LowOnco+Micormet=Chemo?

ASW

Chemo or not chemo? Been diagnosed with IDC. Lumpectomy removed a 1.7 cm tumor and sentinel node biopsy shows 0.25 mm micromets in one of 3 sentinel nodes - I was classified as Stage I.c.  Tumor was strongly ER & PR+, HER2- , Grade 1, Ki67 at a low 4 (meaning, I guess, slow multiplying cells).  Oncotype DX test came at 10.  Had I not had the micromets, it would have been a no brainer: no chemo. Onco test is based on solid data for node negative and says no benefit from chemo.  Newer and not as conclusive data on post-menopausal node positive (up to 3) also says no benefit from chemo. No data for micromets - no agreement in the scientific community if same as node positive or not.  And, I'm 50 but still premenopausal.  Oncologist friend and my own onco say don't think chemo will do much good but studies are still inconclusive and other experts disagree.  My onco offers taxotere/cytoxen X4 (which he says is the mildest form) and thinks I'll come fine through chemo.  I want to look back and feel I've done everything I can, but I don't want to put my body through hell and risk muscle and bone pain for the rest of my life if it won't do any good (I'm very, very active in the outdoors).  Any experiences, both with similar diagnosis and dilemma or effects of similar chemo treatment would be appreciated.  Thank you.

GetSparky

My sister has nearly the exact same stats...IDC, Stage 2, Grade 2, 1/3 nodes, ER+/PR+, HER2-, oncotype 14.  I believe her one positive node was .4mm micromets.  She just saw the oncologist who is not recommending chemo.  He said there is a big debate amongst oncologists these days about the effectiveness of chemo with 1 positive node but such a low oncotype score.  He discussed her case with all his colleauges and they unanimously agreed that chemo would have minimal benefit, so none of them recommended it.  Good luck!!

mdg

I don't have the same diagnosis but I had to decide on chemo. My stats are below.   I was 45 last year at diagnosis and had an oncotype score of 17.  I had LVI present in my tumor and it was 1.4cm with clear nodes.  One onc said no on chemo.  The other onc said I would benefit.  I had to decide....that was a hard decision.  I chose chemo for a few reasons.  First of all my son was only 4 at the time and I wanted to do EVERYTHING possible to beat this.  I had LVI...that was concerning to me even though nodes were clear.  I had a BLMX so I was already treating myself aggressively so why not chemo?  I am also strongly ER/PR+ and HER2-.  I knew I would be given Tamoxifen but I was worried  - what if I couldn't tolerate it for some reason?  Then I would kick myself from not doing chemo.  I did TCx4 and did pretty well.  I used cold caps to keep my hair.  I finished chemo in May and am doing great.  It's a hard decision but just remember there is only one right answer....that is the right answer for YOU personally.  Best of luck!

coraleliz

I was 52 & premeno at diagnosis. 2 positive nodes(not micromets). Oncotype of 4. I was told that I needed to decide for myself. My MO said he was bias........Anyway I chose no chemo. I took my time making that decision.

WaveWhisperer

ASW, I'm right there along with you. I had lumpectomy, 1.1 cm tumor, 1 positive node out of 3 taken with micromets, ER+, PR+, HER2-. I'm considered stage 1b.  I'm post-menopausal, though. I find out tomorrow what the medical oncologist recommends -- chemo and then radiation or just radiation. Let me know what you end up deciding. Sounds as if there's a debate about what to do with us "one positive node" women. Also, does anyone have links to any of these studies about the pros and cons of various treatments for us one-noders?

Thanks, and good luck, ASW! 

Elizabeth1889

ASW, I had a 1cm tumor, Grade 1 with one positive node, but it was a macromet.  My BS, MO, and I all agreed I should have chemo.  I did four rounds of TC and tolerated it well.  Like my MO said at the end, "Your blood counts are none the worse for wear for having done chemo."  Having chemo is a personal decision and you never truly know if you have done the right thing.  I just remember my MO saying that if BC reached a lymph node, it could be lurking anywhere.  I was 59 years old and otherwise healthy.  I wanted to hit BC with every weapon possible.  Good luck with your decision.

moneeme

My stats are exacty the same as yours but I did not have the Oncotype type. My onc recommended TCx4. I thought it was overkill, but because the onc wanted me to have it, my husband was insistant on it. My white blood count never bounced back and it sits between 3.0 and 3.4. That was three years ago. I feel ok. The surgery I had bothers me more. And I do get sick a little more often, but nothing bad. Go with your gut. That is what I would have done if I was on my own.

coraleliz

moneme-My WBC count is the same as yours most of the time. I think I've only had it tested above 4.0 once. My understanding of "normal" range is that 90% of people will be "normal". that leaves 10% outside of range. The bell shape curve thing. I never did chemo.

ASW

Thank you for your responses ladies. After getting a second and third opinion, I've decided to skip chemotherapy.  None of the oncologists thought chemo will be helpful given the make up of my tumor and low oncotype DX values - and even if it did, best case scenario was put at 1-2% benefit.  It was nevertheless offered to me if it would make me feel better.  As I was going through this process, it made me angry to hear - "it is a personal decision" - Was hoping science was a bit more certain than that - but it isn't.  This is a growing opportunity - at age 50, it finally dawns on me that no matter how much one tries to control things, one really can't.  This is true whether or not you've been diagnosed with cancer.  The diagnosis makes it a bit more real.  So you do the best you can and face the future with hope and a smile.  Cheers girls!  I'm not a cancer surviver - I'm a cancer thriver!!!

ASW

Oh - one more thing.  In the middle of my indecision on treatment, a good friend gave me a book called "Your Medical MInd - How to Decide What is Right for You" by Groopman and Hartzband.  It didn't give me an answer but helped me understand how I make decisions and what decision I could in the end live with.  I highly recommend it.  ASW

Miles2Go

Hi, I'm a "thriver" too!!!  I think your choice is appropriate based on your diagnosis and pathology.  See my profile. I'm a bit more a risk; however, other than ILC I'm in good health~active and working at 72. OxnotypeDX # is 17 (just inside low).  I am passing on radiation, anti-hormone therapy, and chemotherapy.  Side-effects are simply not worth the risk for me~as it IS a personal decision, because it's personally up to all of us to do our homework, roll the dice based on our own wisdom, skip second-guessing and thrive.  With joie de vivre, Colorado Morning Glory

coraleliz

Glad to hear you reached your decision! It didn't really sink in that I wasn't doing chemo until my first day on the RADs table. Off to RADs for you?