high grade DCIS: ER/PR-

jadeblue

Just came back from the oncologist and learned that my biopsy sample tested ER/PR negative. Also, the preliminary report listed the DCIS as grade 2-3, but the follow-up says 3 with comedo necrosis.

I'm scheduling a lumpectomy for next week because I want them to get it out and let them run the full pathology. All of these "snapshot overviews" are kind of killing me. I'm doing BRCA testing too, but not postponing surgery for the 3+ weeks it will take to get insurance approval and wait for results.

Today's questions:  I understand ER/PR- is less treatable (no Tamoxifen) and more aggressive/more closely linked to invasive cancers than ER/PR+. They also said that hormone receptors might still be discovered in post-excision biopsy. How common is that? Would that change the ER/PR status, or can there be a mix of ER/PR + and -? Also, can someone explain HER2 status? I have not been informed of that and don't understand what it is.

Thanks, all.  I so appreciate the time you take to give me thoughtful answers to my many millions of questions. -Jade

redsox

They also said that hormone receptors might still be discovered in post-excision biopsy. How common is that? Would that change the ER/PR status, or can there be a mix of ER/PR + and -?

If they find hormone receptors in the lumpectomy specimen that would change the ER/PR status.  Those are reported as % positive and they call it positive with any % positive.  It does lead to the question of how much good tamoxifen would really do if the % positive is very low -- not my issue as mine was highly positive both ER and PR. 

Also, can someone explain HER2 status? I have not been informed of that and don't understand what it is.

According to this website: 

http://www.mayoclinic.org/news2010/5743.html?rss-feedid=1

HER2-positive breast cancer is a breast cancer that tests positive for a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells. In about 1 of every 5 breast cancers, the cancer cells make an excess of HER2 due to a gene mutation.

It is not clear that HER2 results mean much with pure DCIS.  Invasive breast cancer that is HER2 positive can be treated with herceptin but DCIS is not. 

Those test results may take longer to be reported.

Beesie

jadeblue,

There is an older discussion thread in this forum about DCIS and HER2 status that just recently was reactivated with some new posts.  Here's the link: DCIS and HER2+    

To net it out, at this point in time HER2 status is not considered to be a factor in the treatment or prognosis of DCIS.  There are three (at least) reasons for this: 1)There is no real understanding of what it means if DCIS is HER2+; 2) it appears that HER2 status may change as DCIS progresses to become invasive (possibly making the HER2 status of DCIS irrelevant); and 3) there is no difference in treatment for those who have DCIS that is HER2+.