Confused about oncologist's recommendation

[Sandiann]

I was diagnosed with breast cancer and had a lumpectomy two weeks ago.  My husband and I had an appointment with my oncologist yesterday.   After discussing the statistics of my breast cancer, he said he would recommend chemotherapy for every breast cancer patient, regardless.   The statistics regarding my tumor are below:
   Stage 1 tumor, size: 1.7cm, Sentinel cell test: nodes negative,  type: lobular intrusive, estrogen receptor: positive 100%, Her-2-nu: negative, clear margins on the tumor when removed.  Although he said I would do well with hormone therapy  and radiation, he recommended chemotherapy, hormone therapy and radiation.  I am 55 years old.  Considering the above statistics about my tumor and my age (post-menopausal), would this be your recommendation?  I have read Dr. Susan Love's Breast Book (a wonderful publication), and am aware of the treatment side effects and possible future side effects of chemotherapy.  Do you feel the benefit outweighs the risks?   Thank you so much for your suggestions.   My husband and I have been through much emotional trauma (as you might expect) and want to go into the treatment knowing we made the right decisions.

[CCF-RN,MSN-rf]

Dear Sandiann:  In general, the standard of care, currently, is to recommend chemotherapy in tumors over 1cm.  Having said that, there is a chapter in Dr. Susan Love's Breast Book that discusses relative benefit in terms of risk versus percent benefit.  So it becomes a bit of a personal decision in terms of whether the percent benefit is large enough to take endure any amount of risk.  For some women a 1-2% benefit is enough, other women prefer a bigger benefit/risk ratio.

[ritavv]

Your statistics are similar to mine except mine was ductal and yours is lobular.  I won't presume to advise you except to get a a second opinion.  I did get a two opinions from oncologists.  One suggested chemo because it is the standard for tumors greater than 1cm.  The other said mine was a very slow growing cancer (mitotic rate was low) and I wouldn't get much benefit but should benefit a lot by hormonal therapy because of the high Er/Pr percentages.  I opted not to do the chemo.  I am 53 and have been almost 3 years with no evidence of disease (NED).  However, remember mine was ductal and I don't know if it is the same for lobular.  So just get a second opinion and you'll feel better about your decision.

[surgeon]

As has been said here before, treatment decisions are based on data gathered from large numbers of people. There is no way to predict the outcome in an individual. The data are convincing that survival is enhanced by giving chemo to women with tumors larger than 1 cm. In doing so, some lives will be saved. Likewise, some will get treatment they don't need, because they will have been cured already; and others will get treatment that won't prevent the tumor from recurring. Unfortunately there's no way to separate those groups. So one is faced with choices: being cured where you might not have; or not going through something which is unpleasant and might be unnecessary or ineffective. In your case, there's clear benefit from taking anti-estrogen therapy. You ought to question your oncologist in detail -- and likewise the second opinion person if you so choose -- about what extra benefit can be expected from doing both chemo and hormone therapy, as opposed to hormone therapy alone. I think you'll be told the differences are measurable -- in large numbers of people -- but not huge. One way to get understanding is to ask, for 1000 women with my data, how many could expect to be alive at 5 and 10 years with treatment A, how many with B, etc. Sometimes data is reported by saying "the number of  failures was cut in half," for example. If that means there were 10 instead of 20, but it was out of 1000 people, it's much less impressive. An example, only.

[chey101]

hi, i don't have breast cancer but recently had a mole removed because the change in texture and shape. the pathology came back that it was totally beningh(spelling?)but the doctor told me that it was the kind of lesion that if left alone to get bigger it would have turned cancerous. does this mean that i have a greater chance of developing skin cancer because i have like 20 to 30 moles on each arm(all pretty small). i am only 21 and am really scared.please anything anyone has to say would be great.
thank-you
chey