Chemo or No?

Hi, I am writing this on behalf of my mother. She is age 66. Two months ago she found a lump and it has turned out to be breast cancer. It is a grade 3 stage 2. The size of the tumour was about 5 cm so quite large. She had a full mastectomy to remove the cancer and all the lymph nodes removed. The results now show that there is no sign the cancer has spread and all the nodes were clear, it is e + and she has to take tamoxifen for 5 years, the debate now is if she needs chemo? one doctor suggests yes and another no, if the benefit is only so slight i think she would not go for this, as the margins and all areas in tissue were clear what would you recomend? all the tests are on her side to not need the chemo except from the grade 3 part. Please advise? a desperate daughter

[Greta_L]

I'm a 53 year old, 2 year breast cancer survivor who also had a large tumor and full masectomy.  They decision to have chemo for me was based on having 4 of 15 lymph nodes positive for cancer.  Did they tell you how many lymph nodes were positive? That gives a good indication whether cancer cells are traveling in the lymph system.
I am surprised to hear tamoxifen.  Usually that is now for those who haven't yet reached menopause.   After menopause the aromotase inhibitors like Arimidex or Aromasin or usually preferrred. You might want to inquire about that.
The good news is that things are so much more hopeful now. I work at a large company where those of us whom had breast cancer band together for support.  I know of 10 fabulous ladies who are survivors and none has had a recurrence.  

[Fernando Roque, MD]

Hi.  From the information you've posted, your mother has stage 2A cancer. Has HER-2 testing also been done? If so, what is the result? I'm asking about HER-2 because the National Comprehensive Cancer Network (NCCN) guidelines recommend chemotherapy be done after mastectomy for women with 5 cm tumors, who are ER + and HER-2 + and are node-negative.  However, for those who are HER-2 negative (but who have exactly the same characteristics as above), the guidelines are less clear about the use of chemotherapy.  Maybe this is what your mother's doctors are debating about.

I tried calculating your mother's prognosis using a software program called Adjuvant Online.  I factored in all the tumor characteristics (e.g. tumor size, tumor grade, your mom's age, etc.) you mentioned in performing the calculation. The figures I'm presenting to you might help you decide what kind of treatment to take:

10-year survival rate:

     55.1% survival in ten years without treatment
     62.6% with hormonal treatment alone (Tamoxifen)
     69.6% with combined chemotherapy and hormonal treatment

10-year recurrence risk:

     49.4% risk for relapse in ten years without treatment
     35.3% relapse risk with Tamoxifen treatment
     23.6% relapse risk with combined chemotherapy and Tamoxifen treatment

[Gardini]

The essential question becomes: is it worth the risk not to have chemo. If this were my wife, I would want every possible treatment known to the medical community prescribed, to ward of future problems. This stuff tends to lurk  in the system and then pop out just when things are going great. I would use the chemo as a sort of insurance, bearing in mind that there are no guarantees.

This may be a tough decision, but it also seems very clear.
Good luck

[Ray515]

Hi-
I also had a tough time deciding whether or not to take chemotherapy.  My tumor was quite small though, I had no node involvement and a mastectomy.  I had some doctors tell me to take the chemo and other tell me it probably wasn't necessary.  How frustrating!!  I decided to go ahead because I am fairly young (43) and in good physical condition.  My cancer was also ER/PR neg. and HER2 pos.  This meant that the hormone blocking therapy was not an option for me and the HER2 pos. status indicated that it was more aggressive and more likely to recur.  But it also meant that I could take Herceptin which is a targeted, highly effective drug for HER2 pos. cancers.  You need to know your mother's HER2 status.

The grade 3 and the large size of the tumor would make me very nervous.  But the positive ER status is good in that it opens other treatment options.  Is your mother in good physical condition?  If so this decision would be easy for me.  Do the chemo.  If she is in poor health then that makes it more difficult.  Get a copy of the pathology report and then do an internet search to get more information on her specific cancer characteristics.  Nothing was more frustrating to me then listening to the different opinions of all the doctors who looked at my path report.  If they don't know what to do then how am I supposed to know?  Good luck and I wish you and your mother the best.

[leese295]

Than you so much for your help, in answer to your question she is her2 negative and er and pr positive, i think this maybe why there is a debate, still waiting to see oncologist, thank u all for your help

[leese295]

Hi all, Thanks so much for your comments and help, my mom went to the hospital and they said chemo would be a 2 % benefit, she has decided cause of the low benefit and all the side affects not to have this, she is also her2 negative. She is going to be on tamoxofen for 2 years and then another one amidex or for 3 years. she is also having 3 weeks radiothereapy.

Many thanks again take care all.