Does she need chemo?

[BobPaul]

Hi,

My wife is 32 and has a Breast Cancer : Stage 2A, Grade 3, Lymph Nodes Negative, ER Positve /PR Low Positive. HER2 2+ (waiting for FISH result)

Many new studies suggest that chemotherapy won't help much when patient are diagnosed ER+. Oncotype DX is on of those test that can tell you more about the benefit of chemotherapy in this case but it is expensive.

We are struggling to decide whether or not chemotherapy is worth it.

Can you give us any advices to make a better decision?

Thanks

[Irishgal2]

I was 39 years old when diagnoised with BC 19th March last year.  My lump was 1.9cm, no node involvement, Grade 3 invasive ductual cancer, ER and PR positive and Her2 negative.

It was strongly recommended that I have chemo for the following reasons:

1. My age. I was young to get BC as too is your wife.
2. Pre menopausal
3. Grade of tumour i.e. 3 as too is your wife.

I have two young children.  The boys were 4 and 1 when I was diagnoised, so I decided to take every treatment advised of me to give me the best chance of being around a long time to see them grow up.  It was not easy, but doable.  I had radiation for 6.5 weeks and then Tamoxifen (hormone tablet for 5 years).  My full treatment from day of diagnosis to end was exactly 8 months to the day.  It passed quicker than I expected, looking back on it now.

Everyone has to make their own decisions about the treatment plan they follow.  The doctors can only advise.  Also everyones personal situations are different as too their overall health.

Thankfully I was very healthy when diagnoised, so I am physically able for all the treatment options.

There is light at the end of the tunnel and you and your wife will get there.  Good luck.

[lizziecee]

Hi there - I'm not a doctor or nurse, just someone who has invasive ductal cancer, stage and grade 2, 2cm tumour plus associated intermediate grade DCIS. ER+, PR not done, HER2-.

When I was dx in 2003, my surgeon advised I could have a wide local excision (WLE) and radiotherapy, OR a mastectomy and no rads. Sample lymph node removal would also be done at the same time as the WLE.  At that stage though, we did not have the full picture. After the WLE and sample node removal (8), the pathology showed 2 of the lymph nodes to be malignant and I was advised to go back for total axillary node removal a month later, after my wound had healed. Unfortunately, although I look upon it as fortunate, another lymph node was +.

This was the first time chemo was mentioned and it was quite a shock. The Oncologist said they strongy advised all bc patients with a tumour 2 cm or larger, and lymph node involvement, to have adjuvant chemo. My Nottingham Prognostic Indicator (which I believe is the protocol Adjuvant On-line uses) was 4.4, and I have an 88% chance of non-recurrence, having had surgery,chemo,rads and hormonal treatment (Arimidex). HER2 testing was not done then at my hospital, but I had it done privately some 3 yrs later; turned out to be negative.

However, my Onc said ER+ cancers can be HER2+, but only a small proportion.
The interesting opinion he gave me was that even if I was HER2+, he would not prescribe Herceptin, as I was "too long out of chemo".  I recall him saying it is best given alongside chemo, and within one year of chemo treatment. As your wife is HER2+, she will certainy benefit from Herceptin.

Oncologists have differing opinions on chemo treatments, but as I was being treated at one of only 6 Breast Care Centres of Excellence in England, I felt I had to go along my Onc's advice.......and 5 yrs later, thrilled to say I am NED (no evidence of disease - none of my drs use the word "cure").

I had 6 x FEC chemo cycles, and although it was very tough for me, as I had concurrent Crohn's disease and had to stop my normal weekly chemo, methotrexate, I know I made the right decision for me. It is a very personal decision and a small proportion of patients refuse chemo. Everyone is entitled to their opinion.   When I asked: "why chemo and rads?", I was told the chemo would zap any microscopic cells that had gone through the lymphatic system to other organs, which were too small to see on scans, and the radiotherapy was kind of belt and braces, to zap any remaining malignant cells in the breast.

I would respectfully suggest you question the Oncologist more - your wife does not have lymph node involvement so her status is different to mine. Also, you do not state the size of the tumour or type i.e. lobular, ductal, inflammatory, and this also may have a bearing on whether to have chemo or not.

I hope all goes well with your wife's treatment. Medical science has moved on exponentially in the last 5 yrs and there are many new drugs and treatments available today.

Take care - your wife is lucky to have such a concerned husband, who will fight this disease alongside her.

Liz, England.

[PaulMD]

Hi there.

If the Her2 status eventually turns out to be positive, then chemotherapy is indeed recommended.  The oncotypeDx test is only used for patients who are node negative, ER positive, but should be Her2 negative.  There is also evidence that pre-menopausal breast cancer patients would benefit from the addition of chemotherapy.  The grade 3 status means that the tumor cells are dividing faster than other types, and this might also be one reason to undergo more aggressive treatment such as chemotherapy.  I would like to give you the exact percentages of benefit by adding chemotherapy using Adjuvant! Online, but their website is currently down.  Whether you employ chemo or not, she would largely benefit from hormonal treatment (like tamoxifen).

I suggest you discuss these more in depth with the doctors, and I hope you and your wife can make a good decision.  

Regards and God bless.