What are the stats

Has she been to see an Oncologist? They will be able to tell her stats, treatment versus no treatment. I personally have always been told with invasive cancer, no matter how small, that lumpectomy is always followed by radiation. If she had had a mastectomy, then most likely no rads if they had clear margins. Good luck to your friend with her decisions. I know it is mind boggling the choices we have to make regarding this disease, and sometimes wonder myself if the treatment is worse than the disease. Take care!

Dee~

The lifemath site will give her stats if she doesn't have hormone therapy, but it doesn't cover not getting rads with a lumpectomy. I have read that local recurrence (i.e. cancer coming back in the breast) without lumpectomy is around 40%. That wasn't broken down by stage, but usually a lumpectomy would only apply to stage I or early stage II. Local recurrence with lumpectomy and rads is about 8%.

Lifemath calculates for mortality but it doesn't calculate recurrence. There is another site that her oncologist can use, adjuvantonline, that calculates for recurrence as well as mortality.

Please remind her she has an invasive cancer.  I do as well and would have done exactly what I am now, even if my cancer had been smaller.  Best wishes to her, whatever she decides.

Linda

I found it - here is Adjuvantonline's info on when their estimates apply and for lumpectomy, you have to be planning to have rads (7). They don't say anything about HER2 status on their list, but having compared their data to the MD Anderson study on women with tumors less than 1 cm, I'd also say that they don't do a good job for HER2+. They don't take HER2 status into account in their tool and they don't handle Herceptin chemos. I understand the latter because there aren't long term (10 year) results for Herceptin yet, but not the former:

Breast cancer outcome estimates made by Adjuvant! are for women who have the following characteristics:

1. Unilateral, unicentric, invasive adenocarcinoma.

2. Prior definitive primary breast surgery and axillary node staging.*

3. Not undergone pre-operative systemic therapy (usually referred to as neoadjuvant) or radiation therapy.

4. No evidence of metastatic or known residual disease.

5. No evidence of T4 features (extension to skin or chest wall).

6. No evidence of inflammatory breast cancer.

7. Plans to complete radiation therapy if the patient has had a lumpectomy.

For patients with special histological subtypes, for example, pure tubular, medullary, lobular, and mucinous histologies, the Help Files on Special Histologic Subtypes should be reviewed. Also, for patients with inflammatory breast cancer, the Help section on Special Histologic Subtypes should be consulted.

ICanDoThis wrote: Susan Love quotes a study of Grade 1 who went without radiation, that was halted early, because the amount of recurrences was "unacceptable."

I've never heard of study halted early that was specifically done on grade 1's regarding lumpectomy without radiation. I recall something a while back that was halted early, but I really doubt it was soley a grade 1 study...but then again, my menopause brain may be acting up LOL. Even those I've seen that are directly trying to answer the question of whether or not there are some who can safely omit radiation after lumpectomy have included grade 2 in the mix.  I don't have Love's book - could you take a look and see what study she is referring to?

SHELLY,

Your friend has excellent stats... very small tumor, grade 1, node negative, hormone receptor positive and her2 negative (BTW grade 1 is almost, if not always ER and PR positive and Her 2 negative) all add up to a very low rate of recurrence - especially if her surgeon was able to achieve wide, clear margins. 

Specific recurrence stats from the large scale studies (those on which treatment standards are based) regarding grade 1 lumpectomy without radiation are difficult to pin down for a number of reasons but  primarily, large studies always include the more aggressive grades 2 and/or 3 and so the overall results always reflect a recurrence rate that is much higher than if grade 1 had been analyzed separately. Whenever you hear or read a recurrence rate of up to 40% for lumpectomy without radiation you be certain, without even reading the results of the study, that the high rate is reflective of the inclusion of widely variable prognostic factors of those included in the study.  In order to determine the recurrence rates for small, grade 1 BC after lumpectomy without radiation, the information has to pulled from within the larger body of the data. from these studies...and unfortunately, that information is not always published or even examined. 

Here's an example of a small (there are others as well), single institution study done with the specific purpose of trying to identify those that can omit radiation after lumpectomy...and even this one, includes the higher grade 2's but at least offers the information necessary to separate grade 1's from the mix.

http://www.annalssurgicaloncology.org/cgi/reprint/11/3/316.pdf 

You'll notice in reading this study, that they are able to identify certain prognostic factors ("ideal characteristics") which predict for low rate of recurrence (5-6%) after lumpectomy without radiation for short term follow up.

. These factors are; 1) older age  >50 years

                             2) smaller size tumor  1.5 cm or less

                             3) lower grade - grade 1 or 2

                             4) adequate surgical margins  1 cm or greater 

One of the most important things to understand about grade 1 breast cancer is that it is non-aggressive and only very rarely results in eventual death. Therefore a recurrence of grade 1, be it locally or otherwise, does not carry with it the same degree of life threatening consequences that grade 3 and some grade 2 breast cancers do.  Grade 1 is a completely different, and much less threatening kind of breast cancer yet they generally treat it, in regards to radiation, just like the higher grades.   In contrast to the higher grades, Grade 1 breast cancer is the least likely to reoccur and when it does, it doesn't usually present itself  until at least 5 years have passed (and often much longer). So, it's not unusual at all for grade 1 breast cancer treated only surgically with lumpectomy and wide margins to NOT reoccur within the first 5-10 years. It can take a very long time for a sluggish little grade 1 to grow large enough to even be detected...and when/if that occurs, simply surgically removing it again is a reasonably option.

My own stats are similar to what you've posted about your friend (although you didn't mention her age or menopausal status) except that my tumor was nearly twice the size at about 1 cm.  I was diagnosed a week or so after my 49th B-day but already in a natural menopause since the year prior. I refused EVERYTHING except the lumpectomy and it's now been 5 and a half years since my diagnosis in 2/2004 with no known recurrence thus far. Something to think about.