hormone therapy vs chemotherapy for post menopausal woman

[maggie2224]

I am 63 years old, post-menopausal and recently had a lumpectomy. The tumor was 1.5cm with a small local DCIS, All margins were clear. Sentinel lymph node was clear. The tumor was low grade and well diff, 99% and 96% er and pr +, her2 neu negative. MY chemo doctor tells me that chemo will increase my 5 year survival rate from about 96% to 98%. My radiologist tells me that a recent European study shows that for my condition, there is no difference in survival rate for radiation and Tamoxifin (tamoxifen) vs. chemo and Tamoxifin (tamoxifen). He goes on to add that Arimidex is probably better than Tamoxifin (tamoxifen), although long term effects of Arimidex are not as well understood.  Also, my tumor status is generally better than the average person used in the study.  My question is, do I take the chemo? I have been offered CMF. By the way, 2% improvement in 5 year survivability is important to me. (I don't know if I can wait for the new Oncotype DX test to help me make the decision, although one possibility is to start the chemo and get the test...if the test indicates that I don't need chemo then I can stop). Thank you.

[CCF-RN,MSN-rf]

Dear Maggie2224:  Regardless of whether or not you decide to take chemotherapy, radiation therapy should be done if a lumpectomy was the surgical option.  I have not been able to locate the trial your radiologist referred to but I am wondering if it is really comparing like situations (like yours).  The information you received siting an approximate 2% benefit is correct.  Also, the trials suggest that in post-menopausal women, Arimidex may be superior - but he is correct in stating that the long term issues are not as well understood.  As I look at your situation, it appears as if, for you, any amount of benefit is important.  That said, you might be well served to take the chemo (CMF is fairly well tolerated), do the radiation (because you had a lumpectomy), and follow with either tamoxifen or Arimidex.  Good luck to you.  No matter what you decide, you have an excellent prognosis.

[ritavv]

My situation was very similar to yours except that I was on the cusp of menopause.  Mine was a 1.6cm slow growing, 98% ER+ and Pr+, her2neu negative, clean margins, node negative, etc.  One oncologist recommended chemo because it is standard for tumors greater than 1cm.  I got a second opinion.  This doctor suggested that I might only get 1-2% improvement from the chemo and there ARE risks with chemo.  Become informed with the quality of life issues chemo can have.  I opted not to do CMF and in February I will be 3 years NED.

You may be interested in the study on this very subject at:
http://www.breastlink.com/blink/plsql/HomePageNav?h_article_id=437

[rkmsim]

I, also, was in a similar situation.  I had a 1.1cm, node negative, moderately differentiated, ER+ (48%) tumor when diagnosed in October.  After discussing my situation with several doctors - some recommended chemo, others didn't - I decided not to do the chemo this time (I had bc on the other side in 1998). I felt the small possible benefit didn't outweigh another assault on my immune system.  It is an individual choice and one that you have to feel comfortable with.

[tginnj]

My mother was diagnosed with invasive lobular cancer and just had a double mastectomy. She had 17 lymph nodes removed on the right side, 4 of which were cancerous. In addition, her tumors were larger than 2cms on both sides. She is estrogen receptor positive and is 83 years old. Hormone treatment, radiation and chemotherapy were recommended. When we saw the oncologist, she suggested CMF therapy. However, her statistics showed that for a woman my mother's age,there is only a 1% chance that CMF alone will be successful. There is a 6% chance that hormone therapy will be successful and a 7% chance that combined therapy will be successful. My question is, based on her age and the side effects of CMF, is a 1% chance worth going through chemo? Should we just stick with hormone and radiation? Do the risks outway the benefits of introducing chemo?
tginnj

[debann56]

A related discussion, chemo vs horomone therapy after lumpectomy was started.