Should I have chemo

[fiddlin_round]

On 12/1 I had a lumpectomy and have met with an oncologist.  She is not providing any direction and has asked me to decide whether or not to have chemo.  I had an infiltrating and extensive in situ ductal carcinoma.  The infiltrating tumor component was 1 cm.  The DCIS component was 1.6 cm in diameter.  Sentinel nodes - 3 - were negative.  Margins were clean but close.  Grade II, hormones +,+, Her2/neu negative, H67 16%, bone marrow was negative.  I am 42, pre-menopausal and have 2 small children.  Is it worth going through a chemo regimen or would this not be of any great benefit?

[CCF-RN,MSN-JS]

Dear fiddlin_round, Over the past decade there has been more information that more clearly defines the subpopulations of women with localized breast cancer, for whom adjuvant chemotherapy is indicated as a standard component of treatment. 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.  Chemotherapy has been shown to substantially improve the long-term, relapse free, and overall survival in both pre menopausal and post menopausal women up to age 70 years with node-positive and node-negative disease.   Investigation continues as to whether there are specific patient populations for whom it is reasonable to avoid the administration of chemotherapy.  Unfortunately, very limited information is available to answer this important question.  On the basis of available data, it is accepted practice to offer cytotoxic chemotherapy to most women with primary cancers larger than 1cm in diameter (both node-negative and node-positive).  In your situation with node-negative cancer with an invasive component at 1 cm the decision to consider chemotherapy is individualized, based characteristics of the tumor, menopausal status, age, and general health.  Radiation therapy to the breast is standard post lumpectomy treatment.  Adjuvant hormonal therapy is also recommended as your tumor was hormone receptor positive.  

[cow chaser]

Hi, I too have had ductal cancer... I  am praying for you!!!!!!

[ritavv]

Don't hesitate to get a second opinion.  It might help you make this decision.  I saw two oncologists: one recommended chemo, one didn't.  I ultimately chose not to but I'm 10 years older than you.  I was told I might get only 1-2% increase in my odds of no recurrence.  That didn't seem worth the risks of chemo.  Your age and hormonal status may have more of a impact on your decision.  Like I said, don't hesitate to get a second opinion.

[fiddlin_round]

Thanks ritavv - I definitely will.  My oncologist is supposed to be the best in town but I was taken aback by not getting a clear medical guidance from her.  She has stated that my recurrence odds would be improved by 6% (90% up to 96%) if I underwent a chemo regime of 4 cycles.  So, again I have to ask if 6% is adequate improvement in odds for undergoing the toxicity of chemo.

[catsinnc]

I too had infiltrating DCIS and the infiltrating component was 1 cm. I had mastectomy on 10/10/03. Since I am ER/PR +, I decided to take Tamoxifen but not chemo. I am 46 and perimenopause. I tried Tamox. but it hurt my legs so bad so am going back to oncologist Tuesday to see what's up. My onc. also left the decision up to me whether to have chemo or not!

Good Luck!