Multicentric T2N0M0 chemo candidate?

VINE

Hi,

After mastectomy, the pathology results determined presence of 4 tumors, 2 under 1 cm and the other 2 under 2 cm. However these last 2 were at 9 & 10 o'clock positions and were too close to each other and under the microscope there seems to be a continuity, therefore the two were considered as one and therefore the designation moved from T1 to T2. All the tumors were low grade I, they were ER+, PR+ & HR- and none of the lymph nodes were affected.

My surgical oncologist recommends Tamoxifan for 5 yrs and says the chemo would have a benefit but it would be small, perhaps 5%. Basically she has left the decision up to me which makes it even more difficult to decide. I have therefore decided to opt for Oncotype Dx which is not covered under the Canadian Health care system.

Personally I am against using chemo and am not convinced that a smal benefit in my case outweighs its potential serious long term effects. My dilemma in determining a course of action is based on the multicentric aspects (4 seperate ones) of tumors. Also if the last 2 tumors are considered one, then the prognosis changes dramatically because we would then be looking at a 3.4 tumor size as opposed two individual 1.2 cm ones. Plus I am only 49 yrs old and premenauposal. I have not been able to find data that has examined the prognosis for mutiple (multicentrics) tumors and use of chemo. I am hoping that the score results from the Oncotype would help reinforce my decision with regard to adjuvant chemptherapy, one way or the other.

Because of the low grade (I) and zero lymph nodes being effected and the ER+, I don't see the benefits of chemo outweighing it potential risks. On the other hand I don't know if the fact that I had 4 tumors or 2 + 1 supposed larger one would make my prognosis worse if I don't do chemo. Plus I am 49 yrs old which is somewhat on the border of age clasiification and am also pre-menopausal.

If you are aware of any studies that deals with cases similar to mine, please let me know. And of course I am very keen on hearing your opion in choosing a course of action.

Any help you can give, would be greatly appreciated. I really don't want to go for chemo for just perhaps 5%-7% gain.

Thanks so much for your help.

flash

there is a study that was done on multifocal, multicentric cancer that suggested it is understaged and appears to be under treated.  Everyone has to do what is right for them.  Personally, I chose to throw the book at mine. I will try to find the study for you.

flash

Journal of Clinical Oncology, Vol 23, No 30 (October 20), 2005: pp. 7497-7502
© 2005 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2005.02.1147

this was just the first one when i googled multifocal multicentric cancer staging