Single Hormone Receptor Positive -> ER+/PR-/HER2-

LillyIsHere

Hi Ladies, I just want to share some info regarding diet. I had a zoom meeting with a nurse who is trained as an integrative consultant. She reinforced on what most of us know: no red meat, no alcohol, no white flour and rice, and no milk but OK yogurt and cheese - thank God! . Reinforcing what my grandma told me when I was a kid, to stay away from white foods (white sugar, flour, rice, and white salt).

Meditation is very important she said. Life without stress - yeah, once we have this diagnose, isn't stress part of the equation?

SarahSmilesatMe

Hi LillyisHere - sorry to show my ignorance; but; are the diet recommendations (no red meat, alcohol, etc.) to help eliminate side effects; e.g., joint pain and stiffness, or are they to decrease estrogen? Sorry if I’ve missed this in a previous post and thx for some brief background

LillyIsHere

Hi Sarah, basically it is recommended as an anti-cancer diet. I am also reading books on changing lifestyles to fight this disease. Nothing new here but an anti-cancer diet, exercise, anti-stress, and being happy is very important for the body to fight the disease. Honestly, in my case, diet and exercise haven't been a problem but stress is difficult to keep it under control especially having young kids.

Here is a link: https://www.mdanderson.org/prevention-screening/manage-your-risk/diet.html

Beesie

The diet suggested on the MD Anderson site is an anti-cancer diet aimed at overall health and weight control. It's a pretty common sense diet, and is not overly prohibitive. I'm happy to use the MD Anderson suggestions as a guide but I don't believe in the need to completely prohibit foods, nor do I think any research supports such a strict diet. So going beyond what is suggested by MD Anderson (and various other cancer sites) is personal choice rather than medically recommended.

I agree that getting stress under control is important, and often difficult. What I don't want to do for myself is add stress, which is what would happen if I worried about keeping myself on an overly strict diet that took away foods I enjoy and had me watching everything I eat.

This is from the MDAnderson site:

Our experts recommend following the New American Plate guidelines developed by the American Institute for Cancer Research.

You can take the following steps to maintain a healthy diet, manage your weight and reduce your risk of cancer:

• Eat a plant-based diet. Eating a healthy diet can help you stay lean. Fill 2/3 of your plate with vegetables, whole grains and fruit. Fill the remaining 1/3 or less with lean animal protein like fish and chicken.
• Limit red meat. Red meat contains substances that have been linked to colorectal cancer. Pork, beef, lamb, deer and buffalo are all red meat. Aim to eat no more than 18 ounces of cooked red meat per week.
• Choose whole grains over refined grains. Whole grains are high in fiber, which can help you stay lean and lower your cancer risk.
• Avoid processed meat. Hotdogs, sausage, lunch meats and other processed meats contain cancer-causing substances, and eating these meats can damage your DNA, raising your colon cancer risks.
• Choose plant-based proteins. You can make healthy swaps that will add more plants to your diet without reducing your protein intake.
• Avoid alcohol. Research shows that drinking even a small amount of alcohol increases your chances of developing oral, breast and liver cancers. The National Cancer Institute recommends that women have no more than one drink per day and men have no more than two drinks per day.

LillyIsHere

Beesie, I agree with you. Honestly, I lived in the south of Europe and I do have a Mediterranean and organic diet and I like salty foods but not sweets. Always healthy, yogi, and never any weight issues and here I am. It is not working for us who have a similar lifestyle and are members of this community. I really want to change the diet and start eating junk food and hopefully, I will beat cancer . I do blame the stress. I do believe stressful situations don't help. I argue with my kids to get enough sleep . I'm reading a book called: Anti-cancer living.

SarahMaude

This thread is very informative! I've been following rabbit trails of studies regarding ER+/PR-/HER2- tumors, and I'm actually kind of amazed at how much is undiscovered. With a Grade 3 tumor, and now and OncoTypeDX score of 49, I'm certain to be a Luminal B case. Pretty sure this site's definition of Luminal B is incorrect based on my reading. It doesn't have to be HER2+.

I've had to self discover that the PR- is not the "garden variety" HR Positive case. My BSO was almost chirpy about my highly estrogen sensitive (89%) tumor with a mitotic rate of 2. Of course it was Grade 3, and path report also said fast growing. Seems to be some lack of training even in the BC professional community about this minority tumor type.

I was encouraged to see that Beesie found some information that hormone blockers are good mitigation for us. I'd found one recently that implied the opposite, but maybe it was for weakly ER+ cases. I have a lot of questions still, I want to read through all the posts above.

One question, has anyone had success in finding a way to further characterize their tumor? I think OncoType Dx is a great addition to our decision tools, but there really isn't much more information regarding tumor genomic details. I assume that we don't get testing in the clinical population unless there is an action possible from the results.

And, another oddball question, how on earth can I have such a large aggressive tumor that showed no LVI or lymph node invasion. It just seems so strange that people have 1 cm tumors that are in nodes, and others like me have plum size tumors that stay in place?

SarahMaude

Back from doctor today. I feel so special having this cancer type. OncoType DX confirmed that I’m strongly ER+, and negative for PR and HER2. MO also confirmed I’m Luminal B.

She said chemo will bring my risk of recurrence into the teens. Prolia will also slightly reduce chance of bone mets. Then I guess that lifestyle changes and luck are what is left. Oh, and radiation. Still have that on my dance card. I think that is more about getting to the baseline risk level though, as it’s assumed for lumpectomy patients.

I’m very interested to hear any more research treatments on cases of high grade ER+ PR- HER2- Based on these tumors sizes and lack of node involvement or lymphovascular invasion, it’s likely to be something distinct that just isn’t getting much attention. Reading the history here, there are many high RS results on OncoType DX. These are in the very far right tail of the distribution. Almost like triple negative.

I hope some of you are still around to discuss and are paying attention to anything new regarding this type. I also hope you are living well and moving on.

LillyIsHere

sarahmaude, I had 3mm BC that has spread to the nodes. How can it be not aggressive? Grade 1 but it has left the breast. Highly positive too. I'm only on Exemestane and did not have chemo or radiation. I hope MO knows what he is doing.

katg

Thank you for posting. This one showed up in my active thread so i clicked. I am not one of the types listed, but i am Er+/PR- and tumor out became HER2-+. I also had a big tumor, 5.4 with no lymph or vascular invasion. Really? But i have aggressive HER2 and BRCA2 to deal with going forward. I love the couple of pages of posts i have read and hope to read, visit and use the suggestions offered for healthy living.

I still need to find my OncoType DX. I cannot find it in my records.....

SarahMaude

Katg, from my reading, the loss of PR in HR+ BC for both HER2 + and - is a distinct tumor characteristic. I found one paper questioning whether the loss of PR happened when the tumor was created or along the way. It does seem to be something that is of interest. I do know treatment for HER2 is favorable.

Murfy

Katg, the Oncotype is usually not performed if one is Her2+. The Oncotype is used to determine IF chemotherapy is warranted and therapy is a given for those who are Her2+. There are several theories on why our primary tumor is Pr-; for example, abnormal growth factors such as Her2 may cause Pr gene suppression, or there may be a mutation in the Pr gene (these may be responsible for low Oncotype RS), or there may be a loss-of-function of ER (which leads to loss of Pr gene expression. This latter hypothesis simulates a 'triple-negative' situation and may be why anti-estrogen therapy is less effective in some of us and also why some of us have such a high Oncotype RS.

SarahSmilesatMe

I’ll chime in …. I also had a strong Er+, PR- & HER2- tumor(s), with no lymph node involvement. Grade 3, high oncotype, a lumpectomy, chemo (Cytoxan & Taxotere), and radiation. I’ve been on Letrozole for 2 years. I admit, the Oncotype score and the single hormone receptor status are always lurking in the back of my mind.
FYI - There was another thread that may be of interest - titled “High Oncotype Scores” (or something similar). With the new format, if I can find my “favorites,” I’ll double check the thread title.

believe60

This thread has been so incredibly helpful to me, thank you all so much. I am realizing how little I knew as I went through the diagnosis and treatment process. I should have asked more questions instead of being a deer in the headlights! Upon biopsy I had been told it was “just” DCIS, no worries, it’s the “good” cancer, no rush to surgery. More than 2 months later the surgical pathology showed three 1 cm grade 3 tumors, along with 26 flecks of grade 3 cells, and a micromet to 1 of 4 sentinel nodes. ER+ PR- HER2-. (99% ER+). They told me the PR status wasn’t significant, so I never thought twice about it. Needless to say, oncotype came back high at 34. So I went through AC and taxol chemo, which I finished in January 2021. I was not referred for radiation as they said in cases like mine it didn’t affect outcome (whatever that may mean). Now I’m on arimidex for 10 years. I am post-menopausal at 61. Plus I get an infusion of zoledronic acid every 6 months. I am transferring to another doctor as I need someone who will talk to me and not at me. Were those 26 flecks somehow significant? I haven’t been able to find anyone else who had that sort of thing in their pathology. I guess whether or not I should have had radiation is a moot point now. I did have a double mastectomy.

Part of me says don’t even look back, just embrace every day as I feel great these days. And I have my 4 beautiful children and 3 grandchildren nearby. With another on the way! Really, I am sograteful for all these things. But sometimes it gnaws at me that I don’t fully understand my diagnosis and prognosis. Especially on the days a new ache or pain makes me anxious! Not sure why I can’t quite let go. There’s nothing that can really change now, so just eating well, exercising and enjoying life. But thank you all for a place to vent. I really appreciate this discussion board.

Murfy

Believe, it sounds like your docs are treating your situation aggressively and per protocol for your oncotype and your ER+/PR- status. I'm guessing that maybe 1 or more of the 3 tumors were IDCs and the flecks were DCISs. At least, my 'flecks' turned out to be DCISs.

Best of luck with the rest of your treatment! You're so lucky to have a big family nearby!

SarahMaude

believe. I completely understand what you mean when you say you want to more about your diagnosis and prognosis. I think I’m settling on knowing that more statistics on populations of people who are not me isn’t going to help. I would like to know more about my tumor. Basic IHC and my OncoType of 49 leave me wondering too much.

Ultimately. I’m getting the nationally recommended treatment for my stage and grade. I’ve already lost 18 lbs and plan to lose 12 more after chemo. After that,

I’m committed to being active and strong through movement and sensible eating habits.
I will work to enjoy life with family, friends, my career, and hobbies I love.
I’ll engage proactively with my doctors to monitor and manage everything I can.
After that, I’m going to remind myself to accept what I cannot change, and just repeat lines 1-3 above.

And anything interesting I fin about this cancer type I’ll share here.

I agree with murfy, I think your doctor treated you aggressively. But that’s finding one who you can talk to is important.

LillyIsHere

I think I am not treated aggressively. I had small cancer in the breast, but 2 out of 5 nodes were positive as someone said, the horse has left the barn. It was my decision for BMX and I asked for chemo and if radiation was needed and I was told NO.

SarahMaude

lillyishere. BC is such a puzzle to me. It baffles me that you could have a <1 cm tumor that went to 2 nodes. It sounds as if they didn’t try to oncotype your tumor. I would have thought the positive nodes would have led to chemo and radiation.

Have you sought a second opinion? I do know that aromitase inhibitors are much more effective than tamoxifen for ER+/Pr- HER2- , so that is certainly in your favor.

LillyIsHere

sarahmaude, I had the same thoughts as you. Since the tumor was only 3 mm, it wasn't enough to check the Oncotype. I had 4 different opinions. I went to 2 large cancer centers. I assume the new guideline says no chemo and no radiation in my case. I understand no chemo because ILC doesn't respond well however, radiation? Guidelines keep changing and I will feel terrible if radiation will be as required in the future guidelines.