benefits vs risks of chemo

[diva52]

I am 52 years old with Stage 1 breast cancer.  I have had a lumpectomy and 4 lymph nodes removed.  My tumor was less than 1 centimeter, and the cancer had not spread to the lymph nodes.  My oncologist ordered an oncotype DX test. My score is 23. The test said that my cancer had an average rate of distant recurrence of 15% with Tamoxifen alone (although I might be given Femara).  I thought those were pretty good odds.  The test also said that people with scores of 31 or higher had a 40% chance of recurrence with Tamoxifen alone, and 12% with Tamoxifen and CMF/MF.  My oncologist said that the chemo drugs  used in this study are old, and the outcome could even be 30% better with the new drug combos.  Are there studies like this using my score and the new chemo drugs?  A FISH test showed that I am HER 2 positive, but the oncotype DX test put me in the Equivocal range for HER2 (although my doctor says this is still considered positive).  I am estrogen and progesterone positive.  My doctor is recommending 6 chemo treatments plus a year of Herceptin.  My question is, given all of the side effects, some permanent of chemo, is it really necessary in my case?  I have a 5 year old son and a 4 month old daughter, and am worried about being sick and finding someone to take care of them for a whole year of treatment..  How likely is it that if the cancer comes back it won't be caught early again like it was this time?  Won't I have mammograms every 6 months for awhile anyway?

[allmymarbles]

My daughter has been doing extensive research on breast cancer. According to her there is almost no difference, after surgery, between using chemotherapy or doing nothing. The problem with chemotherapy is that it wrecks your immune system. Were it me, I would make sure I was in tip-top health and do all I could to boost my immune system. But that is only my opinion. Many would disagree with me. To boost your immune system, research people like Dr. Andrew Weill.

[Cheerpul]

I am sorry that you have been diagnosed with breast cancer.  I was diagnosed a year ago with a .5 cm tumor, ER+/PR+ and Her2 positive.  (It looks like I was more strongly Her2 positive than your score.)  Oncotype score 31.  19 clean nodes removed.  I faced your dilemma and have two oncologists; one local in Ohio and one at University of Michigan Cancer Center.

I had a mastectomy last Oct. 14.  After much research and deliberation, I decided that chemo was the best way for me to lessen my chances of recurrance.  I began TCH (taxotere, carboplatin and herceptin) on Dec. 29 and took 4 doses 3 weeks apart.  I was very ill (nausea, diahrrea, etc.) but managed to go to work every day full-time.  We did not finish the 6 planned doses because I was so ill and because I have had much neuropathy in my hands, feet and face.  The facial numbness cleared up within 5-6 weeks after stopping the TC component of chemo.  I am still working with hands and feet, but it is not so bad.  I hope to live like this for a long time.  

I work at a living history museum as a historic cook, play piano, sing concerts, and am singing Little Buttercup in HMS Pinafore next week among other things.  I slept my way through Jan. -April when I was not at work.  Once I recovered from the last TCH treatment, my energy returned pretty quickly.  I added working at the Census Bureau and was averaging about 75-80 hours a week late April - August.  And I was taking Herceptin every 3 weeks throughout.  I will be finishing Herceptin either at the end of Nov. or Dec.  I also take Zometa, an osteoporosis drug, every 3 mos. as part of a study to see if these drugs help keep breast cancer from returning as bone cancer, and tamoxifen, as a daily pill.  I think that you will experience very little side effects once you are only taking herceptin.  I have no fatigue or weakness from it.  The only effect I have from it has been softened fingernails that split and a slow decline in heart function (about 1% per month, which still leaves me in a normal range and may improve after the treatment is finished.)  My doctors and I are now planning a prophylactic mastectomy on my other breast to further reduce my cancer recurrance chances.


Based on my study and consultations with doctors, I believe that it is best to hit cancer hard at its first appearance.  If you can eradicate it, it may never come back at all.  If it comes back, it can come as breast cancer, in the bones, brain or elsewhere.  Chemo is rough, but temporary for someone in your situation.    I believe you need to look long term when you talk cancer treatment and do all you can to keep it from coming back. There are no guarantees what type of cancer, where or how early you catch it if it comes back.  Do not allow fear of the treatment, logistics or "what-ifs" to affect your decision.We are all stronger than we ever thought possible and you will find people to be incredibly willing to help you from family, friends, cancer organizations to total strangers.  Please keep in touch as you go through your treatment and we will support you all we can.  I am thinking of you.