For or against chemotherapy?

The NCCN guidelines for breast cancer treatment suggest endrocrine (hormone) therapy only if OncoType is less than 18. Did the doctor who is suggesting chemo give you a reason why he thinks it is appropriate in your case? The score of 18 means you should have a low risk of recurrence without chemo so chemo doesn't reduce your risk much and carries some of its own risks.

I forgot to mention I am 51 years old.

If you are borderline on OncoType DX it is a personal choice but if I knew what I know now and had your score, I'd avoid chemo.

Did your doctor say what the recurrence rate would go down to if you did chemo? That would make a difference, too. If it's only 1% or so, is it worth it?

I was in the gray area too- at 26--- this was a surprise to both my onc and me-- she really believes in the hormonal therapy---

 anyway, without chemo, my risk of recurrence was calculated at 18%, with it, 9% or below.... I jumped for it.... 

For me, it was all about what I could sleep with at night.  I had a lumpectomy with clear margins and nodes, chemo and radiation.  I don't regret any of it...  and, I just saw a study that talked about having cancer cells in the sentinel node (I had 2 small cells, but still considered node negative)  and the recommendation now is that even thought it is considered node-negative, chemo is recommended---when I read that I was SO glad I had picked chemo.

It wasn't terrible, but not great-but I was 48 at dx with young children--I expect to be around for a good long time now!!!!

Best of luck--- go with your gut- just think about how you will feel if you have it, how you will feel if you don't--- you will come to the right decision for you.......

Onco DX scoring for post menopausal people?  I thought htis was  not sidered proven as yet.

 However, as you are node neg, and looking at the other details, I think the choice would really be for you.  If you would feel better "chucking the kitchen sink" at things, then you might  want to do it.  If not, then you maybe don't need to do this.

I am doing chemo and am not negative about it, but then I am  node pos.

Good luck and also, maybe have  look at www.cancerfacts.com which has good info.

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V,aliossifova

Grade 1 is a slow growing cancer. Chemotherapy works best on rapidly dividing cells which is why it doesn't work very well for slow growing cancer. This is also why the side effects to normal tissue are generally seen only in areas of the body that have rapidly dividing cells; scalp, blood, lining of the gastrointestinal tract etc.  You already have a low risk of local recurrence just by virtue of the type and size of your cancer and without even knowing your oncotype score... even doing absolutely nothing other than having the tumor removed by lumpectomy with wide margins or mastectomy, you're very likely to already be rid of the beast for good. That's not to say you couldn't get another breast cancer someday, just that the odds are great that the one you just had is gone, gone, gone. Surgical cure is a definate reality for certain types of breast cancer.  And you also have an even lower risk of distance recurrence too - and that's what chemotherapy would be treating. 

In my humble opinion, having chemotherapy when there is such minimal risk is a major overkill - not to mention the potential risk involved with the treatment itself.  Think of it this way - chemotherapy is systemic treatment meant to kill off any cancer cells that might have escaped to other areas of the body. With a small, grade 1 tumor, the probability that cells have escaped into the blood/lymph system is minimal at best. Sure, it COULD happen, but it's not very likely and it would be the rare exception rather than the expected norm.  The oncologist who is telling you that you don't need chemotherapy recognizes and understands this and is basing his recommendation on that very minimal risk.  While I certainly don't know the logic behind the other oncologists opinion on the matter, unless there's something else that's especially concerning about your particular case,  a recommendation for chemo with a small, grade 1 would raise a red flag in my mind.  There was a time some years back when ANYONE, regardless of the cancer grade or anything else about the particular case, automatically got chemo if the invasive tumor was greater than 1 CM - but now with the advent of Oncotying, chemo isn't usually dictated strictly by tumor size anymore.  And something that's very important to keep in mind when reading forums like this, or anything else about breast cancer for that matter, is that there are major differences in terms of potential risk for both morbidity and mortality between someone with a high grade tumor as opposed to someone with a low grade tumor. They're literally different diseases.

I was diagnosed just about a week after my 49th B-day back in 2/2004. The ONLY treatment I've had was a wide margin lumpectomy with biopsy track removal and a single node removed in a SNB. Chemo wasn't suggested and I refused to allow post lumpectomy radiation, tamoxifen and arimidex. So I've had absolutely nothing in the way of treatment other than the surgery (not into alternatives either) and it's now been over 5 and a half years for me.  

Food for thought.

One thing worth looking at are the ER/PR levels on your Oncotype report.  The higher those levels, the better chance you have of having a good response to endocrine therapy.  ER+ women have a very drawn out risk period, many years, and we may need that endocrine therapy as protection, especially if that is the only therapy we are getting.  Sometimes lower ER/PR levels are what moves us from low risk to intermediate risk. Lower ER/PR levels mean that endocrine therapy has less of a chance of being helpful, but chemo may be helpful.

Valliosifova, I think Marie Kelly said it very well.

I had an oncotype score of 14, stage 1, grade 1 just like you, with no nodes involved.  I was 47 at the time (and the younger in age you are, the more likely that the doctors may lean towards chemo if you're on the borderline).  I did lumpectomy and radiation, and my Onc said that I definitely didn't need to do chemo, that it wouldn't have any benefit for me.  I do take tamoxifen, but am even questioning at times whether or not I really need that,  with such a small, low grade tumor, as some of the side effects do occasionally make me miserable.

Hi, I am 33 years of age and feeling very unsure on whether to do chemo or not. I had my lumpectomy 20th Oct and one onco said I need to start on chemo asap and another has also suggested greater survival if chemo is taken. Chemo scares me to a level I cannot explain and mostly due to info I have read on it causing sec cancers like bone cancer etc. Can anyone pls post some of their thoughts? Both onco have opted for 4 sessions of AC and then radiation and hormone therapy thereafter.

lily76-I would not presume to make treatment decisions for anyone but I also had a 2cm stage IIA but grade 2, er/pr+ and no nodes and I did chemo.  I was 36 at time of diagnosis in January.  The younger you are the more likely that chemo is a given especially with a grade 3 tumor.  I am assuming the radiation is because you did lumpectomy.  I had 4AC and 4Taxol before bilateral mx and I had a complete pathological response.  This was with a grade 2 tumor.  Chemo is scary but very doable.  Secondary cancers are scary but rare.  You are 100% likely to get BC because your already there.  Hormonal therapy is also very powerful.  If you don't do the chemo and the BC ends up in your bones then you would no longer have to fear a rare secondary cancer.  These are just my thoughts and slightly skewed because my chemo trip was not that bad and so worth it when I got my after surgery path report.  You are young so your body will be much stronger during the chemo.  I would say go for it.  We have a lot longer (hopefully) in this life for this beast to reoccur.  Get all of those little suckers now. Just my opinion and it is very kindly meant.  It is my hope for you that any treatment you choose will be a complete success! 

I went on Lupron during chemo to protect my ovaries as we did not have children before either.  We had been trying for a few years.  Do go to a fertility doctor pre chemo to get your options. You may want to freeze some eggs or if you are in a relationship-embryos. The Lupron did a great job of protecting my ovaries as I found out after they had to be taken out unexpectedly because I had started Tamoxifen and the CYP2D6 test showed that I was a poor metabolizer and needed to be surgically put into menopause to take an AI, Femara in my case. I made peace with this, it only happened eight weeks ago, but it was gut wrenching at first and so hard to be the one taking this from my husband. He did not care though as he just wanted me to be with him and well.  We are now looking into adoption.  We will be parents we just will take a different course to get there. Anyway I learned that the Lupron did a great job because my gyno said that the ovaries were "beautiful" ,seriously her words, when she took them out:) I had not had a period since chemo but this all happened so quickly that I never had a chance to get my cycles going again. You will get them back most likely if you do the Lupron.  A lot of women do.  I did not do the embryo freezing because of the hormones that I would have needed to super ovulate for a cycle. My BS said no to that but thought that the Lupron was well worth it. I hope all of this helps and except for the unexpected problem with Tamox all went pretty smoothly.  We do seem to be a minority here as many of these ladies already were moms and the others seem primarily to not have wanted to be. Take care of you but know that options to protect your fertility are out there.  Oncologists have not really been shown to be a group to be very concerned about future fertility but get a fertility doc on board and they will work together.  My oncs office gave me the Lupron shot once a month.  Tamoxifen will be the drug they put you on and assuming all is well with how you metabolize the docs will most likely ok a pregnancy in a few years, at least that is what they told me.  Good luck and best wishes.  Feel free to PM me if you have any other questions that I can help with. Oops I almost forgot to tell you that if you do the egg/embryo freezing my fertility doc told me that chemo may hurt your ovaries but does nothing to the uterus so it will be fully functional and ready to house a baby when you are ready.

Yes.  Mine were hormone sensitive and we just thought that it would be adding fuel to the fire.  A few years down the road, though, they would have cleared me for a pregnancy as long as I was still without recurrence of course.  Onc told me absolutely no way for a pregnancy the first year after treatment.  He said that studies have shown that this is dangerous.  The doc that said the risk might be minimal might be correct and there have been other women that have chosen to go ahead with the egg or embryo freezing ( and the hormones needed to make that happen).  I just felt it was too close for comfort for me.  I guess it really depends on how much you really want a biological child, as egg donors are still an option for an assisted pregnancy after treatment.  I knew that if the Lupron did not work and I had no viable eggs left then I would be completely fine with adoption.  It is different for all and I would get a few opinions before I went either way. Best wishes.