Weak estrogen receptivity and Tamoxifen

[mfried]

I was diagnosed in the spring with a 6 mm tumor - PR negative, HER2 negative, and "weakly estrogen receptive," where less than 10% of the cells responded to estrogen.  I had a bilateral mastecomy and 4 rounds of dose dense AC chemo.  Because I am BRCA1 positive, I will also be having my ovaries removed in a couple of months.  



My primary oncologist has not recommended a Tamoxifen regimen.  However when I got a second opinion, the other oncologist said he would recommend it.  I also read an article recently that suggests the 10% number is an arbitrary cutoff, and even women with a smaller percentage of receptivity might still benefit from hormone treatment.  



I'm interested in being as aggressive as possible with my treatment, but of course don't want to take anything that's unnecessary.  Any recommendations, or can you clarify why there is such a discrepancy in treatment plans?  Thank you!

[CCF-RN,MSN-rf]

Dear mfried:  Estrogen and progesterone receptor positivity is determined based on the number of cells that have these receptors.  Tumors that are estrogen and progesteron receptor negative rarely benefit from the addition of hormonal therapy and, therefore, it is not usually prescribed in these settings.  There is some evidence that women with tumors that are positive, even if it is only weakly, may benefit from the addition of hormone therapy.  It is not uncommon to get slightly differing opinions from different oncologists.  These physicians practice according to their training, interpretation of research and experience.  Unfortunately, medicine is not an exact science and there is room for variation of opinions without any individual being "wrong."

[boninclyde]

Like Lizzie said in the above post. I don't think tamoxifen is use in negative hormone cancers. I believe they use armidex. I had an 0.09mm invasion with widespread multifocal DCIS, no node involevement, ER+, PR+, and HER2 negative, Oncotype score of 20 1/2, a right masectomy and just started tamoxifen. Haven't had my brca1 done yet. I am sure the doctor will respond soon. Wish you well.

[rkmsim]

I was also PR- and only slightly ER+ the first time I had bc in 1998.  I took Tamoxifen for 5 years.  My oncologist felt that if it was positive at all, then he prescribed Tamoxifen since he felt there may be some benefit.  I was diagnosed with a new primary on the other side in 2003, a month after I completed the Tamoxifen so I am on Femara now.  I am BRCA1+ and had my ovaries removed and a bilateral skin sparing mastectomy with DIEP reconstruction in 2004 shortly after I had the genetic testing done.

[boninclyde]

Thanks for sharing. Seems there is no particular standard of treatment.