Chemo for Stage 0, ER+/PR+/HER2-?

hudsonrivergirl

Hello, I am new here. I am trying to find out more about chemo and whether I will benefit, and wondering if anyone else fits this profile.

Here's my story: I went in for a mammogram in January and had microcalcifications that looked different than a previous mammo, so I had a stereo biopsy on 2/3. The results came back positive for well-defined IDC, and the area was (as the doctor said) microscopic. I then had an MRI which seemed to show that all, or almost all of the cancer had been removed in the biopsy. I had surgery on 2/24 and the pathology report came back that there was no cancer in the section at all and none in the nodes (they removed 2). The surgeon is confident that they took enough of a section (almost 2 inches, with the marker from the biopsy right in the middle) that I'm all clear, however the radiologist wants a follow-up mammogram on April 9 to make sure, since it is unusual not to find anything in the surgical section. Then I will see an oncologist on the 15th to decide what the next steps will be. I should add that I am 43 years old, with no history of breast cancer in the family.  I have not had an Oncotype, but from what I've read, my sample might be too small to test.

I have been reading everything I can on the various types of treatment, and there seems to be conflicting info about the use of chemo in my case. Of course, I would rather not have it, but in order to make that decision I think I need more info. The oncologist might agree that it's of no benefit in my case, but I would like to be well armed before I go in anyway. I have had some experience with doctor's overprescribing to cover their own butts, and I don't want to go through something as difficult as chemo, just because someone doesn't want to get sued. That sounds a bit suspicious, I know, but as I say, I have had some experience of that.

Any thoughts on this would be greatly appreciated.

Thanks, and my prayers are with everyone with this terrible disease.

Sukiann

I think that the oncologist probably will prescribe tamoxifin (since you are hormonal positive) but would not recommend chemo for a stage 0 cancer.  You also have a slow growing cancer - grade 1 so that would also play into the decision.  You probably don't have to do radiation treatments either.  Yeah for you!!!!  Good luck at your appointment and let us know how you make out. 

Analemma

It might be a good idea to have a second opinion.  How could it happen that there was NO cancer in the tissue they removed?   Do I understand that ALL of the cancer was contained within the original biopsy?  And so they tested the sample from the biopsy to get your hormone / her2 status?   If so, you're a poster child for routine screening mammograms!  My mammogram came back clear even AFTER I found a lump, and postponed a dx for seven months.

In any case, I probably wouldn't do chemo if I were you.  Even the best chemo is only about 50% effective, and some of the side effects seem to never go away.  There is a lot of conversation that hormone positive BC doesn't respond as well to chemo as hormone negative, so the effectiveness in your case might be even less.   Maybe you could do a course of radiation just for some extra protection.

I think you just dodged a big bullet! 

hudsonrivergirl

Yes, that's correct. All of the cancer was removed in the biopsy and since there was nothing in the surgical section they used the biopsy to do the testing.

 I know I am so lucky. Even more so because I had skipped having a mammogram for 2 years just out of sheer laziness (I DEFINITELY do not recommend that !!!). I don't really know what made me decide finally to go, but I thank God every day that I did.

It has all happened so quickly--frankly I think I am still in shock!

 Thanks for your replies.

louishenry

Hi. It sounds like you have DCIS, not IDC. DCIS is Stage 0.

hudsonrivergirl

It actually is IDC, but it's stage 0 because it was so very tiny. At first they thought it might be DCIS, but the report definitely says IDC.

prayrv

Stage 0 is only for DCIS, once you're dx'd with IDC you are automatically a stage 1 regardless of the size.

Here is the link on BCO that shows the stages

http://www.breastcancer.org/symptoms/path_report/

Gentle Hugs,

Trish

sandee107

I had almost an identical situation to yours. I had calcifications that were seen on my mammo.  I had a core biopsy that showed both DCIS and IDC very small.  Total cancer was less than a cm.  Had an MRI before my lumpectomy on both breasts which showed nothing but the original lesion.  When I had my sugery they found no cancer cells and said all cancer was removed in the original biopsy. They did find what they call sclerosing adenosis (which is a benign condition) and sent that out for a second opinion to an expert in that field as sometimes it can be mistaken for cancer cells.  Then they went back to the original biopsy to verify that there was definitely cancer in the biopsy.  Long story short, I also had not enough tumor for them to send out for oncotype.  My onc did not recommend chemo or herceptin because there was nothing left after biopsy and most of the cancer in the biopsy was DCIS.  He said the benefit would be miniscule (his words) and did not outweigh the risks.I had radiation and am on Femara for 5 years due to it being highly ER+ (96%).  I am going for my 1st mammo since surgery on April 15 and am really anxious about it. I have a lot of lumpiness around my scar which the surgeon says is scar tissue from surgery and radiation boosts.  I hope that is all it is.  By the way, I was told only pure DCIS is stage 0 and any amount of IDC makes you a stage 1.  Feel free to PM me if you have any questions. I also am in NJ.  Best of luck with your treatment.

Sandee

jpernot

Can any of you with calcifications comment on biopsy methods?  I am confused.  Is the stereo biopsy the one where they pull some cells out with the needle?  I'm a BIRAD 4 micro-calc cluster and I need a biopsy.   I consulted with one surgeon but went away confused.  Consulting with another tomorrow. 

hudsonrivergirl

Thanks everyone, for answering. This is such a great resource. I am so glad especially to hear other stories like mine--I feel like it gives me some kind of basis for any decisions that I have to make.I did call my surgeon and confirmed the Stage question, and it is Stage 1. She did say that there was DCIS as well--I must have missed that on the pathology report. It's like learning a whole new language.

Thanks again everyone, and I will keep everyone here in my thoughts and prayers...I guess we could all use the help!!

-jpernot--not sure about the reasons for different types of biopsy, but I had a Stereotactic Core, and yes, they make a small incision and use a needle to remove cells. They use an x-ray to locate the exact position, and usually they leave a marker in place so that the surgeon can see the area. There is another type that uses ultrasound but I'm not sure about the reasons.

Deb