Should I have chemo

Beesie

Neil, there is no single statistic, but dozens of research studies that have evaluated the benefit of chemo in reducing breast cancer metastasis and mortality rates.

There is no question that chemo increases survival but, as you point out, chemo comes with it's own risks. So whether the risk reduction benefit outweighs the risks depends on the individual diagnosis, and the age and health of the patient.

What is your wife's diagnosis? What is her hormone status? What is her age? That is all relevant in the decision of chemo or not.

Some chemo studies:

https://www.ncbi.nlm.nih.gov/pubmed/9390536

https://www.ncbi.nlm.nih.gov/pubmed/22152853

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882502/

https://www.ncbi.nlm.nih.gov/pubmed/18177773

https://www.ncbi.nlm.nih.gov/pubmed/16609087

https://www.ncbi.nlm.nih.gov/pubmed/11441936

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33137-4/fulltext

https://www.sciencedirect.com/science/article/pii/S0140673605665440

SeattleSunshine

Everetta, what decision did you make? I am so glad you posted. I am in a similar situation. I am 67, moderate health, invasive ductal, stage 1b, node neg, 3 cm, grade 3, Er+,PR +, her2 negative.My oncotype is 27 (interesting that you had it done twice!). I think if I was 50, I would definitely get chemo. But at 67 I hesitate. My oncologist says this is a “gray area.”


He recommends CMF but according to my research, this would only extend my projected life span by 70 days, less than the 180 days of treatment! OTOH, TC could extend by two years but given my age is much more likely to give significant cognitive dysfunction and other permanent side effects.


I am willing to do radiation and AI, but very leery of chemo because the permanent side effects: chemo brain, hearing loss, damage to heart and kidneys (I already have stage 3 chronic kidney disease), etc. I really do not want to do the chemo but I am afraid of going against my oncologist or just acting out of fear. I did get a 2nd opinion and she was very wedded to the Taylor study which did not really include women in my age/oncotypeDX.


I need to get my head wrapped around this. The lumpectomy and SLNB were pretty easy. My daughter had breast cancer 4 years ago. She was triple positive and because she is young, they hammered her with chemo. She is alive and in remission 4 years later but suffering from a lot of residual symptoms. She thinks I should not get chemo.


I know it is a gamble no matter what I decide. I just need to believe I made the best decision I could at the time with the information I have.

everetta

I decided to not do chemo but I will never really know if I made the right decision. The doctor I trusted the most recommended that I not do it and I followed that advice. As I understand it with onctotypes between 26-30 that clinical features should help make the decision. Age, size of tumor, grade of tumor etc should factor in. Your grade( mine was a low 2 and yours is grade 3) and size of your tumor(mine was 1cm and yours is 3cm) is larger then mine and might be factoring in their decision to recommend chemo. The oncotype is in the grey area and at 25 they might not recommend but these numbers have variation (it is rare to get the tumor scored twice mine had some inflammation that they thought might effect the score--the difference was not that great though but when you are in the margins of the numbers it is hard to know what to do so your 25 could be slightly higher or lower). If you live in Seattle were you able to go to Fred Hutchinson. Perhaps seeking a third opinion at a cancer center. These are hard decisions, but if you are feeling uncertain I would get a third opinion. And your personal health situation is also important, age too..I know that factored into my decision.I also had a lobular not ductal cancer which also makes it perhaps (they are not sure) less responsive to chemo..so all these things factored into my decision. I still question it from time to time but I think it would have made very little difference in my prognosis.

everetta

I forgot in my response to add this. My doctor recommended CMF since he didn't really think I should get chemo and felt it was less toxic..but he was coming from a place of not recommending chemo. The side effects are supposed to be much less. By and large the doctors who recommended chemo recommended TC. I know what a difficult decision this must be for you and I wish you the best..hopefully you will find a doctor you trust and you will trust in your decision. Some doctors recommended starting the chemo and if I tolerated it well continuing but since I was in the grey area, if I didn't tolerate it, to just quit. Good luck.

Yogatyme

everetta

I am waiting for my oncotype score now and this forum is very helpful. I am 68, BRCA1 positive, ER+, PR+ HER2-, stage 1a, 7mm tumor, no lymph node involvement. My overall health is very good with only glaucoma and hypothyroidism as ongoing health issues. No family hx but all my siblings (including brother) and a niece are all BRCA1+. I had BMX 8/13/19. My MO stated that some people refuse chemo regardless and that it is completely a personal decision. I agree with keepthefaith that regardless of our decision, at some level it’s all a crap shoot. I have used the online risk calculators and found them very helpful and somewhat comfor but ultimately I am the one who will have to decide going forward. I am leaning towards quality of life over longevity but as all of you know, we can change our minds many times as we consider our options. I wish my decisions about chemo and AI were as easy for me as the decision for BMX was. But w risk of recurrence w BRCA1 being 85% in both breasts, it seemed like a no brainer. Good luck w this difficult decision and any other struggle that may present itself.

oldladyblue

I am 64, in good health with thyroid and GERD. I had IDC 1.3 cm (and DCIS), Stage 1, Grade 2, clear but close margins (less than 1mm on one side), 0/4 nodes, hormone positive, HER2 negative, genetic testing not in yet but started, Oncotype score 28. I am in the Oncotype "grey area", past menopause and in the 26-31 range where chemo, though recommended during the TaylorX study, may not have been necessary.

I will have the oncologist run the RSClin model to expand my Oncotype results tomorrow while I am in the office. I didn't know about that physician only risk model till Beesie told me about it on this site. I was really really agonizing over whether to have chemo or not. It makes sense either way as with my score the benefit will be smaller than women with a higher score. Chemo might not outweigh the risks by much.

I did go to the Predict site and run all of the simulations I could using the "little dots representing women" type of graph. Predict Breast Cancer and I wrote down in a chart just for me the options of surgery only, chemo only, chemo plus hormone therapy 5 years, chemo plus hormone therapy 10 years, 5 year recurrence rate, 10 year recurrence rate, and 15 year recurrence rate. With no emotion, the statistics show I have an 80% chance of no recurrence at 15 years out, provided I don't die of something else in that time as 14% of the remaining 20% will. And a 91% recurrence free at 10 years, and a 95% recurrence free at 5 years out. So I decided to do chemo. That chart I made, plus a phone call from a mother of my sons' boyhood friend, helped me firmly decide. She is one of the few that unfortunately had a recurrence after 10 years, and is now Stage IV. Sigh. She never did chemo. So that is why I decided after 3 weeks of flip-flopping chemo / no chemo that I AM going to endure chemo even at my age. One year of hell should be outweighed by 10 or 15 years of life yet.