Is chemo in my future?

jj3000

28y/o recently diagnosed with multifocal IDC in R breast, BRVA neg, strongly ER/PR positive, HER2 neg, well differentiated cells, low Ki67. Largest lesion approx 1cm and no lymphovascular invasion on core biopsy. About to undergo single mastectomy/recon with sentinal node dissection. Fellow breast is clean.

Let's say my pathology still shows the above and my nodes are negative. I know I'll be prescribed tamoxifen for 5-10 years. I'm not sure about ovarian suppression meds. Chemo scares me to death and I'd like to avoid it if possible. Do you think I'll be able to avoid it? The data is very mixed for people in my situation - with favorable characteristics but being so young.

inks

Oncotype or Mammaprint test after your surgery should be a good indicator for needing chemo or not. However being multifocal it may be hard to get them to test all the tumors if there is more than 3 because of the cost. I had 18 lesions so oncotype was not an option. Your diagnosis is not really final until after surgery, a lot of people get either upstaged or downstaged. Try to be ready for either option and keep an open mind. It would be worse if you get all ready for no chemo and something changes, you might get depressed and all that. Prepare for the worst, hope for the best.

LALady25

Hi jj3000,

I am 27 years old and was diagnosed in August. Had a unilateral mx in October, and my doctors had the Oncotype and Mammaprint tests ordered for me. If your nodes are clear after surgery, they'll be able to run the Oncotype DX on you. My doctor had me participate in a clinical trial called PROMIS (http://www.agendia.com/pages/promis/522.php) because I came back with an intermediate Oncotype recurrence score of 20. After running the Mammaprint, I came back as Low Risk, so chemo is no longer in the plans for me.

Most of the time, cancer is more aggressive in younger women. But that's MOST. I happened to have a slow growing tumor and cancer type (mucinous), so despite my age, chemo is shown to have negative to no benefit.

Oncearunneralwaysarunner

Hi jj3000,

I'm 31 and was diagnosed in June of this year. You seem to have a good understanding of your specific situation and have thought of the questions to ask your oncologist to make the best decision for you and your family. I can't answer if you will be able to avoid chemo but wanted to share my experience to hopefully help with the fears you have about chemo. I probably had very similar fears.

Having or not having chemo for me was not really an option, I had locally advanced IDC with lymph node involvement. Due to that it was recommended that I have chemo before surgery to shrink the tumours and prevent any spread. I had my last chemo treatment on Halloween. I'll be honest that it was not the most pleasant18 weeks of my life but it was not as bad as I feared. Each chemo drug has different side effects, different people will be prescribed different drugs, and everyone reacts to them differently. The worst side effects that I had were fatigue, to the point that I would sleep for about 7 days straight after a treatment. I had a bit of nausea but had some excellent meds to control them and these kept being adjusted to get to the point of not having nausea. I had two different sets of chemo drugs and had different side effects for each. I had some muscle and bone aches as well but these were well controlled with Advil and Tylenol. I also had about a week and a half of feeling pretty much normal between treatments, I had treatments every three weeks.

I hope that helps address some of your fears. If you have chemo, know that you can get through it.

edwards750

LALady - I had the Oncotype test done too. I did have node involvement although it was a micromet and in fact my BS said they had to dissect and re-dissect to find it but I am glad they did. My ONC ordered the test and Genomic Labs who performed the tests on my tumor said because the met was so tiny it was considered node-negative. Also, from what I have read they are now allowing Oncotype tests to be done on BC with node involvement. My test came back with a score of 11; non-aggressive cancer and a smaller tumor than first thought. These tests and the path report wont be performed until after surgery. diane

jj3000

update after mastectomy and sentinel lymph node multiple scattered foci 0.1-1.1cm; some are infiltrating mixed moderately differentiated duct and tubulolobular carcinoma, others are infiltrating tubulolobular or moderately differentiated ductal carcinoma with mucinous features; Lymph nodes clean, still ER/PR positive and neg HER2

pupmom

I have had to post this over and over again on BCO, BUT, one can have up to 3 positive nodes and still get the Oncotype DX test. I got it with 2 positive nodes. My score came back 14 and I have not had chemo. I also had no LVI and an extremely low Ki67. Your young age though may necessitate chemo. BC tends to be more aggressive when young. Best wishes!

FairyDogMother

I would go for the mammaprint. I did the Oncotype it came back with a low reoccurrence while the mammaprint came back for me to take chemo. Mammaprint has a better set for people under 40.