Onco type numbers to change.

ChiSandy

Until the TailoRx data on 11-17 is in--and that data includes women treated with only an AI, sans chemo--the article cited really changes nothing. That German study was flawed in that all the women scoring above 11 got chemo (including in half of them a protocol that is no longer used for women at cardiovascular risk)--there was NO hormone-only control group in the 11-25 range. I refuse to panic, nor to ask for chemo, unless and until TailoRx shows a truly significant intermediate risk in the 11-17 group getting AI alone, or another study similar to the German one emerges with AI-therapy controls in both the <11 and 11-17 (and possibly 18-25) groups.

BarredOwl

Hi ChiSandy:

In my post above, I outlined a number of key differences between the the TAILORx and West German Study Group Phase III PlanB Trial ("WGS Plan B"). As I noted above, in WGS Plan B, all patients with RS = 12 or above received chemotherapy ("CT") and were randomized to receive one of two different chemotherapy regimens under comparison (presumably followed by endocrine therapy):

(a) anthracycline-containing (four cycles of epirubicin/cyclophosphamide followed by four cycles of docetaxel every 3 weeks);

OR

(b) anthracycline-free (six cycles of docetaxel/cyclophosphamide every 3 weeks)

Also as noted above, because all patients scoring 12 or above received chemotherapy, the five-year data for these cohorts does not speak to the question of who may forego chemotherapy.

However, the fact that the study design and study objectives of WGS Plan B are different from those of TailorX does not make it a flawed study. In addition, it is important to note that the authors themselves have not misinterpreted the implications of their findings to date. The 3-yr results were published in a full-length peer-reviewed paper in the Journal of Clinical Oncology, where they expressly stated:

"Our study did not test if there was a chemotherapy benefit compared with endocrine therapy alone in patients with RS [greater than or equal to] 12 . . ."

". . .whereas it is yet unknown if the addition of chemotherapy to endocrine therapy will offer benefit to patients with intermediate RS (RS,12 to 25)."

[Note from BarredOwl: TAILORx defined intermediate risk slightly differently as RS of 11 to 25]

The paper explained the WGS Plan B trial design and objectives:

"PlanB was initiated in 2009 as a chemotherapy trial for comparing anthracycline-containing (four cycles of epirubicin/cyclophosphamide followed by four cycles of docetaxel every 3 weeks) and anthracycline-free (six cycles of docetaxel/cyclophosphamide every 3 weeks) chemotherapy. The trial was based on an observation from a retrospective meta-analysis demonstrating more pronounced benefit from anthracyclines in HER2-positive disease.[20] In August 2009, after inclusion of 274 patients, the PlanB trial was amended to recommend omission of chemotherapy (ie, treatment with endocrine therapy alone) in patients with HR-positive disease with RS [less than or equal to] 11. This cutoff was chosen by the study group on the basis of retrospective evidence from Paik et al,[4] who estimated 10% distant relapse risk as the upper limit of the 95% CI at RS of 11."

The WGS Plan B study also included a large translational component, as explained in the paper:

"Nonetheless, there is still controversy surrounding the progostic impact of adding genomic signatures to centrally measured IHC markers and the use of genomic assays for guiding adjuvant treatment decisions, particularly in Europe, as there are no data from prospective studies where patients have been treated according to the RS results.[5,13]

Improved decision making requires understanding of how to include genomic risk assessment with current prognostic parameters such as nodal status, grade, tumor size, and IHC markers (ie, ER, PR, and Ki-67). However, the latter marker is controversial given the lack of data on optimal Ki-67 measurement method and cutoff[12,14] as well as the substantial interobserver variability in receptor assessment]15-17] and Ki-67 staining.[18,19] In this context, it is relevant to understand to what extent there are substantial differences between central and local assessment.

The goals of the present analysis within the translational research program of the PlanB trial were to prospectively assess risk of recurrence at 3 years in patients with RS [less than or equal to] 11, to compare histologic grade review (performed locally v centrally), to evaluate the association between grade/single IHC–assessed markers (ER, PR, and Ki-67) and RS results focusing on HR-positive breast cancer, and to investigate the prognostic usefulness of these markers and RS, particularly in patients treated by endocrine therapy alone."

While the TAILORx protocol indicates a number of stratification factors (features to be compared), including stratification by planned chemotherapy (taxane containing or not), there is no randomization in any group according to the type of chemotherapy regimen in TAILORx. Yet if some subset of patients were to clearly benefit from chemotherapy, one might then wonder whether the type or strength of chemotherapy regimen makes a difference. For example, is it possible that more potent regimens provide greater benefit in a manner related to Recurrence Score? For those who benefit from chemotherapy, can Recurrence Score also provide information about who may safely choose a gentler regimen? In this regard, future results from the chemotherapy arms of WGS Plan B may be of interest.

BarredOwl

Optimist52

marieB, your sister's low score and then Stage 4 status calls into question (for me) the whole Oncotype DX accuracy. Very worrying.

doxie

Not sure what the recurrence score is for 11, mine was higher. Say that with AIs it is 5 %, still 5 in 100 will get mets. ER+ BC by its nature at any grade carries a risk of mets/stageIV later or at diagnosis. It's the sad reality.

Sunnyone22

"I refuse to panic, nor to ask for chemo, unless and until TailoRx shows a truly significant intermediate risk in the 11-17 group getting AI alone..." (ChiSandy in previous post)

ChiSandy and others:

I have an intermediate Oncotype score (20) and posed this hypothetical to my MO: "If TAILORx results for intermediate are announced later this year and indicate that I should have done chemo, can I do it then?" She told me no, that chemo's effectiveness would not be the same as if it's done right after surgery. Does anyone else have this same understanding?

Fe_Princess

Hi every one, I was told by my surgeon that if I had the mastectomy then I would not need chemo since I was stage IIA, grade 2 and no node involvement. I saw my oncologist and she said I was high risk 36% for recurrence and wanted me to start chemo right away. I asked for an oncotype dx and it came back 16 so I did not get any chemo. Now it is a year later so it does not matter. I am just hoping that I got the right advice. I am not taking any tamoxifen either. I am having SGAP FLAP surgery tomorrow to remove/replace the wretched implant. It seems like it is somewhat of a crap shoot with cancer too. I was not menopausal before my oophorectomy either.

readytorock

Sunnyone22 -

Chemo has to be started within a maximum of about 12 weeks after surgery to be effective. And I think it is preferred to be done earlier than that if possible.

Hopeful82014

Fe_Princess - please do bear in mind that the Oncotype recurrence predictors assume 5 years of tamoxifen usage. (You probably know that and I apologize for nagging like a big sister...)

Good luck with your surgery tomorrow. I hope the results are excellent and your recovery is smooth.

ChiSandy

Fe_Princess, best of luck with the surgery--hope you get better results (aesthetically and comfort-wise) this time.

BTW, Lausanne was gorgeous (and the train ticket from Geneva was included in the plane fare from London), and the Diversity & Inclusion conference at PMI Int’l was terrific. The Beau Rivage Palace was luxurious and service gracious. But you were certainly correct about Swiss sticker-shock: 95 CHF for a burger, fries and glass of wine or a Coke? OUCH. The first two nights, dinner was an Atkins bar from home and several Nespressos in my hotel room (friends provided the champagne). I took advantage of the included free breakfast buffet (including carve-it-yourself jamon iberico); PMI fed us lunch and dinner the last night.

reaux2gumbo89

Fe_Princess thoughts are with you during your surgery & healing. My tablet won't let me go to new line or intent, sorry. All of this makes me feel so conflicted & angry. IDC lumpectomy Sept 2015 stage 1 grade 2, then radiation Nov- Dec2015. NO TALK of chemo till AFTER radiation so if what y'all are saying about chemo needing to occur within 12 weeks of surgery, well that was out the window. Didn't find out onconotype (22) till October. Next was told no tamoxafin (long story I put on 40s post), so a week and a half before 45th birthday I was thrown into menopause with 1st rolodex shot & began arimidex. Within 2days massive reactions MO let go for 7 weeks then said was arimidex. Now on "break" from anything. I don't like this at all as I feel Ive never been systemically protected. I was ER 97%+ & PR85%+. From free research I can get into, all of this does not paint a pretty long term picture. I say this not to be a downer, but I want my best shot at many, many, many years - I'm only 45 & I have two preteens. You've all made very valid points that resonate with research Ive read. Treatment listed is from 2 MOs. Was wondering if I needed to search for #3, now I'm thinking for my best shot that's what I should do. Saw Nurse Practitioner yesterday & am to start aromatic in 2 weeks & received 3rd rolodex injection yesterday. Our treatments really are like a bowl of gumbo to me ladies; they throw stuff in the pot, boil & stir. But this is one Mardi Gras Queen that's gonna keep dancing the second line! Who wants to join me?

Sunnyone22

readytorock - sounds like you got the same info I got about chemo needing to be soon after surgery. Does anyone know of any solid research that supports this timing? (I will ask my MO at our next appointment in two weeks.)

reaux2gumbo89 - what is the purpose of a 'rolodex shot'? I don't think I've ever heard of that treatment before. So sorry about your reaction to tamoxofan.

I too was in the Onco intermediate range (20) and got advice from two Oncologists, both of whom advised against chemo. (For the record, I am older than you and had ILC (lobular) breast cancer, which tends not to be as responsive to chemo as IDC.)

There is a calculator for Oncologists to use on the Oncotype website (only available to registered health care providers) which takes input on tumor size, your age, tumor cell grade, type of systemic treatment such as Tamox. or Aromatase Inhibitor, etc. It is a tool rather than an absolute, clinically confirmed guideline however it gives a more inclusive look at the OncotypeDX score as it relates to chemo/no chemo decision. Yes, it's hindsight but might be useful if you see Oncologist #3.

I also found this Breast Cancer Calculator interesting: http://www.lifemath.net/cancer/breastcancer/therap...

reaux2gumbo89

Sunnyone22, I like your question because I have no idea as it is a typo😏! Guess brain was thinking expensive watch? Thank you for your kind words. I see that our oncotype scores are similar. Funny how you feel a connection with the smallest things when life throws you something like this😉. I'm sorry to hear ILC does not respond week to chemo & appreciate your time to respond to my post. Back to the topic, I meant to type Zoladex, but I now see spell check changed the spelling for it & for Aromasin. Sorry for the confusion caused. Zoladex is a monthly abdominal injection to induce menopause for premenopausal women. Due to medications for another illness, I can't take Tamoxifin. That leaves me only the aromatase inhibitors (AIs), but you can only take them if your ovaries are shut down. Zoladex does that. Every 28 days the injection suppresses my ovaries from functioning to create a chemically induced menopause. The 1st AI tried was Arimidex, but I had a severe adverse reaction to it & was taken off after 7 weeks. That was 3 weeks ago. Now I'm to wait 2 more weeks & try aromasin to see if a similar reaction will occur. I'm praying not. My frustration is I'm a retired teacher & I go in with lots of questions yet I come out with a blank look on my face and farther from answers than when I went into the visit. Its like oncologist Ive encountered are offended by questioning my care. As I said this is MO #3 & I'm tired not really wanting to search for a #4, but again I want my best shot. I live by Baton Rouge & New Orleans, but now big cancer hospitals are near. I think my plan is to have some consultation visits with a couple more MOs to get their perspectives. These few post alone have taught me so much & given me so much to consider in terms of my care. I really am stunned that no one ever said chemo should follow close after surgery! These should be my decisions & not info I learn months after the fact. Although I am angry, I will not let this prevent me from continuing to educate myself & move forward to give myself my best chance & for others to get their best chances too😊

Sunnyone22

reaux2gumbo89 - Thanks for the roladex/Zoladex clarification. Now I understand!

Yes, our Oncotypes are similar and both 'intermediate' - that gray area where we ponder chemo in all its glory but don't really know if we should participate in its wretched game. I really wish the scores had been zero but we play the hand we're dealt.

Would you be willing to share what your 'severe adverse reaction' was to Arimidex? Was it something that worsened an already existing condition or something out of the blue?

Lastly, I'm really sorry you can't find a cooperative MO. If they are offended by having to answer your questions, then I understand why you've had to move on. But these are docs we'll be seeing for follow ups far into the future and we need someone we can trust and who will be patient with our questions. I wish you well as you make the tough decisions and hope you'll have the advice of a trusted professional MO as you make them.

reaux2gumbo89

I had my 1st Zoladex shot & began Arimidex 2/17/16. Hubby had strep week later. Following week (2 weeks after treatment began) I noticed IId been nasal stuffy & been having progressively worsen trouble swallowing. I have menieres disease with causes severe vertigo, ear/ nasal pressure, nausea, vomiting, diarrhea- it's lovely for a Louisiana southern belle😉- so I see my ENT regularly for bad spells. Went to her & was negative for strep & flu. Got antibiotic shot & steroid shot & zpack (Ive was been harshly taught by MO I shouldn't take steroids & when I researched it makes sense bcuz I'm high ER 97%+ & PR 85%+..... steroids are standard for menieres & Ive had them MANY times since dx in 8/15 but its only palliative so I won't b taking them anymore as I don't want to chance growing anything or undoing any AI work.... hope this part makes sense). Week later inability to swallow was worse. I couldn't read font size I easily read the week before, then it progressed to where I couldn't read font size I could read from the day before. I stopped driving because I couldn't judge traffic. Fatigue was awful. To wash a load of clothes I'd toss some in the dryer lay on the laundry room floor, catch a second wind & throw in more till the dryer or washer were ready to run. Headed back to ENT who said I really looked great allergy wise just like week b4 but to b sure checked in house for mono (net). Told her had it when 11 year old was infant she said it can sometimes flair & spot test doesn't pick it up so real lab which of course was neg & I was given 2nd antibiotic shot & 10 days antibiotics. During next week I start passing out. Call MO, service called back no way Arimidex. Went in fort routine labs & to get 2nd Zoladex injection & demanded to be seen. Blood pressure 68/37, low potassium & vitamin K (all this time Ive been vomiting & had diarrhea), lost 8 pounds, & was dehydrated. Again, MO says virus & won't shake my hand- tells me stay away from people. Good thing nurse practitioner has bed side manners, he added fluids to the Zoladex injection I'm getting & tells me to rest. I'd get 7 more bags of fluids & 2 bags of Zofran during 4 visits to the infusion lab b4 MO finally 7 weeks after starting the medication & FOUR weeks after bringing it to his attention (all the while symptoms getting worse) MO FINALLY admits Ive had an "adverse reaction" & to stop Arimidex. That was 3/22/16. He said Zoladex may be culprit but he felt Arimidex more likely or it could be a combo of the two. If Zoladex is part, we have to wait it out bcuz it releases for 28 days in your body (can't b undone- still don't like that). This was 2 weeks ago. A week after stopping I felt wonderful!!! Thought I was seeing MO Wednesday 3/13/16, but surprise new med change w nurse practitioner! Oh well, like him better anyway😊. So now in 2 weeks I'll be on Aromasin. On Wednesday I also got the Zoladex injection & guess what? This morning I'm having trouble swallowing😥. Now I have tons of allergies & Louisiana is in beautiful bloom right now but at this moment I'm nervous bcuz if Zoladex is out so is Lupton & then this will put off Aromatic which will mean longer time no protection. I know AIs are a pain in the rear, but bcuz of the gray oncotype & high ER PR & the "drive by" site only radiation I had, I'm really, really afraid for me to not even get at least 3 years out of AIs. I get that it doesn't raise the % by much, but I have an 11 & 14 year old & owe it to them & to myself to try. Family & friends don't understand. They think cancer free. I'm sorry for the verbal vomit. I guess its just that no one ever asks me about any of it so oddly it was nice to be asked about my experience, though I wish it were not such a dramatic one. Laissez le bon temps roulette, sha! (Let the good times roll, my dear!)

4444princessme

I'm 44 years old. I was diagnosed with BC in late January of 2016. I had surgery in March of 2016. I was stage 1 grade 1. My nodes were clear and my margin. According to my oncologist I would just need radiation and tamoxifen. Well my onco dx score came back at 21. I was told I need chemo. I am devastated. It was very hard for me to accept the cancer. I cried for 2 weeks. After crying I finally accepted the BC and moved forward. Now I'm back to square 1 but 10 times worse. I haven't been talking to anyone. I can't wrap my mind to wrap around the fact that I have to do chemo. That wasn't in the game plan. How do I get back to where I was when I accepted the BC. I feel ruined. Just not sure what route to take. My mind is telling me not to do the chemo. I read a lot of horrible side effects. This has taken a toll over me and my family

Manu14

4444princessme: I am so sorry that you have been thrown a curve ball you didn't expect by the oncotype score of 21. But I think you will find, if you read for very long on this site, that chemo was not an automatic given for many women with your profile. I am assuming that you are ER+ and Her2 -. Grade 1 is slow-growing and typically not as responsive to chemo which attacks fast-growing cells.

I had a similar profile as yours although I am older. I remember my doctor saying that if the oncotype score came back greater than 18 but less than 25 that it would make for a harder choice and we would need to think through all the details carefully. Thankfully my score was an 18. Chemo is a big step and I would strongly advise to get a 2nd or even a 3rd opinion opinion before agreeing to chemo

Grazy

4444princessme - I just noticed your post and wanted to comment because I recently received a score of 21 as well. A total of seven oncologists in Canada and the US chimed in with an opinion on my pathology report and oncotype score (four were done as favors as my husband works in the oncology world and three oncologists were from my cancer center) Overall, six did not feel chemo was warranted and one thought I could do it if I wanted a conservative approach, but he didn't have a strong opinon either way. If any one of them wanted to make a case for why I should do chemo, I was willing to listen of course, but none did. My high ER+ percentage was a factor in my decision as well. I will be doing radiation and hormonal therapy (Arimidex) and Zoleta (2 infusions/yr). For me there would have been a very small benefit percentage-wise to doing chemo, which was absolutely not worth the long-term risks for ME personally. Everyone should do what will let them sleep at night. So, get more than one opinion and don't give up just yet!

(edited) You might want to complete your profile and make it public so that your details show up at the bottom of your posts - it's hard to know what your diagnosis was, just for interest's sake..... You can see, for example, what mine was, that my nodes were clear, etc.

Hopeful82014

444Princessme:

Manu's given you really solid advice. 21 is NOT an automatic "sentence" of chemo, especially with a grade 1 tumor. Before agreeing to chemo I would get at least one more opinion, FROM A DIFFERENT PRACTICE GROUP, maybe 2 more opinions. Ask lots and lots of questions about expected benefits, risks, WHY they see these risk/benefits, ask them to go over the Oncotype results very carefully and completely with you.

Ask why a certain chemo regimen is recommended and what other options might exist.

Keep asking questions until you know in your heart what you are o.k. with. If possible, take someone along with you for moral support and use your phone or a hand-held recorder to record your consults. It helps a LOT to replay them when you are at home and analyze what was said and what wasn't addressed.

I know that everyone says that chemo was 'tough but doable'. That's not the issue. The question is whether the benefit outweighs the downsides for YOU.

Leslie13

Sunnyone22, My guess is that your Oncologist recommended against chemo because you have Invasive Lobular cancer. Standard chemo has been shown to not be very effective against early ILC. And different targeted treatments work better for us (ILC) than IDC or other cancers. ILC is slow growing, and many chemo's work on rapidly dividing cells. So you take your immune system down more than needed, and actually raise your chance of poorer results since the chemo's more likely to attack healthy cells. I decided to not have chemo because the risk to both my short and long-term health was higher than just using hormonal treatment.

However, Lobular cancer is more likely to spread, so even though your tumor is small for ILC standards, you want to stay vigilant and have frequent checks. It's not you're low risk, so much is that the chemo won't work. You're actually lucky to have an Oncologist who knows about ILC and treats it differently. There are meds if you do recur, and I don't want to frighten you either. Finding you have ILC early gives you the best chance; many of us don't. Just act quickly if anything feels different. ILC doesn't form lumps, but strands of abnormal cells. It seems like someone should have explained the difference, but I fired 2 MO's because they didn't know, so I'm not surprised. There's also questions about whether the Oncotype applies well to us. If you're post-menopausal, you should be taking Femara or another AI. Tamoxifen isn't as effective either.

Taking an occasional short hormone break isn't that risky. There's researchers looking into whether cycling off and on anti-hormonals help prevent tolerance to them. A subgroup of people have hormone meds lose effectiveness over time, and cycling vs. full-time may slow this down. Check with your Dr. first before changing your meds, as this is only research, not fact

Lobular cancer is a different animal and I encourage anyone with ILC to visit the thread for more info in making treatment decisions. We have a few people who closely follow the latest research to keep us updated.

Sunnyone22

reaux2gumbo89 - Thank you for your detailed description of your 'adverse side effects' to Arimidex. Horrible that you had to tolerate these symptoms for so long. Considering you also have Meniere's, and were taking steroids plus you also were on injections of Zoladex, it's no wonder your poor body was not able to tolerate. I don't think, in my entire life, I've ever been on that many powerful drugs at the same time............ever. I understand how you feel about wanting to be on an AI - I feel the same way because I chose against chemo so AI is the only systemic treatment I'm undergoing. I started Femara almost 4 weeks ago and have tried to emotionally 'welcome' the drug as I know it will be my friend for the next 5 years, at least. No SE's yet but I know it's very early. As previously mentioned, it's helpful to other readers of this thread if you fill out your diagnosis and treatment profiles so the rest of us can see details about your BC.

4444princessme - Did you have IDC (ductal) or ILC (lobular) or some other subtype of BC? That might have entered into the chemo/no chemo decision (as Leslie13's post says).

Grazy - How high was your ER+ % and how do you feel it was a factor in your no chemo decision?

Leslie13 - thank you for your thoughtful post on why my ILC might have been a factor in my MO's (both of them) no-chemo recommendations. I hadn't considered the idea about taking one's immune system down and how that could be a detriment, particularly when chemo isn't strongly effective anyway. Also, I had no idea until my diagnosis that ILC didn't form a discrete lump like the far more common IDC. I had my annual gyno checkup (including manual breast exam) THE MONTH BEFORE my mammogram came back positive for ILC. Gyno felt NOTHING! I'm lucky because my breasts aren't terribly dense so ILC showed up as a distortion on my mammogram. And yes, I started taking Femara almost 4 weeks ago (while still doing rads). So far so good. I will absolutely ask my MO about short breaks while on Femara. I worry that it will lose it's effectiveness and it seems to be the best AI for ILC. I'll head over to the ILC thread for more info.

Leslie13, what was your OncotypeDX score? Also, you said there is a questions as to whether OncoDX applies well to ILC (as opposed to the far more common IDC). Can you point me to articles about this?

Finally - a note to all:
One thing my MO said that struck home with me is that for those of us post-menopausal women, there is one more treatment that is equally as effective as chemo or AIs - and that is keeping a healthy weight through diet and exercise. Adipose (fat) cells create estrogen and the more fat we have on us, the harder the AI must work. Maintaining a normal weight AND exercising is a huge anti-BC recurrence tool.

Grazy

Sunnyone22 - the major factor in my decision not to pursue chemotherapy was clear lymph nodes; the ER+ 98% was something my MO felt was a real positive too as the higher the percentage the more sensitive the tumor to hormonal therapy (my layperson's translation of her words - happy to stand corrected if I'm wrong on the exactness, but she did cite the high percentage as an additional factor her recommendation - all the other oncs consulted agreed). The Zoleta I will eventually be taking will combat bone loss to the Arimidex but is also believed to give an added layer of protection against recurrence in early breast cancer for post-menopausal women. You can google that to get more information. All in all, it was everyone's feeling that I'm getting enough protection with radiation, the Arimidex and the Zoleta. Every case is different, so always important to get more than one opinion.

Sunnyone22

Grazy, thanks for the info about high ER+%. Mine was high too (100%+) . It makes sense that an AI (which blocks the creation of estrogen from androgen) would be very effective on high ER% tumors. My Pr was positive but low which is a challenge but not enough to warrant a change in my treatment. (Also, no chemo because it's not as effective on ILC.) Zoleta wasn't indicated for me because my most recent bone scan showed normal bone density for my age. Are you taking it as a preventative or do you have an osteoporosis risk?

Grazy

Hi Sunnyone - in answer to your question, it's preventative.

BarredOwl

Regarding time to chemotherapy (TTC) in the adjuvant setting (where chemotherapy is administered post-surgery), there is this relatively recent study entitled "Delayed Initiation of Adjuvant Chemotherapy Among Patients With Breast Cancer" (unfortunately behind a paywall):

Abstract of article: http://oncology.jamanetwork.com/article.aspx?artic...

Commentary (first page preview available): http://oncology.jamanetwork.com/article.aspx?artic...

BC.org summary: http://www.breastcancer.org/research-news/timely-t...

BarredOwl

Fe_Princess

ChiSandy, I am glad you had a good time in Switzerland. The prices are shocking! My surgery went well but I am completely bashed by the operation. I had do go right back under after the surgery because they thought I had a hematoma. The drains are killing me. I had had a mammogram a week before and they found a lot of breast tissue left over so I had to have that removed too. There is close watch on right breast too now.

4444Princess, follow your gut instincts about chemo. I did not take it because I did not want to destroy my body. I am. sorry you are having such a hard time but it is so appropriate. Five surgeries and a year after diagnosis, I am still reeling from it all. I think we can only digest a little at a time.

Hopeful8201, you can reprimand me anytime you like. I appreciate it. I know I do not know.

dtad

marieB... Im so sorry about your sister. Unfortunately there are many women on the stage 4 boards that had a low oncotype and recurrence score. It just tells me that recurrence is more of a crap shoot that anything else! Its so frustrating. Good luck to all of you fighting this disease....

Hopeful82014

FePrincess - It sounds like you've been through the wringer. I hope you can take all the time necessary to recover. Sorry to hear that your right breast is looking iffy now, too.