How much is necessary?

I recently had a lumpectomy with the following pathology:  1.5 cm, stage 1, grade 2 intermediate, progesterone and estrogen positive, her2 negative, clear margins and no lymph node involvement.  I am 46.  Protocol for this, I understand, is to have chemotherapy (AC) followed by radiation.  I have had differing opinions, though, regarding the chemotherapy.  Most indicate that it is given because of my age.  I have been told to do as much as possible and the opposite, to do no more than necessary.  I am concerned about the chemo and its long term effects - altering dna, future potential for leukemia, heart problems, not to mention the short term - I am single and alone and sole support.  One doctor asked if I could take three months off - not an option at all. My question is what is the percentage of reoccurance with chemo and radiation for someone my age?  Radiation only?  what is the percentage that develops the long term side effects?  I am trying to make the best decision for me now and for the long term.  Any input is appreciated as I need to make this decision very soon.  Thanks...

[CCF-RN,MSN-rf]

Dear weezer:  Chemotherapy reduces the risk of recurrence by about a third.  For example if you have a risk of 30% that the cancer will recur, chemo will reduce that risk to 20%.  So the key question is what is your risk of recurrence.  Your age and your estrogen positivity make the risk of recurrence a little higher.  Of course this takes into consideration that you are less likely to have another life-threatening problem.  I recommend that you discuss with your doctor, your risk of recurrence.  Also, there is a good discussion of this issue in Dr. Susan Love's Breast Book.

[surgeon]

actually, estrogen positive tumors, as a group, behave better than estrogen negative ones.

[ritavv]

Hi,
  I was in a similar situation as yourself.  I got two opinions.  The first oncologist recommended chemo, the second did not.  I was 50 and premenopausal.  If you're interested in my story you can go to http://www.bcsaf.com/stories/rita.html
You can also contact me by e-mail through that site.  

Also, you may be interested in a recent study: Hormonal Therapy Proves Superior to Standard Chemo for Premenopausal Breast Cancer Patients.  You can read about it at: http://www.breastlink.com/blink/plsql/HomePageNav?h_article_id=474

As the article points out, this study compared chemo alone against Hormonal alone.  It does not deal with using both.

[vermontgirl]

Just wanted you to know that chemotherapy doesn't automatically knock everyone off their feet for three months.  I had Stage 2b invasive cancer and had 4 rounds of chemo three weeks apart.  Generally I took off the day of chemo treatment as well as the day after  and worked the reminder of the time.  That means out of 60 work days, I missed only 8 days of work.  Everyone reacts to chemo differently but don't go into it expecting to be sick--you probably will bounce back after each round just fine.  I also had radiation every weekday for 6 weeks--missed 3hrs a day of work for traveling back and forth to the hospital for treatment and maybe 3 days total for the rest of the 6 weeks due to tiredness.  Again, everyone is not the same but ya gotta think postively!!!  Good luck!

[omacar]

I had mastectomy  stage II B. I had 8 rounds of chemo   one every 3 weeks.  I worked part time thru it all.  My only effect  was that in the second week I felt very tired for 2 days.  Not every one gets sick.  Good luck!!!

[heidiho]

I don't know if this is typical, but I was literally TERRIFIED of the side effects of chemo before starting. I was dx'd in early May with 1.5 cm. IDC, node positive 1 of 10, ES/PR+, her(-). I had a lumpectomy and axillary dissection on 5/15. (Due to the one positive node & tumor size & the fact that I only had a lumpectomy, I knew going without chemo & rads was not an option, but actually feared the chemo almost as much as the possibility of BC recurrence.
   My onc recommended 4 AC's followed by 4 Taxols, followed by simultaneous radiation along with 5 years of Tamoxifen.  I chose the DOSE-DENSE regimen, whereby I receive chemo every 2 weeks instead of every 3 weeks--along with a shot of Neulasta 24 hours after each treatment.  I am now between my 2nd & 3rd treatment & have so far had almost no side effects, aside from the hair loss. The Neulasta will probably take care of the higher risk of infection; I got Kytrel (anti-nausea) along with each infusion & prescription Zofran pills, which I take once a day for 3 days afterwards--only had a very slight case of "queasiness" about the 3rd or 4th day.  I'm also pleasantly surprised that my blood work (taken weekly) has so far remained good, but I do expect them to go down, and my main concern is that I'd be overly tired/drained over the next 6 cycles.  Insurance only pays for the Procrit once the anemia actually sets in, or the CBCs drop below normal, & then it'll take a few weeks then to set it straight.  I'm also concerned about the side effects of the impending TAXOL in a few weeks.  
  Can anyone clue me in on this? How tired or "wasted" can I expect to feel from this in the following weeks?  Does it get worse with each additional cycle?  Anyone wishing to share info please e-mail me at:  ***@****.  I'd like to share chemo experiences with other readers.