Chemo or not Chemo

My 38 year old wife has breast cancer.  She originally had a 4 mm lump removed during a biopsy.  We decided to have a mastectomy to get rid of all the cancer.  Our doctors attempted a skin sparing mastectomy with immediate reconstruction (tissue expander).  The pathology report after the initial mastectomy indicated invasive was left in the breat but Nodes were negative, Estrogen and Pergesteron positive, HER2 neg. Our surgeon went back in a few weeks later and removed several segments of skin and tissue until he had a clear margin.  In addition to the original 4 mm lump, we found segments/strips of invasive of the following max length:  8mm, 6mm, 4mm and 2mm.  We have since had a total mastectomy and found additional DCIS but no invasive (4 surgeries total).  We have gone to two medical facilities.  One recommended radiation and tomoxifan only.  The other recommended 4 doses of AC Chemo plus radiation and tomoxifan.  Even they said we are in a gray area and we could sleep comfortably at night if we chose not to do Chemo.  That's assurance is not helping either me or my wife sleep.  What marginal benefit does my wife get by taking the AC Chemo over hormonal treatment and radiation?  What are the long term risk and probabilities for something else?

[CCF-RN,MSN-rf]

Dear AFMAN:  If I am understanding your question correctly, it sounds as though your wife has "multifocal" disease.  If this is the case, it certainly validates her choice for mastectomy.  Status of margins would dictate radiation.  The decision to do chemotherapy is based on a risk benefit ratio that can be very individual.  Given the size of the individual "tumors," one might decide not to have chemotherapy.  However, given that it is multifocal, one might lean toward chemotherapy.  Dr. Susan Love's breast book has a section that discusses individual benefit ratio's. You might want to borrow from a library or purchase her book to help gain a clearer understanding.  Clearly, there is no absolute guarantee regardless of which option you choose.  To learn more about chemotherapy check out www.chemocare.com.

[JCB197]

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