you determine how to go forward.

[squiggles]

Anyone can use the adjunct online site. Register yourself as a doctor or student, then plug in your numbers. It will show the benefit you will get from all the different treatments. My guess is that the tamoxefen (hormonal treatment) will show the biggest benefit for you, followed by the radiation.  

Ask your oncologist to order an onc DX test on your tumor (if there is enough tissue left). It is now sometimes used to decide which ER+/PR+ women with no nodes would benefit the most from chemo.