How serious is stage 1, low grade cancer?

I can tell you of my experience, but it may not be that everyone has the same one.  I am stage 1, grade 1, ER PR+ in my right breast.  I made the decision to have a BMX knowing that I would always worry about the other side.  pathology on the others side showed cysts, calcifications and a pappiloma (sp?). While all of these were benign, the potential for problems was there.  I'm told pappilomas sometimes need to be removed anyway, so I was glad I had made the choice foe BMX.  Because I made that choice, I did not have to have rads which would have need necessary if I chose lumpectomy.  I am 58 years old.

barry, I really understand how you feel. I am also a teacher, and I've had to take 5 months off because of how sick I was after the 1 chemo I had. I have been lucky in that my sub is very good, but I did worry about the kids the entire time.

As I understand it BC grows very slowly, so more than likely it's been there for a while. If you aren't comfortable with your BS suggestion I would suggest you get a 2nd opinion.

AS far as it being serious, it is still invasive even if it is stage 1 grade 1. If you look at my stats that's me as well. My Dr. with Moffitt in Florida felt a lumpectomy was all I needed at this time. As I said if you are uncomfortable with his suggestions see another Dr.

catbill I agree she needs it removed, but she has time to get a second opinion about a lumpectomy over a mx if she is not comfortable with the Dr's feelings. A couple of weeks to make her decison isn't going to cause her any problems

I had a 1 cm, grade 1 cancer and had an appointment with the surgeon within 2 days and surgery the following week.  It's invasive cancer, so by definition  it's dangerous and deadly. I would not wait until the summer, or even the spring. And any invasive tumor, regardless of grade, will eventually metastasize.

I had a lumpectomy and rads. I'm in my thirties and all three of my doctors felt a lumpectomy was the way to go. I did consult with a reconstructive surgeon who also felt a mx wasn't necessary.  But I also had multiple MRIs, all of which were clear except for that one tumor. With the lumpectomy, I missed a total of two days from work and could have taken off more time if I needed to, but I always felt okay.

I would suggest you get a second opinion regarding mastectomy vs. lumpectomy because I'm guessing your doctor is recommeding a BMX because of your previous diagnosis of high grade DCIS.  In any event, I would not wait until the summer.

The link below is to a radiology book on Google books (highlight the link and paste it into your browser).  Look at the graphs on pages 92-94 - they provide a time line of tumor growth. According to this radiologist, a low grade tumor doubles in size every 180 days. 

Best,

J

http://books.google.com/books?id=LvU_v_dP08cC&pg=PA118&dq=breast+caner+radiology&hl=en&ei=T3k7TdyFI47EgAe_6uy3CA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CE0Q6AEwAw#v=onepage&q&f=false

Throwing my two cents in...work, responsibilities, etc...must take second place to your health. I don't mean to sound cold but it is the simple truth. Believe me, you have to take care of yourself. That is the point and pure luck we have in having caught it in a early stage SO IT DOES NOT DEVELOP INTO SOMETHING WORSE. Like Lago said, a few weeks is one thing, but months makes no sense at all....Mine too was very early very low grade but I opted for full BMX with reconstruction. if you have lumpectomy, at the least you will need rads. I did not want to deal with the worry and fears over the other breast or lingering cells in the one with cancer. Please do not put this off. Get another opinon if youwish, but please do not wait.

Good luck and we are all here for you.

Barry,

As others have pointed out, waiting too long is dangerous. I, too, had stage 1, grade 1. I understand your concerns about working. I had a lumpectomy and radiation. I took off one week after the lumpectomy (and could have gone back after a couple days, if truth be told). I worked throughout radiation, just leaving work early for treatments. Please listen to what Annette said - your health is more important than your job.

Wishing you the best,

Karen

Barry - has your tumor been tested to see if it's Her2+? That made all the difference in my treatment - even though my tumor was only a Stage 1, Grade 1, ER+ and PR+ - even with an Oncotype DX score of 22 (which is low-intermediate) I had a uni-lateral mx with immediate reconstruction (and a lot of infections afterwards). I should have just waited to make this decision after getting the breast MRI (which showed no other abnormalities). A lumpectomy with rads has the same survival rates as a mastectomy...........however..........the more important decision you'll have to make will be concerning chemo treatment - do you need it or not? Did you get an Oncotype DX test done? Was your tumor Her2- or equivacal? If equivacal, you need to get the FISh test done - if the tumor is Her2+, you'll need Herceptin with chemo for a year.

I understand how difficult all these decisions are............good luck and may God's angels watch over you!

P.S. Edited to add - after my breast cancer dx 3 years ago, my thyroid was tested and showed to be hypothyroid and was immediately put on a low dose of Synthroid every day. It never interfered with any of my chemo/Herceptin/Arimidex treatments.

I was told I had a small <1cm, grade 1, stage one cancer too. That was before surgery. To everyone's surprise, it was 2 cm, grade 2 and there was a 1 cm tumor in the sentinel node. Stage 2. You really can't know for sure until it is out.

Your doctor is recommending mx because of your history and knowing that you are rejecting radiation. You can go with a lumpectomy, but if I were you, I would try to get mentally prepared to have to change plans following that surgery if anything unexpected is discovered.

Once you receive your pathology information, consult the 2011 NCCN guidelines regarding your breast cancer and the standard of care for it.

Can Stage 1 Grade 1 breast cancers metastize?  Yes.  You can read through these boards and find women who had Stage 1 Grade 1 breast cancers that metastized.  While they may take longer to rear their ugly heads, they do occur.

Furthermore, you need to be proactive in reducing your chances of getting another primary breast cancer.  You might not be as "lucky" the next time.  I have a Stage 1 Grade 1 breast cancer.  While my physicians have assured me that they think I will eventually die from something else, they are treating me aggressively to avoid not only a metastisis, but a second primary.  So far, I haven't had any side effects from my treatment.  Only time will tell if I made the right decision.

Good luck.

barry- I don't place alot of value on the Staging of grade 1 tumors. Mine was 7mm IDC, ER/PR +, Her2-. What should be the most slow growing, least aggressive cancer. However, after lumpectomy and SNB, I had 2 sentinel nodes positive. One was in the IM chain between the sternum and ribs. The other was an axillary node. My tumor was on the far rt side of the rt breast, yet one of the sentinel nodes was all the way to the center of my chest, and positive!! My BS was able to remove it (the first IM node she'd ever removed). I got unclear margins, and proceeded with a mx and had axillary nodes removed....with one more positive.

I couldn't believe my teeny, grade1 tumor had spread like it did. And I had had a mammo every year. So, I sent my path to Johns Hopkins for a 2nd opinion after they told me this kind of spread would be unheard of for a grade 1, 7mm tumor. Pathology came back the same.

For me, a stage 1, grade 1 diagnosis did not prove to be non-aggressive. I ended up with 6 mos. of chemo, rads, and a bilateral mx to treat my grade 1. Please realize this is not typical, but does happen.

Best to you...Joni 

I was diagnosed with DCIS in my right breast after a biopsy.Then had an MRI on both breasts. MRI showed 2 small area's of suspicion on left breast,therefore I decided to have bilateral MX .Went into surgery not knowing what the area's of suspicion were.Less than 1 week later I get a call from my Surgeon telling me that they both were ILC tumors. So I am thankful that I decided to go with the bilateral or I would have been in there later doing it anyway. I had no chemo or radation since my tumors were less than 1CM. could not take the tamoxifen due to blood clotting disorders so had my ovary out. Been 14 months and doing good.

I wish you the best in your decision.

Barbe, your point that the Oncotype result assumes that the patient takes Tamoxifen is a very important one. I don't know however if this means that barry shouldn't waste her insurance dollars if she is not willing to take Tamoxifen.  I don't understand enough about how the Oncotype test works in terms of how it determines your score, so I'm posing this as a question:

If someone gets an Oncotype result (which assumes the benefit of Tamoxifen), is it possible to reverse out the benefit of Tamoxifen to determine what the recurrence risk would be without Tamox?

- We know that on average Tamox. reduces recurrence risk by approx. 45%.  So is it as simple as taking the recurrence risk as determined by the Oncotype score and increasing this risk percentage by 45%?  Would that provide an approximate risk level for someone who is not planning to take Tamoxifen?  Or alternately, is enough information provided within the Oncotype results that a doctor would be able to do the math to determine the benefit without Tamoxifen? And therefore could the Oncotype test still provide a meaningful (or at least informational) result to someone not planning to take Tamoxifen?

- Or is the Oncotype more precise in determining the specific benefit of Tamox. for each individual, based on the biology of their cancer?  In other words, in some cases might the benefit of Tamox that's incorporated in the Oncotype result perhaps represent only a 15% reduction in risk (maybe because the tumor is only mildly ER+) while in other cases the Oncotype might represent a 65% reduction in risk (maybe because the tumor is highly ER+)?  And if these differences exist and are built into the Oncotype score, is there no way to know from the information provided what the expected benefit of Tamoxifen is for each individual? 

Does anyone know?  

Also, for anyone with DCIS who is reading, just to clarify Barbe's point, it is true that someone initially diagnosed with DCIS can go on to develop mets.  However, for this to happen, one of two other conditions needs to happen first:  1) The individual has a local recurrence which is not caught until it has advanced to become invasive; or 2) The individual was initially misdiagnosed and in fact there was some IDC in the first diagnosis (i.e. the cancer was not pure DCIS). The first is what happens in the majority of cases; the second can happen but is very very rare. For the second to happen, someone would have both an undetected invasive component hidden in their DCIS and some of these invasive cells would have moved into and through the lymphatic system undetected or moved into the vascular system undetected prior to the surgery to remove the cancer from the breast.

In most cases where someone progresses 'from DCIS to mets', if there was not an intervening invasive recurrence (which changes the diagnosis to IDC), it pretty much always turns out that there was a known invasive component right from the start.  In other words, although someone considers herself to have DCIS (which is how I often think of my diagnosis since I had over 7cm of DCIS), in fact the diagnosis is early Stage I IDC, which could be either DCIS-MI (with a microinvasion, which is my diagnosis) or perhaps DCIS with a small T1a tumor.  

barry, my apologies for taking your thread off topic but I know that whenever someone comments about DCIS progressing to mets, this has the effect of scaring a lot of the newly diagnosed DCIS women. Hopefully the discussion does not stay on this topic and gets back to your question.

Jacee, 

Good point. When I was waiting for my oncotype results, I read an article in one of the Oncology journals that examined the correlation between tumor grade (well differentiated, moderately differentiated, poorly differentiated) and the Bloom Richardson score versus oncotype score. Apparently, a low grade tumor is not predictive of the oncotype recurrence score.  

J

My cancer never showed up on a mammogram or 2 high level ultrasounds. It looked and felt like a fibroid but my surgeon and I had a bad feeling about it. We discovered it at 1 cm; as it started growing over a six month period, I had the biopsy. 1.2 cm. er+pr+her2- breast cancer. I had a double mastectomy because I never wanted to go thru this again. My waiting 6 months allowed the cancer to get to the sentinal node, 1.98 mm, right below the comfort zone. 19 axillary nodes later, it had not spread. If I had waited one more month it would have gone to my armpit. Get it out, get a lumpectomy for now, decide on reconstruction later.  Please take care of yourself.