HER2+ breast cancer

Motherof7,

I am not sure why your doctor recommended or did not recomend breast removal except that decision is pretty much entirely yours to make since your tumor was small.  From what I understand, very small tumors or DCIS is not routinely tested for Her2 status and this test sometimes takes longer to get back than the other tests.

I also believe and serve the Lord and Saviour, believe that I am healed and will continue to be cancer free for a long life. 

Motherof7 welcome to the boards although I am so sorry you have to be here. First let me say I am no expert, I can only tell you what I was told by my Dr.s. I am also her2+, which they knew from the very beginning, but my tumor was almost 5cm and in the lymph nodes. I was but immediatly on herceptin, carboplatin, and taxotere. I was told because of where my tumor was (12 o'clock) A mastectomy would be better for me, and because it was so large. After I went through my chemo, my tumor shrunk to about 2cm. I was told then I might could have a lumpectomy because it had shrunk so well, but cosmetically it would not look good.I was told there was no better advantage with having a mast. I don't know how small yours was, but if they were able to get clear margins, I would not worry too much.

I don't kno0w why you were not told about the her2 to begin with. Did they do a biopsy first? That should have told them. At any rate herceptin is very doable. Not many side effects, they just have to keep a close look on your heart. And it is THE wonder drug for us her2 patients!!

It sound like you have a bad infection in your breast, I would definatly call your dr. and let him know it is still red. I just had an infection in my right expander after double mast. I was put in the hospital for IV antibiotics. Not trying to scare you, just don't let it go.

I hope it works out o-kay, just pray to that wonderful savior of ours and try not to worry too much. You will be in my thoughts and prayers. Maybe someone who might have a little more info will chime in also! Susan  

You are right Deanna, I went back and reread her post. It did not say....I just assumed!

I'm with Sassa - I've never heard of getting herceptin without chemo. Everything I've read indicates that the efficacy of herceptin depends upon it being given in conjunction with chemo. Hopefully, your medical oncologist will clear this up when you see him. I did 6 treatments of taxol and carboplatin with herceptin and now get herceptin alone every 3 weeks. I'm sure the thought of chemo is frightening, but all of us who have had it will tell you that it's "doable."

There is lots of valuable info about herceptin on this site and also the herceptin site.

I received 4 cycles of dose dense A/C followed by 1 year of herceptin so it very much is approved to use without chemo...my doctors are at a comprehensive cancer care center.

I had Herceptin without chemo for 1 and 1/2 years.  It worked well, I also took Aromasin.

Motherof7,

You mention that you had a biopsy.  Was this a surgical biopsy (rather than a needle biopsy)?  Having a surgical biopsy is exactly the same thing as having a lumpectomy.  So if you had a surgical biopsy and the entire area of cancer was removed with adequate margins (i.e. there was a sufficient area around the edge of the removed tissue with no cancer cells), then your doctor no doubt feels confident that all the cancer has been removed from your breast.  In this type of situation, additional surgery is usually not necessary. 

You ask why it wasn't advised that you remove your breast.  Ultimately, this is your decision, but when someone has a tumor that is small enough to fully remove with a lumpectomy or excisional biopsy, then from a medical standpoint, a mastectomy usually isn't considered necessary.  The survival rate for those who have a lumpectomy + radiation is the same as the survival rate for those who have a mastectomy.

The need for Herceptin, and the questions about whether or not to have chemo, relate not to the breast cancer that was in your breast, but to a concern that some cancer cells may have escaped the breast.  These treatments are used to fight against distant recurrence, a recurrence that happens outside of the breast.  So if it's believed that you need Herceptin, you would still be advised to have Herceptin even if you'd had a mastectomy.  And if it was felt that you needed chemo, you would still be advised to have chemo even if you'd had a mastectomy.

As for whether chemo should be considered, one big factor is the size of your tumor.  You say that it was small, but do you know the exact size?  Someone who has tumor that is 6mm might not be prescribed chemo but someone who has a tumor that is 10mm might be put on chemo.  So even a small difference in size could make a difference in the treatment plan.  And did you have a sentinel node biopsy? Was it confirmed that there is no lymph node involvement?  This would be another key factor in the decision on whether or not to prescribe chemo.  Age, since you are only 65, shouldn't really be a factor, in my opinion.  If you were 80 perhaps that would be different, but at 65 I would think that if the pathology of your cancer indicates that you should have chemo, then you should have chemo.  And in any case, I think that this should have been discussed with you - if someone younger with the same pathology as you would have been given chemo, then certainly your doctor should have discussed it with you and given you the choice.

As for prescribing Herceptin without chemo, while it appears that Herceptin combined with an AI but without chemo has been seen to be effective for those with later stage BC, for those with early stage BC, Herceptin without chemo seems to be contrary to approvals and what's generally accepted as standard practice procedures.  It does appear that there is interest in this as a therapy: 

• From BC.org:  Most U.S. oncologists have favored chemotherapy in patients whose tumors are HER2-positive. The use of hormonal therapy and Herceptin without chemotherapy is particularly appealing in somebody with an otherwise "lower risk" tumor, for example, small tumor, negative nodes. The benefits of chemotherapy may be small in somebody with a small tumor and negative lymph nodes. Nonetheless, as I said above, most oncologists will recommend chemotherapy in this setting. This is something you'll want to talk about with your doctor in your particular case. At the San Antonio conference, the combination of an aromatase inhibitor and Herceptin was shown to be highly effective in women with advanced, metastatic breast cancer. Most of us who take care of patients have used this combination for quite some time, often with long-lasting results. Studying this combination without chemotherapy in women with early stage disease will be important before it becomes standard practice. http://www.breastcancer.org/news_research/archives/ask_expert/2006_12/
• From a Dr. Susan Love interview: "DR LOVE:   But, bottom line is, we haven't really tested Herceptin without chemotherapy in the adjuvant setting. But what about, you have a 70-, 80-year-old woman who you're really concerned about giving chemotherapy. Would you discuss giving the Herceptin without chemotherapy?  DR SLAMON:   Absolutely. I think you have to discuss all options with the patient. And, in fact, we've used monotherapy in a couple of examples where patients come in and - what goes on, we tell them what the possibilities are, tell them what the toxicities are, not just what we've talked about with cardiotoxicity, but the nausea, vomiting, hair loss, increased risk of infection. And many of these patients that are looking at quality-of-life issues will say, "I don't want any of that. I'll accept the therapy if it doesn't cause any of that," and for those patients, we've used Herceptin monotherapy. There aren't very many out there like that, but there are a few."  http://breast.cancerqanda.com/interviews/detail.dot?inode=38071&topic=40983&clickedONfrom=page

Here is the prescribing documentation for Herceptin, which confirms that Herceptin is approved for Adjuvent Breast Cancer only for use in combination with chemotherapy: http://www.gene.com/gene/products/information/pdf/herceptin-prescribing.pdf