do I really need chemotherapy?

[Isissydney]

I am 27 and was recently diagnosed with invasive ductal carcinoma. I had a lumpectomy and sentinel lymph node biopsy and bone marrow aspiration. The nodes and bone marrow were negative and my lumpectomy revealed the tumor to be 1.6 cm, grade 2 of 3, er/pr+, her-2-neu negative. The margins were clear, but had DCIS close (1mm). I have a strong family history of breast cancer, with an aunt that died from metastasis and my mom is currently fighting a recurrence around her spinal cord. I met with an oncologist last week and he recommends four cycles of AC therapy given three weeks apart. The statistics he gave me said for my situation, 20% will have recurrence. With chemo, 12% will have recurrence, and if you add tamoxifen, 6% recur. (*)Do these statistics sound accurate? 1) Does this sound standard, as many people have told me that for my size tumor, chemo AND radiation is unusual?; and (2) can you comment on the seriousness of the side effects...heart damage and increased risk of leukemia with adriamycin and how much nausea and vomiting even being premedicated for it? (3) Also, at 27, I know there is risk of infertility, especially with adriamycin, but I've heard that at the younger age, you have a better chance of periods and fertility coming back. Can you comment on this and any future worry of birth defects due to chemo?

Thank you so much for your help and a very informative site!

[CCF-RN,MSN-JS]

Dear Isissydney, Adjuvant treatment with combination chemotherapy is recommended for most patients with tumor's greater than 1cm in size, this is regardless of the lymph node status.  (from the Consensus Statement regarding Adjuvant Therapy for Breast Cancer from the National Institute of Health, December 2000).  Hormone therapy is also recommended for women with hormone receptor positive disease.  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.  

Seeing as you have had a lumpectomy to remove the cancer, the rest of the treatment to the breast itself is the radiation therapy.  Findings from clinical studies show that lumpectomy followed by radiation therapy is equal in terms of local recurrence and overall survival to mastectomy.

Side effects such as heart damage with adriamycin the risk increases after a certain life time maximum dose.  Risk also is greater in persons with pre-existing heart problems.  

There is a slight increased risk (1-2%) of developing leukemia years after taking adriamycin and cyclophosphamide.  

You are correct in terms of the fertility issue, there is a slight risk, and increases the closer a person is to natural menopause.  You would want to take precautions not to get pregnant before or while on chemotherapy as well as hormone therapy because of harm to the baby.  It is usually recommended to wait a couple of years after chemotherapy to try to become pregnant as that is the time of greatest risk of recurrence of cancer.

[Isissydney]

Thank you for your answer and the following comment. You are a great help!

[ritavv]

Hi... until you get the expert's answer, here is my experience.  Except for your age and margin clearance, my stats were almost identical to yours.  I was 50 when diagnosed.  My tumor was 1.6cm, 98%ER+/PR+, 1cm clear margin, and I was node negative.  I had 3 aunts who had breast cancer and my mother died of primary brain cancer.  First, I went for genetic testing and found out I didn't carry either of the known BRCA genes so I didn't feel the need for a prophylactic bilateral mastectomy.   I found out that the "standard" is to have chemo if your tumor is greater than 1cm.  However, recent studies have shown that post-menopausal ER+ women on Tamoxifen do as well as those with chemo.  That's why at age 50, I took a drug for ovarian ablation to force menopause.  I opted not to have the chemo. (Also, my S-factor showed it to be a very slow growing tumor) I am sure you are being advised for chemo because of your age.  Usually tumors in younger women are a little more aggressive.  Studies have shown that the chemo improves your odds.  In addition, a recent studies showed that women who have had chemo who previously had trouble getting pregnant later, may be helped by the use of Tamoxifen.  That study just came out a few days ago.  Good luck.