Maximum time between Mastectomy and Chemo.

I was told by an oncologist that there is a 3 month "window" to react in. I missed it. Well not me, my surgeon had heart surgery so my follow-up appointments kept getting bumped. Then when I finally saw him he said "Oh, keep the big guns for next time!"

Once you open the site to oxygen, the cells go wild as they thrive on oxygen. 

Sheedap ~  I was in a similar situation in 2008 when I had to wait for a bit of necrosis to heal before I could start chemo, and my UCLA oncologist pointed me to research that showed no difference in outcome for women who started chemo one, two or three months following surgery.  I'll see if I can pull up that research and will add a link to this post if I can find it quickly.  At the time, there was no research beyond 3 months, and I don't know if there's anything more recent.   

I ended up waiting 10 weeks.  When I asked at that point if I could wait one more week to attend a family wedding across country, I was told, no -- that waiting for a medical reason was okay, but absolutely not for a personal reason!  So I think they still felt some urgency about getting it done.    Deanna

Here's one I just found that's even better and should ease your mind:  http://jco.ascopubs.org/cgi/content/full/21/20/3792

Here's the one I was referring to above: http://www.jco.ascopubs.org/cgi/content/abstract/24/30/4888

If at all possible, I think I would push for your Mom to aim for that 3 months mark.  Good luck!

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"The soul would have no rainbow if the eyes had no tears" Native American proverb
Diagnosis: 2/1/2008, 1cm, Stage IIa, Grade 3, 1/16 nodes, ER+/PR+, HER2-

dlb823 -- thanks for the pointer to the research -- it's always helpful to have real data on these questions. But I wonder if the BCs included in the study were HER2- or +. Hormone-stimulated cancers (ER+ and/or PR+) do tend to grow very slowly and a delay in starting treatment might not make any difference in outcome. But HER2+ cancers can grow VERY fast -- from 0 to 6cm in the case of a colleague of mine. For me, I got lazy and put off my regular mammogram for about 3 months, which picked up a very small tumor. My onc told me that had I had the mammo when I was supposed to, it probably wouldn't have been picked up and then if it had been another year before the next one, I might have been a lot further down the road than Stage 1a. So, Sheedap, what does your mom's Onc say? I'd take his/her advice over anything posted on this forum, but I'd also not mess around with a HER2+ cancer!

Excellent point, jenbal -- and perhaps the reason a couple of others who posted to this thread were told 4 weeks.  I'm so glad you raised the Her2+ issue, which hadn't occured to me when I relayed my experience or provided those links.    Deanna

Thank you, Sheedap, for the link.  It's an interesting article.  

I tested positive for Her2, but not "highly positive".  My cep17 ratio was about 2.4; 2.2 is the borderline for that test.  (Note: I'm not a medical professional and I learned all this stuff on the internet, by googling every word on my path report.)  I was also 90% ER/PR+.  This all means that some parts of my lesion were one thing, and some were another.  My middle of the road scores on the SBR scale might have been mitigated by the fact that some parts of my lesion might have been less/more assertive than others, because all the cells across my tumor weren't identical.

All this by way of saying, I'm in year 2 of Herceptin because I'm not sure of any of this. But my own opinion is that you get one whack at "early" stage, and my instinct was to be as aggressive as my providers would allow me to be.  I tolerated all of the treatments very well.  I was 56 at the time, and in good health, although I have a cardiac arrythmia and a lot of allergies.

I liked the article that you shared, because it does shed light on the gray areas that doctors seem to not even try to explain to patients.  When I asked my physician's assistant about retesting my Her2 level, we agreed that that meant I could be denied Herceptin.  Not that Herceptin wouldn't help me, because that is the grey area, but that I could lose the option of getting that treatment on the basis of the retest.  I don't think either of us thought that that would happen, but why tempt fate or the insurance company? I didn't retest; I started a second year, which could well mean I'm being overtreated.   That was the risk.

Regarding your mom's situation, I can understand her feelings.  I imagine she feels very secure being near her family and that's really important when you face what she is facing.  I hope the medical oncologist you consult can provide good guidance.  It is valuable time, but that's her point too, I guess.

Warmest regards,

Cathy