How large does Tumor gets chemo and herceptin

Hindsfeet

VR....final words...My school, Christian School, sent out a prayer request for my upcoming BC surgery. In the past I've kept it quiet...but for a few close friends who knew. It was nice because after the mx, they brought over meals, and so much more. I haven't been on the receiving side so it was indeed a different experience...humbling, but appreciate the support of so many good friends.

I live in an area where alternative and holistic is preferrable...the great N.W. Even a lot of the medical professionals here are alternative supportive.

Another comment in regard to "read the threads here and see all who are surviving"...actually,one of the reasons, I fear tamoxifen, rads and chemo. I see how so many of them are struggling, and the pain they have been through. I know there are a few who stay here on bco who continue to do well...but too many others, who shared side effects have scared me away from it.

I feel tried. I guess I'm getting tired of explaining myself and having to defend my choices and etc. After reading your post VR...although you are a very supportive to those going through BC, I realize, not so much you, but others here too, who do not consider everything in my health that needs to be taken into consideration before "standard" treatment is administered. 

Hope the best to all of you. ((((hugs)))) Evebarry 

voraciousreader

Eve... You may recall my niece is a medical oncologist and did her residency and several years of practicing in Portland! I know exactly what you are talking about! I am sorry that she has moved on to Denver... Otherwise I would have had you get in touch with her...



I hope you get all your questions answered fully. I would hate to see you make a decision as important as this when you are confused. Furthermore, once you receive answers, perhaps you will have a change of heart.



Without a doubt it can be comforting to be enveloped by folks who are concerned for you. But Eve, at the end of the day, no one should be angry with your treatment decisions. Everyone should support your decision....



I

bluedasher

Bessie, regarding your 3), the MD Anderson study wasn't looking at all stage I. They looked only at tumors less than 1 cm without chemo and  the HER2+ group in that study had 77.1% 5 year disease free survival so about 23% recurrence. The 95% confidence interval was 67% to 84.5% (i.e. if one gets that result looking at a random group of that size, the real probability of recurrence is probably somewhere between 15  and 33%).

In the article that VR posted, they also said that they didn't see a significant difference in recurrence rate between the T1a and T1b HER2+ tumors. With these small tumors, your logic of twice the number of cells meaning it is more likely that some have gone beyond the breast doesn't seem to hold true. Perhaps that is because the women also had cancer cells in varying amounts of non-invasive tumors (e.g. a combination of DCIS and IDC). Or perhaps something is happening when the cancer goes from non-invasive to invasive that sometimes means that the cells go wondering.

Beesie

bluedasher, the results you quoted are correct but you have misinterpreted what I was saying. As you said, the study that VR quoted shows that "The 5-year recurrence-free survival was 77.1% and 93.7% in patients with HER2-positive and HER2-negative tumors, respectively"  Note that they are referring to "recurrence-free survival" which therefore includes both local recurrence and distant recurrence.  

The comment made here (more than once) that I challenged was that there is "a 25% chance of the HER2+ cancer spreading through the blood without lymph node involvement....when first undergoing staging, there is a 25% chance that BC will be found outside the breast with no involved lymph nodes." This refers specifically to distant recurrence.  So here is the next sentence in the study report, which refers to this: "The 5-year distant recurrence-free survival was 86.4% and 97.2% in the 2 patient groups."  So this says that for those with HER2+ tumors that are less than 1cm in size, the risk of distant recurrence (over 5 years) is 13.6% - not 25%.

http://www.medscape.com/viewarticle/585328 

I understand that all HER2+ cancer are more aggressive than non-HER2+ cancers, whatever the size. That is what these studies are telling us. I also agree with VR that treatment standards for smaller HER2+ cancers (including T1a tumors) are likely to become more aggressive in the future as more data about these small HER2+ tumors becomes available. These recent studies certainly suggest that even small HER2+ can be concerning, particularly as compared to HER2- cancers of the same size.

However while I understand all that, what I don't see anywhere in these studies is any statement that says that the distant recurrence risk for a T1a HER2+ tumor is the same as the distant recurrence risk for a T1b HER2+ tumor. (If I missed that, I would appreciate someone pointing it out.) The studies in fact seem to group all patients with T1a and T1b (i.e. 1cm or smaller) tumors together, and therefore they draw their conclusions for this group as a whole.  But saying that those with T1a/b HER2+ tumors face a greater risk than previously understood and saying that T1a/b HER2+ patients may need to consider treatments such as chemo and Herceptin, is not the same as saying that the risk is the same for those with T1a and T1b tumors.  The studies have simply grouped both sizes of tumors together to reach a single conclusion; they have not compared the results of each group and determined that they are the same.

I have tried to see if I can find any studies that actually compare HER2+ T1a and T1b tumors. The study linked below did group the two tumor sizes together however they reference the results for the T1a tumors, as well as providing total results.  Therefore, by subtracting the T1a numbers from the total numbers, it leaves the results for the T1b tumors.  Here's the finding (over a 41 month follow-up period):

- HER2 T1a tumors:  3 recurrences among 36 patients who did not receive Herceptin & chemo, therefore an 8.3% recurrence risk.

- HER2 T1b tumors: 9 recurrences among 76 patients who did not receive Herceptin & chemo, therefore an 11.8% recurrence risk.  This is 42% higher rate of recurrence.  I don't know if the results are statistically significant - they possibly aren't due to the small sample size.

http://www.abstracts2view.com/sabcs11/viewp.php?nu=P2-18-03 

So back to my earlier point, it is my understanding that, all other factors being equal (grade, ER status, PR status, HER2 status, etc.), a larger tumor will present a greater risk.  

bluedasher

Bessie -

Quotes from the article that VR posted in the second to last post on the first page of this thread:

"There was no significant difference in the risk of recurrence or distant recurrence in patients with Stage TIb vs Stage TIa disease."

and

"The M. D. Anderson study, which showed no significant difference in recurrence rates between women with Stage TIa and TIb HER2-positive tumors, suggests that even the smallest tumors may benefit from trastuzumab, Dr. Rakkhit said."

I haven't seen the numbers published - I'm just going by those statements. 

They did show the DFS survival and Distant Recurrence Free Survival for the whole group in the San Antonio poster. 

It was (95% confidence interval in parenthesis):

DFS for all patients in the study:

1a     92.5% (88.9%, 94.9%)

Ib      91.8% (89.3, 93.8%)

Distant recurrence  Free Survival

1a   96.6%   (93.8%, 98.2%)

1b   95.9%  (94%, 97.3%)

In both cases, while there is a small advantage in the actual number for Ia vs Ib, there is  considerable overlap in the confidence intervals - the difference might be random variation. I wish they had broken out the numbers for the two parts of the HER2+ group so that we could compare for ourselves and to see if those were closer than for the whole group, but they didn't.

I understand that as tumors get larger, the risk that they have spread gets greater if all other factors are equal. But it is possible that the difference between a T1a and a T1b tumor isn't enough for that to be a significant factor and other variations may overwhelm it. 

orange1

No statistically significant difference between recurrence rate of T1a and T1b does NOT mean that the recurrence rates are similar.  It means in the population studied, that a statistically significant difference wasn't demonstrated with 95% confidence.  There could still be a real (even statistically significant difference) in the recurrence rate in  the overall population of Her2+ T1a and T1b tumors - it may just be a matter of doing a larger study.  Due to huge variation, with a sample size of < 100 women, its pretty hard to demonstrate a difference unless the difference was huge.

Beesie

bluedasher, thank you!  I read VR's posts on this page and the previous page but I missed the one that you referenced. I too really wish that we had the raw data because it's hard to know what's actually going on without having the data.  Saying that there was "no significant difference" means only that there was no difference that was certain at a 95% level. So maybe there really was no difference at all, or maybe there was a difference but it was only significant at the 80% level (just as an example).

Looking at the numbers quoted, part of the issue may be sample size.  It's mentioned that there were 965 patients, of whom 10% were HER2+ - let's say that's 96 women.  Of those, 2/3s had T1a tumors and 1/3 has T1b tumors.  So that's roughly 63 patients with T1a tumors and 33 patients with T1b tumors.  

Of the 96 women who were HER2+, 77% were recurrence-free and 86% were distant recurrence-free over 5 years. Personally I don't think that the recurrence-free numbers are relevant to this discussion because that includes local recurrence. Tumor size may be a bit of a factor in local recurrence but other factors such as margin size are much more critical.  So it's only the 14% who had a distant recurrence - approx. 13 women out of the 96 - that's relevant to the question as to whether tumor size makes a difference or not.  So it's all a question of how that small group of 13 women was split between the T1a and T1b tumors.  

I pulled up a statistical significance calculator, and discovered that with the sample size split the way it is between T1a and T1b tumors, you need some pretty extreme results in order to reach the 95% statistical significance level. For example, if only 6 of the 63 T1a women had a distant recurrence (9.5%) while 7 of the 33 T1b women had a distant recurrence (21.2%), the results would only be 89% significant and therefore the conclusion would be that there was no significant difference in the risk of distant recurrence in patients with Stage TIb vs Stage TIa disease.  We only reach the 95% statistical significance level when no more than 5 of the T1a women (7.9%) and no fewer than 8 of the T1b women (24.2%) have a distant recurrence.  So to me this suggests that the statement that there was no statistically significant difference between the T1a and T1b results really holds no meaning, given the small sample size in this study. 

The other important point is that the study did not distinguish between other important factors such as grade and ER/PR status.  I understand that a larger lower grade ER+/PR+ tumor might present less risk than a smaller high grade ER-/PR- tumor - even if both are HER2+.  In this study (and most of the studies discussed here) all those other factors were blended together so there is really no way to measure the effect of tumor size, in isolation of everything else.  

There has been a lot of discussion in this thread that seems to suggest that all HER2+ tumors present an equal risk, regardless of size. People have presented "average" risk numbers and suggested that they apply to someone who has a smaller than average tumor. I believe that this is misleading and wrong.  I was not suggesting that other factors such as grade and ER/PR status are not also important, nor was I suggesting that tumor size is a more important than any of these other factors. What I simply was saying is that when all other factors are equal, the bigger the tumor, the greater the risk.

orange1, just saw your post as I was reviewing mine.  We are thinking the same thing! 

suzieq60

Ladies - I've posted this study before and still find it very interesting. It may be helpful to ccjj - the original poster. A lot of us HER2+ve girls who had chemo/herceptin were very happy to read this when it was first posted on this site.

http://jco.ascopubs.org/content/28/28/e541

voraciousreader

Susieq58...Thanks for posting the letter to the editior indicating these authors retrospective analysis of T1a and T1b HER2 + tumors.  IMHO the most important paragraphs are the following:

"In addition to the retrospective                     nature of our study, other limits are the small number of patients and the short follow-up, which may have led to an underestimation                     of the benefit of trastuzumab-based therapy. As chemotherapy was associated with trastuzumab in most occurrences, it is difficult                     to ascertain the respective impact of each therapy. However, our results are strikingly close to those presented by McArthur                     et al¹³ at the 2009 ASCO breast meeting.                 

Adjuvant trastuzumab combined with chemotherapy is now a standard of care for HER2-positive breast tumors that exceed 1 cm                     and/or pN+. We believe it should also be considered for T1ab, pN0, HER2-positive tumors, especially in the presence of other                     poor prognosis factors (ie, high grade, high MI or HR negative). Of course, the incremental gain in absolute benefit observed                     by adding trastuzumab-based therapy in this series cannot be predicted, and long-term toxicities should be carefully considered                     on an individual basis during the decision-making process. As trastuzumab has proven its efficacy in the adjuvant setting                     exclusively when combined with chemotherapy,^5-10 we would recommend the administration of adjuvant trastuzumab along with chemotherapy when considered. We also propose that                     patients with T1ab, pN0, HER2-positive breast tumors have access to current adjuvant trials of HER2-targeted agents."

It is important to note that THIS study was a retrospective analysis of patients. The downside of the study was that they were NOT able to base their conclusions on clinical trials and that the sample populations in the studies were very small.     The researchers all would welcome a clinical trial  to answer the question as to whether or not the benefits of aggressive treatment for very small HER2+ tumors would outweigh the risks.  Again, it seems that in retrospective analysis, the answer is there.  With the latest Lancet study, I think it is just a question of time before the NCCN guidelines will be updated WITH A FOOTNOTE because the level of evidence is NOT as certain as it would be had there been a clinical trial.     

bluedasher

Susieq, While I was really happy to see that letter when I first skimmed it - especially the graph with the flat 100% line for those who received Herceptin, the short follow up period (25 months median) makes the results not terribly useful. Is Herceptin preventing or merely delaying recurrences? Only 11 Herceptin treated cases had 3 years of follow up and only 2 had 4 years.

In BCIRG, with over 600 node negative cases (with larger tumors) getting Herceptin, almost no recurrences had occurred by 24 months of follow up and DFS at 5 years was 93% for AC-TH and 90% for TCH. If one looked at only 11 of those cases at 3 years or 2 cases at 4 years in that study, one would be likely to see zero recurrences too (if DFS was 94% and one randomly chose 11 cases there would be a 50% probability of finding 100% DFS).

I'd like to see at least 5 year follow-up numbers but Herceptin hasn't been given for women with such small tumors for long enough to build up that data I guess.

suzieq60

I know that the study didn't have many patients, but we all loved that flat line when we saw it.

AlaskaAngel

Well, it would also be more honest if they put a footnote indicating that they don't have information as to what effect or how much effect is due to the addition of chemotherapy, also.

A.A.

orange1

AA -

From large studies we know that:

For Her2+ breast cancer, chemo without herceptin cuts recurrence risk approximately in half.  Add Herceptin, and recurrence is cut approximately in half again.

So perhaps they should put a footnote in saying half the effect was from chemo?

Beesie

orange1, good point!  But shouldn't it say that 67% of the risk reduction was from chemo?

If someone starts out with a 28% risk, chemo cuts that risk in half to 14% and Herceptin cuts it in half again to 7%, the total reduction in risk is 21 percentage points (75% risk reduction!), of which chemo provided 14 of those percentage points - 67%.

Not making a statement here, just following up on the math!  

AlaskaAngel

Orange1,

I can see how easy it would be to take that point of view with numbers.

But since we don't yet know whether trastuzumab alone used on a system that has not had the effect of severe depression of the immune system through chemo may actually be enough for very early stage HER2 positive aggressive cancer all by itself (since we only have other studies of use of H used alone with higher-risk patients), or whether it would be 100% adequate for early stage HER2 positive HR+ bc in combination with hormonal therapy, we can't just arbitrarily assume we know whether any chemo or how much other therapy would be needed.

A.A.

bluedasher

AA and orange,

first off, they only have two years of follow-up on half the Herception group in that study. That makes the chart pretty meaningless. They carried the line out to 5 years, but they only had two women who had more than 3 years of follow-up in the Herceptin group. In BCIRG 006, the lines for both Herceptin arms in the node negative graph stay pretty horizontal for the first 2 years while the non Herceptin arm starts dropping at 12 months. So it isn't surprising to me that in this group of women with smaller node negative tumors there were no recurrences at 2 years follow-up when Herceptin is given. There aren't enough women who got Herceptin and had follow up past 2 years in this study to tell whether the zero recurrences is because Herceptin delayed or prevented recurrence. I hope that it prevented it but there isn't information here to confirm that.

secondly, in that study, some of the non-Herceptin group did have chemo. They mention that one of the 5 recurrences in the non-Herceptin group had had chemo. They don't mention what proportion of that group had chemo. 

thirdly, it isn't clear that the effect of chemo or Herceptin or the combination of them scales the same independent of how far along the cancer was. For example, in BCIRG 006, adding Herceptin to AC-T cut recurrence by about half in the node negative group but by about 1/3 in the node positive group. And even with such a large sample (~3000 in the study with about 300 node negative and 750 node posititive in each arm), the confidence intervals on the hazard ratios are still pretty broad. For example, when node negative DFS was improved by about half, the 95% confidence interval was 0.28 to 0.77 - anywhere between cutting recurrence by 1/4 to 3/4. Effect of chemo and Herceptin has been studied so little on node negative tumors >1cm that IMO there is no support for saying how much Herceptin improves odds compared chemo alone.

Also, even if one knows that chemo plus Herceptin cut recurrence by x and chemo alone cut it by y, there is no way to use x and y to figure out that Herceptin alone would kill z. There can be cancer cells that Herceptin kills without help and cancer cells that chemo kills without help, an unknown overlap between those two sets and some cancers that only the synergistic effect of chemo plus Herceptin kills.

AlaskaAngel

I don't disagree with that. At all.

A.A.

orange1

Thanks Beesie!  I never remember to check my math. 

Anonymous

There is no rubber stamp, one size fits all treatment for any type of breast cancer. 

Age of the patient is a huge factor in what combination of treatments is recommended.

Comorbidities are another huge factor in treatment decisions.

Heart disease is the leading cause of death in women over 40, so the cardiac risks associated with Herceptin may become a much larger factor as a woman ages.

No matter how well you think you know another person, there may be factors in their health history or their family history that you may not be aware of that may significantly influence treatment choices.

There is no treatment that will guarantee a successful outcome.  When one becomes available, the word "cure" will be used, until then, we do the best we can to make the best choices for our particular circumstances.

To the original poster - the standard approach is for a medical oncologist to prescribe the AI that seems to be the anticipated treatment for your step mother, but they may be waiting until all surgery is completed before adding that component.  This journey can be overwhelming, and sometimes time is needed to deal with one issue before moving on to the next.  Wishing you all the best as you search for the best possible outcome.

gsg

My aunt was just diagnosed IDC Triple Positive, Grade 2, 8 mm.  Her breast surgeon said she would not get chemo nor Herceptin, just lumpectomy, radiation, Arimidex because tumor is so small.  I asked her to make an appointment with an oncologist for another opinion. She saw her today.  Guess what.  Lumpectomy, TCH and then radiation and Arimidex.  Would definitely advise people to see an oncologist on their own and not take the word of the breast surgeon.  They're not oncologists.

I also just sent my aunt a link to this thread, so you may have a new sister joining you!  Bonus:  She's hysterical.

Best wishes to you all.

lago

gsg Do send your aunt over to these threads:

 taxotere,carboplatin and herceptin  and TRIPLE POSITIVE GROUP 

Let her know she won't possibly be able to read the entire thread but it's worth a skim. Introduce herself and start asking questions. The gals on those threads are awesome.

dancetrancer

Beesie wrote:   "HER2 T1a tumors: 3 recurrences among 36 patients who did not receive Herceptin & chemo, therefore an 8.3% recurrence risk."

Beesie, I just looked at this study.  The follow-up is at 41 months (3.4 years).  How do you evaluate how bad this 8.3% recurrence risk over 3.4 years is?   I mean, how do you know if this risk is high enough to warrant the risk of chemo/TZM?  I don't know how to weigh it.  Does this risk get higher as time goes on, or does it get less?  (BTW, it is duly noted that the small sample size indicates these numbers may not be statistically significant or accurate.) 

bluedasher

Dancetracer, the risk will go up as time goes on as the numbers are tracked cumulatively. Once 8.3% have had recurrences, their recurrences can't unhappen so the number can only go up. HER2+ tumors tend to be aggressive and grow relatively quickly so recurrences tend to happen (really to be found - something has to get big enough to be found) sooner rather than later.

In the MD Anderson retrospective study, it looks like most of the HER2+ recurrences happened in the first 3 and a half years. The line for DFS has dropped below 80% at that point, It gets down to 77% by 5 years so a few more percent happen later. What I can't tell is whether the T1a's are the late occurences - it seems logical for the tumors that start smaller to take longer for a recurrence. 

I think that the best one can say at this point is that your risk of recurrence is probably somewhere between that 8.3% and the 23% in the MD Anderson study. The studies are so small.  

AlaskaAngel

What I would want to know is, what percentage of those who recurred were within 5 years older or younger than my age, and what percentage had the same HR status as I did (within 5 years older or younger than my age). If a huge percentage of them were much younger than me (farther from natural menopause), or had hormonal status that was less favorable than mine, it might help in deciding about treatment.

A.A.

Beesie

dancetrancer, 

You asked:  "How do you evaluate how bad this 8.3% recurrence risk over 3.4 years is? I mean, how do you know if this risk is high enough to warrant the risk of chemo/TZM? "

My understanding, as bluedasher points out, is that most recurrences of HER2+ BC occur within the first few years.  If I'm interpreting correctly, bluedasher is saying that the MD Anderson study suggested that 80% of recurrences were within the first 3 1/2 years.  If that's correct, that would mean that a 8.3% recurrence rate over 3.4 years probably equates to a 10% - 11% recurrence rate overall. 

Is that enough to warrant the risk of chemo/TZM?  What's "enough" is different for everyone, based on how we see risk.  For me, the question would be "what percent of those recurrences were distant recurrences?"  There are other ways to deal with the risk of a local recurrence, and frankly, after a MX the risk of local recurrence is likely to be very low.  But a distant recurrence is what you really want to avoid and that's the reason why women take chemo/TMZ.  Personally I'd be okay with a reasonably high risk of local recurrence before I'd subject myself to the risks of a treatment (depending of course on what those risks are) but I'd be willing to expose myself to quite a bit of risk from a treatment if it meant even a relatively small reduction in my distant recurrence risk.  

To the data that is being discussed, I want to point out again that the MD Anderson study that showed the 22.9% 5-year recurrence risk included both local and distant recurrence and both T1a and T1b tumors.  So it's not a clean comparison to the study that shows the 8.4% recurrence rate for T1a tumors only over 3.4 years.  Unfortunately I haven't been able to locate the numbers for distant recurrence risk only for this second study (the study is so small that I suspect the numbers wouldn't be meaningful anyway) but for the MD Anderson study, the 5-year distant recurrence rate for the T1a and T1b tumors was 13.6% - quite a bit lower that the "23%" or "25%" (rounded up) numbers for total recurrence that continue to be quoted here. Truthfully, for me, a 13.6% distant recurrence risk would be plenty to warrant chemo/TMZ; similarly, if I had a T1b tumor, for me the decision would be an easy one.  With a T1a tumor I'd be in the same quandary that you are in because the question that doesn't seem to have an answer is "what is the distant recurrence rate for HER2+ T1a tumors?" 

bluedasher

Bessie, you misunderstood what I said. The MD Anderson study poster has a chart of disease free survival versus time (as such studies often do). The HER2+ line on that chart is a bit below 80% at 3 and a half years. (It doesn't have grid lines so a bit below 80% is the best I can do.) The table says disease free survival is at 77% at 5 years. So at 3.5 years, around 11% had had recurrences and by 5 years about 2% more had recurrences.

dancetrancer

Thank you so much everyone for the responses and education.  Beesie, you nailed it - that is my exact question - what is the distant recurrence rate for t1A's?  (I agree, I'm MUCH more concerned about a distant recurrence, b/c that is MUCH more scary.)   I just emailed one of the authors of the study to see if he will answer my question on this.  We'll see if I get a response...I've been pretty lucky getting responses from authors when I email them!  (2 for 2 so far!) 

 Has anyone seen this study? (sorry if it's been discussed before)

Age and Survival Estimates in Patients Who Have Node-Negative T1ab Breast Cancer by Breast Cancer Subtype

 Dr. Gonzalez said they use the charts in this study when discussing risk with their T1a and T1b patients, to help decide on whether to go ahead with treatment or not.  I was able to get my hands on the entire article yesterday and am still analyzing it.  They did some type of multivariable model using hazard ratios.  I will only report distant recurrence info as that is what is most concerning to me: 

HER2+ compared to HR+:  4.70, p value < .001

TN compared to HR+:   2.08, p value .039

<= 35 y/o compared  > 50 y/o:  2.60, p value .04

35-50 y/o compared to > 50 y/o:  2.01, p value .008

Grade 3 compared to Grade 1 or 2: 1.00, p value .99

T1b compared to T1a:  1.45, p value .16

Hormonal therapy compared to no hormonal therapy: 1.19, p value .51

I highlighted the areas pertinent to my particular case.  This table required quite a bit of head scratching on my part to figure out, but I think the take home message for me is, that I can say that my age makes a significance difference (not as much as < 35 y/o, but still reaches significance < .05) in increasing my risk and should be an additional factor to consider alongside the HER2+ factor, which we all know of course increases the risk.  The other factors - grade (I'm grade 2) and stage/tumor size (ta1) did not reach significance level and no conclusions about their importance can be drawn from this study, at least. 

Here's an excerpt from the conclusion:

"There is a paucity of data guiding clinicians on how to proceed with patients with small, node-negative breast cancers.  However, as more information regarding these aggressive biological subtypes emerge, planning systemic treatment based on stage alone appears to lead to worse outcomes.  Taking into account aggressive biological subtypes such as TNBC and HER2-positive breast cancers, as well as age at diagnosis, may better aid the patient and clinician in forming an individualized treatment plan.

Several limitations should be considered when interpreting its results.  This is a retrospective single-institution cohort, which lends inherent bias.  Because clinicians may have been biased to treat t1b tumors with aggressive biology, patients who received systemic chemotherapy or TZM therapy were excluded from this cohort.  This may account for the more frequent t1a tumors in this analysis.  However, this may provide further support for the need to consider the higher recurrence risks for these small tumors."   

Feedback from the research gurus here?  I love that you guys love to pick this stuff apart.  Hope someone else is able to get a copy of the full article.  BTW, my hospital has a patient library.  I can call/email the librarian, and she will get me full articles if they are available and email them to me at no charge.  I try to only request really important ones, so I don't do it all the time and lose my privileges.  But just an FYI for anyone else who may be affiliated with a large university hospital - it's a great resource!   

Minnshark

Sorry Bluedasher, my post wasn't clear. I understand the purpose of chemo/radiation and that the type of surgery doesn't impact the chemo decision. The sentiment I was trying to convey is I did a BMX and haven't looked back. Lumpectomy would have required rads and I was not that attached to my breast to keep either one of them. Actually with the discomfort of reconstruction had I have known I wouldn't have done that either.

Kheng

Blue dasher

May I know your age and did you opt for chemotherapy

 What is your chemo drugs?

Is your tumour 7 mm?

I am 60 and may not opt for chemotherapy as William Woods from Sloans Kettering Cancer Centre said that he will not recommend adjuvant therapy for hormones negative, her2 positive, node free , 1 cm tumour , grade 3 survivors

From his study, 98.7% mastectomy survivor has 10 years DFS without adjuvant therapy

goh_sweekheng@Yahoo.com.sg