Is Chemotherapy going to make a difference?

[dee england]

Hi there,

I am 48 yrs old and pre menopausal.
I have had a full mastectomy on my right breast due to a cancerous lump under the nipple.
The lab results showed the lump to be:
Grade 11
2.4 CM in size
I am Oestrogen receptor-positive.
With clear margins.(there were also 2 small areas of pre cancer immediatly behind the cancerous lump)
No signs of spread to the lymph nodes (just the blue dye used from the sentinel node biopsy method no radiation as not licenced to use yet in our hospital, 6 nodes removed)

I have been given a prognosis of 85% survival rate without any treatment.
I am now being transfered to Oncology for future treatment which my surgeon has said he thinks will be 5 years Tamoxifen, with poss 2 years Zoladex and possibly a course of 4- 6mths of chemotherapy (no radio therapy)

I would be very grateful if you could answer the following 3 questions:

1/ Taking my results, what percentage increase would you apply to my survival rate of 85% with each of these 3 treatments?
Chemo
Tamoxifen
Zoladex

2/ I am aware that America is at least 5 years ahead in terms of advancement of treatment compared to the UK,therefore I am extremely interested to know; is it common practice there to treat my type of diagnosis with chemotherapy?  

3/What drug combination would you perhaps presribe?

I know I will be presented with some options when I visit Oncology tomorrow your opinion will assist me greatly in my decision.

Such am informative site, I have recomended to many friends. Thankyou.

[CCF-RN,MSN-JS]

Dear dee england, The current standard of care in the United States is to treat breast cancer that is greater than 1 cm in size with adjuvant therapy (Adjuvant treatment is treatment given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor).  Adjuvant chemotherapy has been shown to prolong the disease-free interval and survival and is recommended for most patients with tumors greater than 1 cm, regardless if the nodes are positive or negative, menopausal, or hormone receptor status.  

The chemotherapy prescribed is usually a combination of drugs and the inclusion of an anthracycline such as doxorubicin or epirubicin produces a small improvement in survival over nonanthracycline-containing regimens.  The treatment lasts 4 to 6 months in most programs.  

Decisions regarding adjuvant hormone therapy are based on the presence of hormone receptor protein in the tumor tissue (estrogen-receptors).  If the tumor is positive for estrogen-receptors adjuvant hormonal therapy is offered.   Currently five years of tamoxifen is standard adjuvant hormone therapy.

The use of Zoladex to stop ovarian production of estrogen (ovarian ablation) is used less often in the US.  Combining ovarian ablation with chemotherapy has not been shown to provide an additional advantage to date.  The value of combining hormonal therapies has not yet been adequately explored.

[ritavv]

Until you get your official answer you may want to check out the Mayo Clinic's recurrence calculator that figures things out based on different treatments.  Go to:
http://www.mayoclinic.com/takecharge/healthdecisionguides/avt/pg21.cfm

Just remember these numbers are based on past data.  Also, everyone is an individual.  You may have only a 1% chance of recurrence and be that person who does, or you may have poor odds and yet beat it.  

As far as your question about chemo... I know in the US, the norm is to have chemo if your cancer is bigger than 1cm.  Zoladex is used more outside the US as a way of improving the effectiveness of the Tamoxifen.  It's one thing that I personally think the US is behind the other countries.  However, that's just my opinion.

[lizziecee]

Dee, I live in Cornwall. I had a 2 cm er+ tumour, with associated DCIS, 3 nodes out of 18 positive. After 2 surgeries (lumpectomy and sampled node removal; total axilliary removal) I was recommended to have chemo - I had 6 x FEC at 3 weekly intervals, then 25 sessions of radiotherapy. Mammo in March (one year after diagnosis) showed no recurrence. I understood from my Oncologist that FEC (5fu, epirubicin and cyclophosphamide) was the latest chemo treatment for my type of tumour. I was started on Tamoxifen when doing rads, but my Onc changed it to Arimidex in Feb 04, as this has been to show that there is less chance of a recurrence, or indeed a new tumour. If you want any further info you can e-mail me at ***@****
Liz.