histology report

[Dolly44]

Hi.  Have infiltrating ductal carcinoma, grade 2/3 12mm in maximum dimensions and closest to deep margins at distance of 2mm.  other margins greater than 1cm.  1 lymph node contains 2 intralymphatic isolated tumour clusters.  A single micromiliscopic deposit present in 1 or 3 lymph nodes.  I am 44 years old and have no children.  
1. What is my prognosis?  
2.  On Tamoxifen and thinking of stopping it.  What would happen if I just stopped it?

Thank you

[Dolly44]

Thank you.  I forgot to mention that I had chemo and radiotherapy.  Having lots of side effects from tamoxifen which is why i am thinking of stopping it.

[Fernando Roque, MD]

Hi.  Before giving you prognosis statistics, I would just like to make it clear that these statistics are applicable to POPULATIONS of women who have breast cancer of the same stage and type.  The numbers may not necessarily be applicable to INDIVIDUAL patients.  For example, when I say that the five year survival rate of women with Stage IIB is 81%, it means that of 100 women studied with Stage IIB disease, 81 were still alive after 5 years while 19 have died.  Whether an individual patient with Stage IIB disease shall belong to the 81 who survives or the 19 who die after 5 years will depend on a lot of variables unique to that individual (and which are hard to factor all in).  Thus, giving an exact number is possible for populations, but may not be possible for individual patients.

But since you asked for prognosis, I'm giving you an estimate based on this software program called Adjuvant! Online, which is a tool available to doctors to calculate prognosis based on the latest clinical trial data.  The software is updated as new data from studies come in.  I used version 8.0 of the calculator for breast cancer.

I calculated two aspects of prognosis: 10 year survival rate, and 10 year risk of recurrence.  Since you have been taking tamoxifen, I also calculated your survival and  recurrence rate with or without 5 years intake of tamoxifen.  I also made separate calculations for tumor grade.  Since you did not give information about your estrogen receptor status, this was not factored into the calculation. Just remember that these results should merely serve as a guide for you.  They are at best ROUGH ESTIMATES of your true prognosis!

10 year survival rates:

If grade 3 tumor, ER status undetermined, no treatment: 65.4%
If grade 2 tumor, ER status undetermined, no treatment: 80.1%
If grade 3 tumor, ER status undetermined, with 5 years tamoxifen: 70.9%
If grade 2 tumor, ER status undetermined, with 5 years tamoxifen: 83.4%

10 year recurrence rates:

If grade 3 tumor, ER status undetermined, no treatment: 52.5%
If grade 2 tumor, ER status undetermined, no treatment: 35.7%
If grade 3 tumor, ER status undetermined, with 5 years tamoxifen: 43.3%
If grade 2 tumor, ER status undetermined, with 5 years tamoxifen: 28.5%

Since your tumor grade is between 2-3, your survival and recurrence rates probably fall somewhere between the values I've given.  From the above calculations, its quite clear that your prognosis will be a lot better if you did not stop tamoxifen.  Your prognosis would also improve further if you underwent chemotherapy, but I did not bother calculating this.