Endocrine Therapy vs. Chemo

I am a 53 y.o. woman dx'd with 2.1cm IDC. I had a MRM with dirty deep margin which was resected this week with a clean margin. The tumor was invasive into the muscle. I had a total mastectomy on the left breast.
Grade 1.  One lymph node positive with micromet, sentinel negative.
Er/PR+ and HerNeu2-.

I am strongly considering endocrine therapy with an AI x 5 years vs. chemo.  I had a hysterectomy in March to shut down estrogen.  I feel endocrine therapy offers me very close to the same relapse/mortality stats as four rounds of AC.

I would consider radiation for local control.  What are your thoughts?  I have had this tumor for three years and feel it is indolent and may not respond well to chemo.

Thanks so much,
Veronica

[CCF-RN,MSN-rf]

Dear Veronica:  The discussion of whether to do chemotherapy is an important one to have with your oncologist.  Treatment with chemotherapy and hormonal therapy are not mutually exclusive and some women will receive both hormonal therapy and chemotherapy.  It may be that hormonal therapy has a greater chance of reducing your risk of recurrence given the low-grade nature of the tumor, particularly if the hormone receptors are strongly positive.  Regardless, there may be an additional modest benefit to chemotherapy and the ultimate decision should take into account all of the available data and your estimated risk of recurrence as well as the presence of other medical conditions.  A relatively new test that may be helpful in a situation like yours is the Oncotype diagnostic test that can help estimate, based on the gene expression profile of your tumor, the risk of recurrence at ten years if treated with hormonal therapy alone. You may wish to discuss this further with your oncologist. In any given woman, the percentage of benefit must be weighed against the potential risk. Some women feel any amount of benefit is enough to warrant treatment.  Others want to see certain percentages in order to justify going through chemotherapy.  Although most oncologists will make a recommendation, it is ultimately up to the individual to decide.  Your oncologist should be able to give you all the numbers and make a recommendation.