Homone Therapy compaired with Chemotherapy and Homone Therapy

[jema]

I'm trying to make a decision on which therapy to use.  Health report: 60 y/o good health (rhumoroitd arthritis).  Still have ovaries & uterus. Lump found in Left Breast was removed (2cm tumor removed) tumor (DCIS) 60% invasive and 40% noninvasive, surgical margins were free, tumor maker test was negative, Mastectomy removed left breast and lymph nodes, 25 lymph nodes removed no evidence of metastic carcinoma (0/25) ER 100% favorable and PR 98% favorable.  Could you offer any history/advice on hormone therapy versus combo hormone/chemo to help with decision?   Have been advised that chemo only offers 1-2% decrease in change of spread over anti-hormone therapy.  Is the risk of chemo worth the 1-2%?  In gray area--decision left up to me.
Thanks  

[kkamminga]

Hi,

I am now going through the same decision process.  My nodes were negative and my receptors are positive 80 ER and 90 PR.  I too have heard the 1-2% as well as 2-3%.  It does scare me when my doctor talks about a cell slipping through the nodes.  Right now they say that with just radiation and tamoxifen there is a 89-90% chance of non recurrence.  My s-phase is very low .7%, but no one has talked about that.  To me that sounds as if the tumor was all but dormant.  Should I ask about the s-phase when making this decision?  

Thanks....Katharine

[Napoleon]

Hi - We have two ladies in our support group, one had 3 positive nodes, no chemo, tamoxifen only, it's been 13 years.  One had 1 node, no chemo, tamoxifen only, 8 years.  I think chemo is very hard on your body and that 1-2% just doesn't sound worth it.  But you have to make your own decision.  Just a thought.

[ritavv]

I'll throw in my 2cents as I had a somewhat similar story.  My tumor was 1.6cm, nodes clean, good margins, and both 98% Er+/Pr+.  My S-factor was a low 1.8%, so slow growing.  The first oncologist recommended chemo based on the size... usually it is recommended for tumors greater than 1cm.  I got a second opinion and the second doctor said he felt I'd only get 1-2% gain from it.  Usually the gain is more, but since my cells were dividing so slow, he didn't think it was worth the risks of chemo.  However, he said 80% of oncologist would recommend chemo and if I wanted to go for the 1-2% I could.  Well, after much soul searching, I opted not to.  I worried about it a lot at first.  However, since then (I'm coming up on my 2 year anniversary) I've read studies that have found hormonal therapy as effective as chemo and hormonal therapy in post-menopausal women with early stage node negative cancer.  So it all comes down to: can you live with a decision not to go for the extra 1-2%.  If you're going to worry about it forever, then go for the chemo.  Otherwise, I would definitely consider not doing it.

[CCF-RN,MSN-rf]

Dear jema:  In either case, tamoxifen would be advised.  In trying to evaluate benefit, it is not entirely clear.  The benefit for you might range from 2%-5% over a 10 year period.  There is a very good write up in Dr. Susan Love's Breast Book c2000 pp. 386-388.  It is too long to include but may help to clarify the difficulty in advising on this.  You can probably get a copy of this book at your local library and copy these pages or pick it up at the bookstore.  It usually runs about $20 dollars.