Do we really need chemotherapy?

prodigeo

Hello!

Thank you for your warm welcome

My wife had a mastectomy on her right breast due to 3 tumors with τthe largest being 1 cm. She also had an infiltrated lymph node and for this reason, she removed all lymph nodes on the same side. The Oncotype test showed a grade of 12. My wife is 49 years old and is in the pre-menopausal stage. Does she need to do chemotherapy along with hormone therapy? and if so then how many sessions do you think she should take? Pleas note that she would prefer not to have chemotherapy for purely psychological reasons. The doctor also recommends doing at least half of the sessions for precautionary reasons. Do you agree? will something change dramatically in terms of life expectancy if she does the chemotherapy?

Thanks in advance for your reply.

ruthbru

No one prefers to have chemotherapy! But if it saves your life it is well worth the unpleasantness at the time. If she is uncertain about her doctor's recommendations, a second opinion would be a good idea.

MSWife

The Predict tool can be used to calculate the benefit from chemo vs surgery alone, if you have enough info to input.

https://breast.predict.nhs.uk/

1982M

I’m sorry to hear your wife has cancer.

Not all breast cancers are the same. Some cancers are more aggressive then other cancers. I’m 39 years old, Stage 1A -A very early stage- and am doing chemotherapy as research shows benefit in my situation. I view it as investing this one year now so I can have 40 more.

Oncologist follow protocols that were rigorously tested to see who would get the most benefit from chemotherapy. Write down all your questions and ask your doctor. Chemotherapy can be scary before starting, but now that I’m ‘in the routine’ of it, I know somewhat to expect. It’s not like TV. I’ve not thrown up once. I’m not losing weight. I am losing hair, but depending on the chemotherapy and the Center some people have options for cold caps.

Best of luck to you and your wife.

prodigeo

Thank you all for your replies!

Much appreciated!

We have a meeting with the doctor on Monday.

We'll see how it goes.

All the best to all of you

prodigeo

Many thanks for your input!

Really helps a lot!

All the best to you too!

AMG2

I want to add to what 1982M states: My cancer looks like it's early stage, no lymph involvement, etc, but it's Her2+ which tends to be very aggressive, and while the sentinel lymph node was not involved, there is evidence of lymphovascular infiltration (LVI) in my case. When there is LVI with a Her2+ tumor, chemotherapy greatly reduces the chances of recurrence, as in, takes it from a greater than 50% chance it will recur in 5 years, to a 95% chance it will NOT recur in 5 years, so while I hate chemo, and really, really hate it this week in particular because my feet no longer seem to know where they are and it feels like the nerves in my fingers are dying (they aren't: this is all temporary, it's just super unpleasant!), I am doing the stupid chemo, and I am going to finish the last 5 infusions of the stupid chemo, and then go on and finish the rest of my 7 year protocol exactly as recommended.

Your wife's oncologist will very likely have an idea of what is best for her. I'm so sorry you're both having to deal with this, and my very best to both of you going forward. This site is very supportive, and if either of you needs us at any point, we will be here for you.

If it's hair loss that is, among other things, worrying your wife - hair loss is traumatic, no doubt. HOWEVER, I personally am cold capping, and after 7 weeks of chemo, I still have a full head of hair. Had some shedding and scalp sensitivity at weeks 3 and 6, but this week, so far, there has been no shedding, no sensitivity, and if you look at my head, it just looks like I need a haircut, which I do. There are ways of reducing hair loss and making this whole thing less psychologically traumatic.

WC3

prodigeo:

I'm not sure what the standard of care is for your wife's type of breast cancer but she can always get second and third opinion to see if there are differing perspectives out there. Chemotherapy is part of the standard of care for the type I had. It was a long slog but was not anywhere as bad as I envisioned it would be. I thought vomiting would be a regular occurance but most MOs are very good about controling nausea these days. I had very little nausea as a result and only dry heaved once when I got off my medication schedule.

moth

Your physician should be able to give you an estimate of the recurrence risk that your wife faces with or without the chemo.

I second the recommendation to play around with the Predict website & see what results you get by adding 3rd gen chemo.

Some other things to consider:

-Oncotype 12 is the bottom end of intermediate for women 50 & under but your wife is close to the 50 yr old mark, where a score of 12 is considered low -- so that would tend to suggest chemo is probably not a benefit.

-There is another stats analysis your doctor can do, it's called RSClin and will take into account age and other factors. You can read more about it here & ask the physician to run it https://ascopost.com/issues/march-10-2021/prognost...

-*some* women find hormone therapy very harsh and may want to stop if they don't tolerate it well. Many tolerate it just fine so it's not to scare you but there's no denying that it does have many effects on the body. So if you're counting on the hormone therapy, you need to be prepared to go through with it and all its side effects. That is sometimes an argument to do a course of chemo just in case hormone therapy is not well tolerated ...

-personal attitudes to risk. Are you comfortable with taking a risk? when your dr is suggesting a half course, it almost seems to me like they're trying to hedge their bets. The thing to be clear about here is we're talking about metastatic recurrence which is not curable. Metastatic cancer is the type that kills & your wife is still very young so I'm sure you're hoping for more than 5, 10, 15 yr survival which is how oncologists think of cancer...

-multifocal breast ca *may* have higher recurrence risk - I believe this issue is still being investigated but here is one study from 2015 that did try to address it https://www.ncbi.nlm.nih.gov/pmc/articles/PMC45381... . I suspect this is what's making your dr a bit nervous.

Nobody really wants to do chemo. We do it when it's prescribed because the benefits outweigh the risks and everything that comes with chemo. And it's not always horrific. I've been on IV chemo for 19 months straight now and I'm still chugging along. If your wife has specific concerns, we can help address those. It's nothing like on TV....

I'm sorry you find yourself having to make these tough decisions. I hope you get clear answers from your physician and come up with a treatment plan you're comfortable with.

kathabus

You can look at my stats, but I was premenopausal, had an Oncotype of 10. 1 positive lymph node. MO recommended to get ovarian suppression (I opted to just get oopherectomy) and to get on an Aromatase Inhibitor. No chemo. My MO felt that the benefit from chemo for my situation would come mostly from the menopause I would be in from it....and she said that there are easier ways to get you in menopause.

Now if I had a higher score, different tumor type.....we would be in a whole other ball game. And honestly, I could have found a MO that would have recommended chemo in my situation....but I felt comfortable with the menopause/Aromatase Inhibitor route. I also had a fairly aggressive radiation course of 6 weeks. Good luck with these decisions!

Ratched28

Hi WC3,

We have almost the exact cancer, including size, stage and treatment. Am I reading your surgery correctly that you had DMX? I’d like to go with this option, but wasn’t sure if the surgeon would remove a healthy breast? I just want them both gone in hopes of not having to go through all of this a second time. It seems to happen too often. Hope you are doing well.

De

moth

Ratched, some surgeons will offer a BMX depending on the patient's situation. You need to understand that a mastectomy does not eliminate regional recurrence risk, though it does drop it. But people have had recurrence in the breast after mastectomy.

The big issue is that it has NO impact on distant/metastatic/stage 4 recurrence risk. It can come back in another organ and having a mastectomy doesn't affect that risk. So it's a lot to discuss with your team to understand the actual benefits and risks of the surgery.

best wishes

MinusTwo

ratched - prodegio never came back after October 15, 2021 so there won't likely be answer there. Moth has given some good information. Looks like you are in the US. IF so, you should have no trouble getting a bilateral mastectomy.

WC3

Ratched28:

Sorry I just now saw your post. I had a BMX but there were various factors that lead me to that choice which might not apply to your situation. For example, there is bilateral breast cancer in my family.