IDC with Micropapillary

Darwesh

My mother, age 70, was diagnosed in screening recently. Went through BCS.

Surgical Pathology:

• Node negative, stage 1a
• IDC with Micropapillary component (approx 30% and mucinous component)
• Tumour size: 1.2 x 1.1 cm
• Grade III (Tubule 2/3, Nuclear Pleomorphism 3/3, Mitotic count 3/3, Score of 8/9)
• Clear Margins
• ER/PR Strong positive
• HER2 negative
• Ki-67 is 50
• Family history of BC

Given patient's age, and the fact though she is active but she has a plethora of other health problem, she and family are resistant to Chemo. She is fine with radiation and hormonotherapy, but not mentally ready for chemo.

Does anyone else, same age group, have the similar results? Did you opt for chemo? We are not sure what chemo (TC 4 rounds) would do to her. We are just scared that chemo will just really break her down physically and mentally.

Do you suggest Oncotype DX? Is it inevitable, given her grade III and high Ki-67, oncotype will be in high range?

Any comments will be appreciated.

(Please ignore the treatment and info in the signature. That is for my sister who I initially discussed on this forum)

bluepearl

Even though it is early breast cancer, your mom's has components which suggest it is aggressive...grade 3 and high Ki67. There are lots of surprises with oncotypeDX, which she should probably have to determine where she stands with or without chemo. The more information, the better. If it were me, I would do the chemo....but I don't know what her other health problems are, which would influence treatment options. Anti-hormonal for sure. BTW...mitotic score of 3 also mean aggressive)

obsolete

Dawesh, so very sorry about your dear mother's BC. It's so inspiring to see dedicated daughters and sisters (such as yourself) looking out for one another! Bless you!

If I were your mother's daughter, I might coerce her to obtain a 2nd opinion on surgical pathology from a dedicated breast pathologist, including the molecular subtype of her tumor. It's probably either Luminal A or Luminal B, where A would be less aggressive.

The fact that your mother's nodes were negative is VERY positive news, as her 30% micropapillary pattern frequently yields positive nodes... however, your mom's did not infiltrate the nodes examined. Micropapillary is a less frequent pattern with mucinous, although there have been other patients with it if you visit the MC thread: https://community.breastcancer.org/forum/137/topic...

I personally had MC (mucinous) mixed with Solid Papillary, IDC and DCIS, both grades II & III. Scored low on Oncotype and still kicking almost 5 years later. Only treatment has been hormonals, but I had later opted for a bilateral mastectomy. Please ask your Mom to seek that 2nd opinion pathology. Hugs to all 3 of you!

Polly413

A year ago at age 72, I was diagnosed with IDC with primarily micro papillary features, ER+(90%) Pr+ Her2 -; Stage IIA, Grade 2, 1/3 positive nodes, tumor <1cm. When a mammoprint was done it showed my tumor was 1) about half basal type and half luminal with the basal predominating by a small margin; and 2) "high risk" at the bottom end of the scale (14 on a scale of 1 to 100). My MO at the time made the chemo decision completely on this Mammoprint finding of 'high risk". She did not want to discuss the micro papillary finding nor the basal-type finding. My current MO also does not want to discuss those findings - maybe because there is nothing more to offer me chemo wise than what I had. I had surgery, did chemo AC/T and am now on Femara. I did well on the chemo and have been on Femara only about 7 weeks but no SE's yet. My health was good prior to the diagnosis so I was given aggressive treatment although I did decline radiation as that is hard on older patients especially when the cancer is on the left side above the heart and as it would not have increased my chances of overall survival. Good luck to your mother in making her treatment decisions. Polly

obsolete

It's unfortunate that some of us patients cannot motivate our oncologists to become more engaged in patient discussions regarding pathology findings. It's been most discouraging. Please know that you are not alone.