breast cancer treatment plans

My mother is 54 years old. She had a lumpectomy on March 2006. She is perimenopausal. The pathology report came back as follows: T1N0M0 0.7 cm IDC with 0.8cm DCIS component. Well modified Bloom & Richardson- Architectural Grade 2, Nuclear Grade 2, Miotic Index 1. Negative margins. SLN was done with negative nodal involvement. Negative for vascular space invasion. 90% staining for ER+ and PR+. 3+ for Her 2 neu (Dako). Oncotype DX test score is 17 (with no her2neu mRNA detected). Fish test was done but came back inconclusive because of limited tumor sample. However, the pathologist did say there she could not see amplification with the nuclei which were available (but fewer than 20 nuclei were able to be examined). My mother's oncologist had put her through radiation therapy (5 weeks) which my mother will complete by the end of this week. Due to the small size of the invasive tumor and being ER/PR+, my mother's oncologist does not recommend my mother for chemo or herceptin. Instead, the oncologist is giving my mother Zoladex monthly(to help her reach menopause) and tamoxifen daily. Please tell me if these treatments are effective for my mother. I am concerned mostly about the 3+ for Her2(DAKO). Is my mother'sHer2+ tumor very aggressive even if it was so small and node negative?Is there "cross-talk" between hormonal and her2 receptors through the use of Zoladex and tamoxifen? Is it true that reducing estradiol (by Zoladex) would increase Her 2 level? Do Zoladex and/or tamoxifen make it worse for ER+/PR+/her2+ tumor? Please answer these questions ASAP. Thank you.

[CCF-RN,MSN-rf]

Dear daughter2:  The FISH test is considered to be the most accurate in terms of determining HER2 status.  The decision to do or not do chemotherapy is usually based on the size and other histological features of the invasive component of the tumor as well as lymph node status.  In women who are premenopausal, tamoxifen is generally recommended for ER/PR positive tumors.  The addition of zoladex (chemical ovarian ablation) will further limit estrogen production.  There is some evidence that this approach may improve outcome.  An oncotype score of 17 places the tumor in a "low-risk" category. While treatment must be individualized for each patient, the "low-risk" group appears to derive substantial benefit from tamoxifen but may not have significant benefit from the addition of chemotherapy.

[Naniam]

The posting by Elainehz is one only in which she is preying on our illness and trying to make money.  I hate it when someone comes and does this to us as we have had to deal with so much mentally, emotionally and medically and then they pull something like this.  Beware!!