Progesterone negative stage 1b IDC

Brooklinemon

I'm hoping for some advice about two different treatment recommendations. I was diagnosed with stage 1b IDC, micro met to sentinel lymph node, all other nodes clean. Strongly estrogen positive (>95%) but progesterone negative (<1%). HER2/neu negative, too. Grade 2, mitosis score 1 but no Ki67 test results. Oncotype score 23. Primary tumor is 1cm. One onc suggests tam only, says stage 1b cancer not likely to be responsive to chemo. Second onc recommends chemo based on progesterone negative status and oncotype score. Suspects luminal B, though tumor does not seem have a high proliferation rate or high grade. Don't want to have chemo if it's not likely to have any effect, but also don't want to have just tam if chemo likely to have greater effect (if this were luminal b). Also, second synchronous primary, .9cm, estrogen + (>95%) and progesterone positive (20%) and HER/neu negative, too. That one was grade 1, mitosis score 1, too. Would appreciate your thoughts.

inks

You are definitely in the grey zone with grade 2, Oncotype and a micromet. In order to make your decision you should involve some other factors too. Were you just multifocal or were you both multicentric and multifocal? What is your age? It is known that sometimes the only benefit from chemo is menopause, so you could look into ovarian supression either with tamoxifen or an AI. Would a milder chemo be an option? Will you get radiation for the micromet in lymphnode? It's a tough descision and either way there are no guarantees.

voraciousreader

Have your case presented to a tumor board.

I wish you well.

Brooklinemon

thanks, inks. I am 54, post menopausal, alnd, bmx, so no rads indicated (on this, the once agreed). Multifocal. Central/lower inner quadrant (8 and 9 o'clock) of left breast. Yes, mix of "better" and "worse" stats. Truly grey. Maybe that's why the recommendations of on a differ so radically. Still, don't want to get this wrong -- one way or the other.

Brooklinemon

thanks, voracious reader. I may need to do that.

Brooklinemon

correction. Though in the same quadrant (arguably), judged to be multicentric, due to diff. Characteristics of 2nd tumor (grade 1 vs. 2, PR+ 20%).

inks

If you were 75 it would be an easy decisions to skip chemo and go straight to Tamoxifen but even your age makes it tricky.