deciding chemo or no chemo...help!

I would ask you onc if it were her sister what she would recommend. Also keep in mind that you will be doing some kind of hormone suppression. If you decide against chemo you must commit to that hormone suppression for 5 years.

Grade 2 is intermediate grade. Grade 1 is low grade.

and nothing wrong with getting a second opinion from another onc.

i would also get a second opinion, just so you have another

viewpoint...many oncs recommend chemo just to cover them

selves,..but remember chemo can have serious side

effects also...many times that is not mentioned....looks like

you will need somekind of anit estrogen therapy as well.

You will rest better having two different doctors views..

That's a tough one. I would have no hesitation to say "no chemo" except for the angiolymphatic invasion.  Personally, that would make it a little tougher for me.  I tend to lean more towards the chemo may do more harm than help ~ in lower onco score cases.  Sometimes people still get recurrences even after chemo.  Unfortunately, nothing is guaranteed with bc.

My oncologist actually did tell me what he recommended would be the same for his wife or daughter. We have very similar stats, including age.

I'm a little surprised  you have all this info BEFORE the BMX?  Did you have a lumpectomy first? I thought they need to do final pathology and oncotype score from the tissue taken during surgery?

It sounds like you are doing alot of research and hopefully that will empower you to make the decision that feels best for YOU.  Hugs to you and hopes for a smooth and speedy recovery from your surgery.  I am 7 weeks out and feel pretty damn good.  

mdg

I don't know what this lymphatic invasion issue is, but honestly, that would give me pause.  I think the second opinion would be critical--

I was a worrier--- and I think I have said this before-- once I made the decision to go with chemo, I just never looked back.  And I have not lost a night's sleep since.  I think you know yourself well enough--- the % might or might not matter--- all helpful to make a decision-but you don't want to be laying in bed at night second guessing yourself.

I did chemo because I have kids--- and I wanted to give myself the best possible chance to be around for a very long time...... it was an easy decision, but then again, my onco score was in the mid 20's.  

Get the second opinion then really think about it---- I think the right answer will absolutely rise to the top for you--you are doing due diligence...... but knowing yourself is half the battle.

mdg...

I am 48 (as of yesterday) and a woman in her 40s is not a reason to skip chemo... I have 4 friends going thru this, age ranged 37-50,and all of us are in chemo except the 50 year old... and these are not friends I met at the cencer center, these are people i know.

As much as chemo isn't fun, it does give you a better chance that stray cells aren't floating around your body that can show up later. I wouldn't want to think later, when I'm 55, 65... that I hadn't done everything I could do to prevent recurrance. My onc decided to do chemo without the oncotype because he said he would't sway his opinion with the oncotype... He said that my tumor at 1.9cm was a larger stage 1... I had a micromet in my sentinel Lymph node, meaning even tho it was small .38mm, it had migrated... not liking that... I think the only way I'd feel comfortable without chemo would be if I had DCIS... I am young at 48 and have a LOT of life left... so I am pleased with my chemo and agree with the decision.

Good luck and get a few opinions.

Like everyone else, I think you should get another opinion to ease your mind.  My oncotype was 17 as well, but I think due to my age (36), my oncs wanted to be as aggressive with me as they could.  At first I was shocked as the type I had was supposed to be slow growing (and I was WAY naive) so I got in with another onc for a second opinion, consulted over email with one at another cancer center (thanks to a friend), and talked to a private doctor who is also big into alternative therapy as well and they all said the same thing: chemo.  It all came down to my age they said.  I felt so much better after getting another opinion and it made the decision a lot easier and I was lucky and did really well on the 4 rounds of TC.  That being said, if my oncotype score was lower (say, under 10), I think there's a chance they would have just recommended hormone therapy, who knows?  Good luck with everything!

You are totally young!  Sorry, I hope my comment didn't come across wrong, I was just stating what they we telling me.  When you're premenopausal like us, they want to hit it with as much as they can and as hard as they can although I did decline a few other recommended therapies.  My one onc told me that if I was 18 or over in my oncotype score, they would have had me do AC-T, and I really didn't want that at all (and I could have just said no anyway).  I wasn't excited about chemo, but it went by really quick and I did well on it (with the help of an ND among other things) and after radiation I'm looking forward to detoxing it all out of me as much as I can.  Everyone is different though.  When you finally come to a decision, it will be what you feel most comfortable with and that is half the battle of getting through a lot of this  Good luck!

MGD I just posted on the other thread. Get all the pages of the oncotype chart...look at where you fall, the margin of error, and the mortality rates. You can make a case for skipping chemo...or probably for doing it.

On the node positive chart there was really only a benefit north of 20.5. My onc said up to a 20 he was fine with people not doing chemo. The bars on the node negative chart are a little different , because there is much better data.

I think if you want to do chemo I would get a couple of opinions.

You might also be a good CMF candidate.

Good luck!!

Good luck and feel free to message me...or look at my old threads on this.

I just went thru this decision over Christmas.  I'm 52, ER/PR +, HER -, 1 cm, neg nodes with an Oncotype of 17.  I have 10 year old twins which somewhat puts me in the "younger" situation.  However, I decided against the chemo - downside seemed higher than small potential risk reduction.  I just finished day 15 of accelerated whole breast radiation.  Will be starting Femara in about a week.  I was on HRT before I got the cancer diagnosis in November so having wicked hot flashes and am emotional wreck.  Has anyone hear anything on use of antidpressants for hot flashes with potential interaction w aromatase inhibitors?  I know there were issues with Tamoxifen.  Meeting with my oncologist this afternoon so would love some advice.

katherine, my oncologist said that Effexor is a very good antidepressant for hot flashes and there is no interference with AI's.  there are a lot of women on different threads that use it.  I researched it and decided against it, especially because my hot flashes mellowed out.  The only down side that I have read is that it is very hard to stop taking it and you have to ween off it slowly or you will have withdrawals.  You might want to check on the Hormone Therapy section.  I know there were lots of discussions reguarding effexor there.  good luck!

I was 42 and in my onc's eyes that is young. He told me if I was 20 years older he would be comfortable of not recommending chemo, but being in 40-ties was way too young.

mdg, it sounds like you had a great appointment.  Please keep us updated as to what the tumor board thinks and what you decide.  I know its such a difficult decision.  If it makes you feel any better I have heard that the TC X4 is easier on the body than ACT (not that any chemo is easy).

bdavis, I also had micomet in my sentinal node.  Today someone posted an article that might make you rest even easier!  it was on the clinical trial forum called "analizing the sentinal node for tiny mico tumors". It was very an encouraging article.

And MDG... TC isn't bad... if you need it, you should be fine.

mdg, thanks for the info from your onc about angiolymphatic invasion.  My biopsy showed no evidence, but the surgical pathology report did.  It makes sense that taking a chunk of tissue out of the tumor would cause it to "react".  I am going to ask my new onc about this.  The previous one I went to (I'm also in the Detroit area) practically started the conversation with chemo, didn't even discuss Oncotype until I brought it up, and never pulled up Adjuvant Online for me or give hard data--and obviously in a hurry.  I think having an onc you can trust and relate to makes all the difference in the world, given the important role they play.