My doctors want me to do surgery first before chemo

Zenmushroom

I am a 29 F. IDC. Stage 1. Tumor size: 1.8cm. Her2+ Est+ Proj -. Grade 2. No spread or lymphnodes.

Doctors initially wanted to do chemo first (THC), but after finding out my insurance was changing, they decided to do surgery first.

They tell me whether I do surgery or chemo first, the outcome is roughly the same, and they say the most important thing is getting the tumor out instead of letting a month go by without doing anything (because of this insurance change).

But this makes me really uncomfortable because I see all kinds of people on this site recommending chemo first, because that way you can see the tumor shrink and see if your cancer is actually responding to the treatment. I would hate to do 4.5 months of chemo without even knowing if my cancer is responding at all. And then what if the cancer returned, or grew, and I had to go back?

I'm really uncomfortable making a decision this big based on insurance.

What do you guys think. You think surgery first is okay, even though more people are doing chemo first these days?

SpecialK

It has not been that long that neoadjuvent chemo has been used - initially it was used for those whose tumors were large and needed to be smaller for good margins to be achieved surgically, or for triple negative patients because they have no anti-hormonals to take as additional systemic therapy. The more frequent use of neoadjuvent chemo for Her2+ patients is relatively recent, with the approval of Perjeta in late 2013. This arrangement of chemo prior to surgery is because it is currently the only FDA approved usage of this drug for early stage patients. That is due to change to approval for adjuvant use for early stagers in 2018, so you may actually see fewer Her2+ people doing neoadjuvent treatment. Prior to 2013, unless you had a big tumor or were TN, we all did adjuvant chemo, and yes, we had to go on faith that it was doing something. However, it is the drug combination, not necessarily the order of treatment that is providing effectiveness.