MO said hormone therapy reduces recurrence risk by 20%??

orangeflower

Hi all. I'm recently diagnosed, stage 1A, 1.6cm, strongly ER/PR+, HR-, node negative. I've had a bilateral mastectomy, no chemo or radiation because my Oncotype score was only a 7. I expressed concern about hormone therapy side effects to my medical oncologist. He oncologist said, "With hormone therapy, you have a 97% chance of not having a recurrence in the next nine years. That's considered an excellent prognosis. If you don't take hormone therapy, you can take 20% off of that. That's not considered an excellent prognosis." He might have said "20 percentage points," I don't remember. I've brought it up twice to him and he insists that hormone therapy has a dramatically positive effect and that I definitely need to be taking it.

I'm very confused. Does this mean that if I don't take hormone therapy, my chances of having no recurrence drop down to 77%? I thought that hormone therapy reduced the chance of recurrence by something like a third. That seems like my odds of no recurrence would still be over 90% or something. I also don't know where he got the 9 year figure, I'm sure it must be some study. I would really like to better understand how much I'm increasing my risk of recurrence if I don't take the hormone therapy.

I'm on day 6 of ovarian suppression with Lupron and day 4 of anastrozole. My body feels weird like I have the flu, I'm fatigued and unmotivated, I have nausea. So far none of the infamous hot flashes, but I'm sure those are coming. I have a lot of fear that BC means I either get to feel crappy for 10 years or I get to have a much higher chance of stage IV BC.

Yogatyme

Danee, Beesie is the person to pose this question to. She is a wealth of info. She will likely respond to this post, but if not, I encourage you to send her a private message. I have gotten clearer answers from her than some of my providers.

Beesie

Danee, my understanding is that Tamoxifen reduces metastatic recurrence risk by approx. 30%, while the AIs reduce risk by approx. 35%. Assuming that you will be taking Tamoxifen (I checked another post and see that you are 42), with such a favorable diagnosis, the difference between a 20% risk reduction benefit and a 30% risk reduction benefit is very small.

If you have a 97% chance of not having a recurrence by taking Tamoxifen, the reverse means that you have a 3% risk of mets, even when taking Tamoxifen. Taking Tamoxifen reduces the risk of mets by 20% - 30% (depending on which number you believe). This means that your 3% risk of mets would be either 3.75% (a 20% reduction of 3.75% = 3%) or 4.3% (a 30% reduction of 4.3% = 3%). So your 97% chance of not having a recurrence with Tamoxifen would be reduced to a 96.25% risk (assuming 20% benefit) or a 95.7% risk (assuming 30% benefit) if you don't take Tamoxifen.

It might be easier if you look at CancerMath: http://www.lifemath.net/cancer/breastcancer/therapy/

Complete the inputs about your diagnosis, input that you will be taking Tamoxifen, and then at the top of the right side, where it says "Display As", select Pictogram. This will show you how much benefit Tamoxifen provides. The info is an average for everyone with your diagnosis, and doesn't incorporate your low Oncotype score, so the absolute numbers won't exactly match your Oncotype score, but the results will be close and will help explain the amount of benefit from Tamoxifen.

orangeflower

Thanks Beesie. I guess when we’re talking about our very life, we might tolerate some side effects for even just a 1% reduction in risk. I just don’t understand why I would tolerate anything other than the mildest of side effects for such a small improvement. My MO made it sound like it would be totally crazy not to take these drugs.

When I was first diagnosed, I asked the radiologist, “what is my chance of living?”. He said 85%. I’m not sure where he got that figure? It was before we knew anything else about the cancer beyond what the MRI and biopsy showed

elizapt

Hi, Danee78,

I am in a very similar position. My oncotype was only a 3, same type of tumor. I did have radiation (16 rounds) and now my MO wants me to take Anastrozole for at least five years. she tells me that if I take it, my recurrence chances are only 3% in 9 years. If I don't take it, she says my risk is 7-10% ( a 40% reduction according to MO) . I am a very young 60 and am struggling with the possible side effects versus the low chance of a recurrence. I think I'm going to start the med and just see how it goes......It's a tough decision.

Beesie

Eliza, your MO can't do math. Or she is intentionally trying to mislead you to push you into taking the AI. It has to be one or the other.

Even if a 40% reduction was correct (vs. the 35% I was told by my MO for AIs, confirmed in research I've read), there is no way that a 3% risk with the AI would translate to a 7% - 10% risk without the AI.

7% is a 133% increase over 3% (a 100% increase would be the same as doubling, and 7% is more than double 3%). 10% is a 233% increase over 3%.

Try out the CancerMath link I provided in my post to Danee to see what it shows your risk to be with and without the AI.

Moderators

As always, thanks Beesie for your support here!

Rain88

Hi Beesie,

I just wanted to thank you for the CancerMath link. I knew I had a favourable prognosis, but having the results calculated made me feel better. Thanks again.