Breast Cancer Recommendation Question

mitchellde49

My sister-in-law  had surgery on the 28th of Dec.

Here is what we know according to surgeon and oncologist.

Grade 3, Stage 2, 2.8 centimeter, Estrogen Positive, Her2 Negative.

Radioactive dye showed breast drained into 4 lymph nodes so they were removed during the lumpectomy. 2 of the lymph nodes had traces in them. (Axillary Nodes)

Recommedation is Chemo once every 3 weeks for 6 times. With the Estrogen Blocker Pill for 5 years. Followed by Radiation to the breast and lymph node areas.

The percentages given were as follows:

64% recurrence somewhere in the body within 10 yrs if no treatment at all.

35% recurrence somewhere in the body within 10 yrs if estrogen blocker is taken.

25% recurrence somewhere in the body within 10 yrs if chemo and estrogen blocker is taken.

Our question is why put your body through chemo for such a small percentage difference?

Has anyone out there taken only the blocker, and how did they do?

idaho

It is very smart to think of the side effects of chemo for that much gain.  You did not say if your SIL is fairly healthy or not... if I wasn't very healthy I would not do chemo. In fact.. I chose not to do chemo at all.. the difference in stats for me was only 4%.  I did radiation and am taking tamoxifen... almost a year out.  Peace and health to you.  Tami

mitchellde49

I want to take this time to thank both of you for your responses, and apologize for taking so long to do so.

We have been busy with researching and calling trying to get all the info possible for her to make

the right decision for her.

She went today for her PET Scan and Oncotype DX Test.

She will probably make her decision after these.

If you or anyone else has more info to share, please do so .

I believe you can never have too much when it comes to making this kind of decision.

Thank you all once again .

otter

My cancer was Stage I, with an Oncotype DX score of 26.  Based on that score, it was estimated that chemo would reduce my risk of "distant recurrence" (that's the risk of metastatic cancer, not just a local recurrence at the original site) by 5 or 6%. 

Here's how that works:  According to the risk calculations, if I were to take tamoxifen or an AI for 5 years but decline chemo, my risk of distant recurrence would be around 17%.  Add chemo to the mix, and my onco said the risk would go down by about one-third, bringing it to somewhere around 12%.  Not spectacular.  But, remember:  the purpose of chemo is to kill off the cancer cells that might have broken free and wandered off to somewhere else in the body -- bones, lungs, liver, brain.  Things get really grim, once that happens and those metastatic cells start to proliferate.

But, it all depends on a person's risk-taking threshold.  As you've said, what's a big enough gain to justify chemo?  10%? 5%?  2%?

For me, the threshold for accepting chemo was when the estimated benefit (absolute benefit) from chemo was greater than the estimated risk of serious. long-term side effects of the chemo regimen.  If the risk of cardiac problems, or myeloid leukemia, due to chemo, was down around 2 or 3% (or less), then that 5% benefit was sufficient for me. I'd probably have accepted a 4% absolute benefit; anything less would have been doubtful.

So, I decided a 5% benefit was adequate.  I had 4 rounds of Taxotere & Cytoxan (4 treatments, 3 weeks apart) in 2008; and so far, things are going well.  The short-term side effects of chemo are downright ugly; but oncologists have some fantastic ways to keep most of those side effects under control these days.  Except for the part about our hair falling out, as my oncologist noted -- they haven't got that one figured out, yet.

One way to deal with the "chemo/no chemo?" dilemma is to consider the following hypothetical situations, and decide which of them would cause the greatest regret:  declining chemo, and developing metastatic cancer; or going through chemo, and developing metastatic cancer anyway.

I decided I would hate myself if I turned down a possible 5% gain from chemo, and went on to develop metastatic cancer.  On the other hand, if I went ahead with chemo and developed metastatic cancer anyway, at least I wouldn't be kicking myself later.  I would know that I had tried to stop it.  I would not be shaking my head and always wondering if chemo might have killed off those metastatic cells, letting me live the rest of my life cancer-free. 

I wasn't (and I'm not) the type of person to do "everything possible," just for a very small gain.  Chemo does pose real risks to our health, and we need to be aware of those risks.  We shouldn't be terrified of chemo, though.  Tens of thousands of women go through chemo every year, and come out the other side with no regrets.

otter 

weety

I think, too, that you have to remember that percentages are always confusing!  When you wrote that your sister-in-law's risk would go from 35% with the estrogen-blocker alone to 25% if she added chemo into the mix, that is NOT just a straight 10% difference.  Going from 35% chance of recurrence to a 25% chance means that the chemo cuts the risk of recurrence by one-third.  To me, that is not a small difference--that's pretty big to me!  Look at otter's post above to see the same example with the tricky percentages--her risk went from 17% (no chemo) to 12% (with chemo)--that's not a 5% reduction in risk--her risk went down by one-third.