chemo or lupron or what ??

my wife age 44, pre-menopause ,11/01 first mamogram (mammogram) ever, some calcifications ,biopsy insitu non-invasive, 25 radiation visits ending 4/02. 11/02 mamogram (mammogram) something there, biopsy invasive carcinoma, 12/02 mastectomy, 1.6cm, nodes negative, estrogen positive receptor, her2new neg. local oncologist, 4 doses of chemo.  went to dana-farber and was told she could get same results from lupron to shut down her ovaries and put her into menopause, and tamoxifen??? what she she do?? this is too much at once....lupron looks to get a lot of bad press, but chemo doesn't seem to be a cake walk??  help??

[CCF-RN,MSN-rf]

Dear sugood:  The doctor at Dana Farber may be referring to a study that was done in Europe comparing CMF chemotherapy to Lupron and Tamoxifen.  In this study, the two regimens were found to have comparable results.  The potential flaw in this study is that the standard of care has been that chemotherapy is generally followed by tamoxifen in ER+ women.  Would the addition of tamoxifen have made the outcome from the chemo arm of the study better?  Also, this study compares CMF chemotherapy.  In the U.S., the current standard of care is generally AC (adriamycin and cytoxan) - I think this is what the one oncologist recommended.  When compared to CMF, AC is superior in terms of outcome.  So, if in the European study, AC were substitued for the CMF, would the outcomes still be equal?  In most cases, in the U.S., the recommendation for your wife would be 4 cycles of AC followed by 5 years of tamoxifen (lupron could be given in addition to induce menopause).  You could, of course, seek another opinion to get clarification.

[ritavv]

I am 52 now but was diagnosed at 50 (premenopausal) with a 1.6cm VERY (98%)ER+/PR+ tumor.  My nodes were clean, Her2-, and my S-phase factor was low (slow growing tumor).  My first opinion suggested chemo, the second did not.  My second opinion, and ultimately my current oncologist, recommended Lupron when my estrogen levels remained high.  (He was hoping that the Tamoxifen would put me in menopause...it did not)  Anyway, I've been on Lupron for 11 months (6months at first and now, again, for a year) and done very well with it.  It was very scary because it does get a LOT of bad press, especially from endometriosis patients.  I lucked out, I don't get hot flashes which is the most common side effect.  I did notice vaginal dryness and loss of libido, however, both of those problems have improved as my body got used to the lack of estrogen.  It's a very difficult decision to make.  If you want to read more of my decision making, you can go to bcsaf.com/stories and click on My story by Rita.  You can reach me through that website.

[ritavv]

One more thing... the Lupron for breast cancer is considered "ovarian ablation".  If you do a google search on that you'll find several good articles about it.  Some doctors use Zoladex instead of Lupron... but they achieve the same results.  Good luck!