whether to have chemotherapy or not

please help
i have seen 3 oncologists 2 have told me that i need radiation therapy and then hormone therapy decapeptyl and tamoxifen for five years
the other recommends chemotherapy fac 6 cycles and then radiation therapy and then hormone therapy although she is not pushing  tamoxifen
i will not take tamoxifen because of the risks i am too sacred of another cancer
i am ok with decapeptyl because the side effects are not life threatening
i am pre menopausal  
45 years old
invasive ductal carcinoma
stage 1 (0.9mm)
no node involvement ( 0/1 sentinel node)
g2
er+pgr+ 66%
her2neu negative
only familial cancer was grandmother 84 years old pancreas (diabetic)
grandfather 70 years old lung cancer (probably work related as he worked in foundary god bless him)
no oncotype score they don't test in italy under 1cm
the tumour was removed on the 18th of july with clear margins
i need to make a decision by friday
i have 3 small children who need me
any insight would be an enormous help
thankyou

[zouzi]

Hi,
Decisions about chemotherapy or hormonal treatment are based on several factors including tumor size, status of lymph nodes under the arm, the appearance of the cancer under the microscope, the presence or absence of hormone receptors for estrogen/progesterone, as well as HER2 status, your general health, etc. We can not make any recommendations about treatments for anyone in this forum.The decision regarding Chemotherapy has to be made between you and your Oncologist who has access to all the information concerning your particular case.You could seek a fourth Oncologist's opinion about your situation,if you are not sure how to proceed.
Sorry if I can't be more helpful.But this is an important decision that has to be made only by Medical professionals.
Best wishes and good luck...

[maia1]

dear zouzi
thankyou so much for your reply
in fact
i have been trying to post this question on the ask a doctor forum
with no luck
wish you all the best..

[Cheerpul]

I had a small tumor (.5 cm) that was Er+/PR+ and Her2 positive.  Especially because of the Her2 positive, I took chemo after my mastectomy.  I saw two oncologists at a local hospital and a big teaching hospital, and a surgeon who studied my case, did tests and made recommendations.  It was very hard for me to get the oncologists to make definitive recommendations.  I was told, "Whatever you decide will be ok."  We looked at all the factors that zouzi cited above and I did have the Oncotype test, which came back at 31, which pushed one oncologist into suggesting the chemo would lessen that chance of recurrance.  Making the decision without more hard facts was very hard for me.

Look at all of those factors, find studies that deal with tumors like yours and look for trends in the literature.  How were tumors like yours treated in 2000?  2005?  2008? the most recent studies?   Focus on the facts you know and try not to let "what-ifs" distract you from analyzing and making your decision.  When you make it, follow through, do what you must and then enjoy your family and your life.  

Your best advice should come from the doctors whom you are consulting who have access to all your records and know you.  We do not have all the facts, but are people who have been treated for breast cancer and come together to support other people who join us on this road.  We are here to support you and I am thinking of you.

[Cheerpul]

I forgot about the Tamoxifen question when I posted above.   I am 47 and was premenopausal until I took chemo and stopped periods immediately. I have taken tamoxifen for the past 6 months.  The only side effect that I have had are 1-2 hot flashes each night.  I have a friend who has been taking tamoxifen for about 18 months.  She has many more hot flashes than I do, but feels that she has more benefit from the drug than the drawbacks of the hot flashes.  

I think that it is probably worth discussings all the pros and cons of treatment and maybe a trial of the drug to see if you even have side effects that outweigh its benefits before you reject the treatment entirely.