Fourth Opinion?

Dear Med Help,

I was diagnosed in January at the age of 37. I was stage T1A (5mm), Invasive ductal, er+/pr-, low grade, well differentiated, her2 neu negative (confirmed by Fish), no vascular, lymphatic or perineural invasion.  I also had a 7mm DCIS component in and around the Invasive cancer. My tumor was non-palpable, detected by mammography (non-casting microcalcifications, I believe they were infrequent and pleomorphic) I had a lumpectomy and am now having radiation. My margins were clear. I've been to three oncologists. One did not want me to have any adjuvant treatment (including tamoxifin (tamoxifen)). The other two agreed on the tamoxifin (tamoxifen). However all refused to give me chemo, stating that the side effects will outweigh the statistical benefit in my case. I have, however, read on the internet of some woman with tumors under 5mm getting subsequent distance recurrance and I do NOT want to be one of these - especially at my age. After pleading with one of the Oncologists (from a major teaching university), I was told they could prescribe goserelin injections along with the tamoxifin (tamoxifen). (I was provided information from the ZIPP study which indicated that this may be equivalent to CMF in er positive woman. Have you ever heard of anything like this?

Should I go to a fourth Oncologist in an attempt to get the chemo? Is it true that the benefits of chemo do not outweigh the risks in my situation?  Also, does the fact that I'm er positive but Pr negative negate the benefit of the hormonal treatment that has been recommended to me?

[CCF-RN,MSN-rf]

Dear Dazedandconfused: The standard of care for your situation in the United States would be Tamoxifen.  Having said that, I will attempt to address your other concerns. There is little data available looking at the role of chemotherapy in tumors less than 1 cm, particularly in young women. There is European data that supports the use of goserelin in ER positive women and suggests its equivalency to CMF.  If you were both ER and PR positive, the response to hormone therapy may be superior but it does not negate the benefit.  Finally, regardless of what is done, your risk of recurrence is low but not zero.  There is no treatment that can make this sort of guarantee.

[DazedandConfused]

I left out the fact that I had 12 lymph nodes checked and all were negative.  I also had a ki-67 test (instead of s-phase) and it came in at 15%.

[MrsH]

This is just my opinion, and I'm just another breast cancer patient. But having been through chemo I would say only have it if you absolutely have no other choice! For a lot of us chemo causes lasting damage, to skin, nerves, libido, etc. - it's pretty heavy-duty stuff, even if they have improved it. Anyway, best wishes and hang in there!