Chemo or Not?

Darwesh

I am 47 years of age, with no family history of Breast Cancer. My Oncotype Score is 19, and Ki-67 is 15%, Tumor size 1.6cm, IDC Right Breast, Stage 1a, Grade II, Mastectomy of Right Breast completed about 60 days ago. I am on Tamoxifen for a couple of weeks now.

I am faced with the million dollar question, whether or not to do chemo. Different oncologists have different (chemo or no-chemo) recommendations. There are also a couple who have left it on me. I have seen 4 to 5 oncologists so far.

I am very concerned about long-term effects of chemo. Are secondary cancer, death and cardio problems really extremely rare? I also have diabetes so I am prone to more impact from TC Chemo.

Has anyone with the same type of cancer and mastectomy and similar scores, Onco score 19 and Ki-67 15%, skipped Chemo.

Any input will be highly appreciated.

Meow13

You should do what you believe the best treatment is for you. I can tell you my situation I was 53 and had 2 tumors one ILC and one IDC grade 2 both 1cm. I had mastectomy no radiation. I was er+ 95% and pr negative less than 1%. No nodes involved. My oncodx was 34, high risk but I like you was worried about the long term side effects of chemo. I was in fantastic health and my surgeon and oncologist suggested chemo. I decided not to do chemo. I listened to the statistics and just was not convinced it was worth the reduction in recurrence risk. I am 6 years no recurrence. I did do 4 years of AI drugs. I have been off 2 years now and still have some arthritis and my ear still rings.

Meow13

I would also ask your doctor about tamoxifen vs going into menopause and taking AI drugs. I say this because they say there is a small risk of uterine cancer. My sister in law was on tamoxifen when a tumor developed and they were slow to biopsy and by the time they discovered a second primary, they believe may have been to her taking tamoxifen, it turned into a deadly cancer,. It is a very rare side effect from tamoxifen but it happened to her. It is something to consider and talk to your mo about.

ChiSandy

You should ask about having a 70-gene assay--such as Mammaprint, Prosigna (and a third, newer one I can’t recall)—performed on your tumor tissue. They are extremely helpful in deciding which “intermediate-risk” (and 19 is low-intermediate) Oncotype-scoring tumors are candidates for chemo. Their advantage over OncotypeDX is that they have no “intermediate” risk category, just “high risk” and “low risk.” One bco sister scored 20 but her MammaPrint came back “low risk;” another scored 21 but her Prosigna came back “high risk” and she opted for chemo. There was a study released (I forget the publication, but will look for the url) saying that these 70-gene assay tests can often allow more OncotypeDX “intermediate” patients than originally thought to safely skip chemo. But the converse isn’t true: low-Oncotype tumors (0-17) test “low-risk” in these 70-gene assays.

Jackster51

Thats a tough decision for sure. I agree with Chi sandy about the mamoprint test. I was 47 when dx and - in 20/20 hindsite, wish I had not done chemo - or possibly done a milder form such as CMF. I do have a lot of crappy side effects from TC 5 years later. Not everyone does, but I found the T of TC to be brutal.

Darwesh

Thanks for everyone's input. Mamma Print may be too cost prohibitive (on top of Onco DX already done) at this time for me. Has anyone heard of RSPC and how does one get access to this tool? It seems like a tool that takes input Oncotype score and other pathalogical conditions to refine the prediction of Oncotype DX alone.