How serious is stage 1, low grade cancer?

barry, How you set up a time to see another BS? I know how you feel, and think at this point you should hear what they might say. By the way are you at a BC center? I went to a BS connected with a cancer center, and am very glad I did.

Hi Barry,

I am probably going to have a bi/lateral on Thursday- I am seeing the 2 doc's tomorrow. I have stage 1  5mm- nodes unknown. My mother, aunt, and others had bc. I had a supervisor who mentored me for several years and was only given a lumpectomy.  Within 3 years in came back in the breast bone and later in spread...Because of everything I have seen,  and having extensive lcis as well I am having a bi/ lat.  I am not happy and I am scared but I hope I don't need chemo and want to go on. The onco already stated that she would like a trial of tamoxefen to kill off any sleeper cells- so I may even try it. So  I understand- I work in a school system and it does make it challenging, but sometimes you just need to take care of you so that you can take care of everyone else.  Good luck and hang in there.

Good luck this week on your surgeries...the key is to take care of yourselves and make the deicsion that is right for you. My thoughts will be with/on you this week.

Barry, a galpal of mine had under 2cm breast cancer, stage 1 7 years ago (at the age of 36) and she ended up having a lumpectomy, chemo and rads and then tami for 5 years . They factor in age, size, and, in her case, margins. My margins were wide because I said "Take more than you need to. I have enough to spare!). In my friend's case, one side showed the margins were too close so they decided better chemo and kill it than the possiblity of it returning.

I also worked through the whole event...I took the week off after my lumpectomy because it was planned already as my summer vacation and I had not idea if all the ;fatigue' stuff I had read about would affect me ...I worked through rads...would teach in the am, do a session right after lunch, drive across town for rads and then come back to give feedback to the teachers...not ideal but it was better than going home after rads and staring at the ceiling thinking dark thoughts, which was mor emy fear than the rads.

I would say 'Get 'er gone' Barry. It is small now so don't wait until it is more of a problem if you can help it.

Barry,

I dont' understand why you can't take estrogen inhibitors if you're HYPOthyroid. If you were hyperthyroid like me, I would understand. I can't take estrogen inhibitors and it drives me nuts, as my BC was so strongly ER/PR positive.

Estrogen is a thyroid uptake inhibitor. So, the more of it is in your body, the lower your thyroid hormone. The moment you start inhibiting it, then the thyroid starts perking up - so this should actually help with your Hashimoto's and you should need less thyroid hormone treatment. I cant' take the AI's because if I take them my thyroid starts going berserk and my free T3 and free T4 leves start skyrocketing.

barry you're so right we all must do what is right for us. By the way if you are considering the mammasite radiaiation I would highly recomment it. For me it was very easy. Just don't let any Onc. rush you into chemo in too short of a time after it that is where my problems started. As far as my tumor grade you can see my stats. The only thing that caused me to stumble was my Oncotype score of 24.

barry, I was just reading the posts discussing whether or not chemo is given to those who are Stage I and I thought that I would refer you to the NCCN treatment guidelines. I see that voraciousreader beat me to it. ;-)  The NCCN guidelines are the treatment standards used by most doctors in North America (and probably beyond); they are updated annually and they really do represent "standard of care".

Here is the Physician's guide, the ones that doctors use. You need to register to be able to access the info:  NCCN CIinical Practice Guidelines in Oncology - Breast Cancer

Here is the Patient's guide, which you can access without registering: NCCN Patient's Guide - Breast Cancer  

If you look at pages 13, 15 and 17 you can follow the treatment recommendations for those who are have a mixed tumor, are Stage I, node negative, ER+ and HER2-. For grade 1 tumors, the guidelines suggest no need for chemo if the tumor is less than 1cm in size however for grade 1 tumors that are larger than 1cm (Stage I includes tumors up to 2cm in size), they recommend using the Oncotype test as a guide as to whether chemo would be beneficial or not. For those who have grade 2 or 3 tumors, they recommend using the Oncotype test starting for tumors that are 6mm in size and larger. So clearly they are saying that there are cases where chemo should be considered for patients with even quite small Stage I tumors. 

I hope that the guide is helpful to you.  

barry just to let you know the chances of being BRC+ if you are Ashkenazi Jewish are slightly higher. If there is no history of breast cancer in your family there is probably a very small chance you will test positive. I took the test too because I'm Askenazi Jewish. There was no history of breast cancer in my family till me. I tested negative.

Good luck with the test. I hope you get a negative too.

  Barry - Are you scheduled for an MRI BEFORE the lumpectomy?  This study, reported at the 2009 San Antonio breast conference, came out a few months before my diagnosis of mucinous breast cancer.  What it is saying is that if you have a mucinous breast cancer, there exists a possibility that you have more than one.  In my situation, the mammogram missed my tumor.  The ultrasound found it. And, the MRI found a tiny bit of DCIS located right next to the tumor.  I was offered Mammosite, but chose full breast radiation because of the small risk of all of those tests being inaccurate.

Also want you to know that the size of your tumor will not be "official" until it is removed and the surgical biopsy is done.  

Once again, good luck! 

  

  

MUCINOUS BREAST CANCER IS OFTEN
MULTICENTRIC-MULTIFOCAL


December 18, 2009 (San Antonio, Texas) - A
rare subtype of breast cancer, described as mucinous because the tumor produces
mucous, has long been associated with a favorable prognosis, but new research
suggests that the picture may be less rosy than previously thought. Researchers
found that about one third of these women have multiple tumors that are
undetected by mammography and ultrasound, and they caution against
undertreatment of this patient population.
he new findings were presented in
a poster here at the 32nd Annual San Antonio Breast Cancer Symposium by George
Perkins, MD, from the Department of Radiation Oncology at the University of
Texas M.D. Anderson Cancer center in Houston.
"While mucinous breast cancer is thought to be a disease with a favorable
prognosis, our study is the first to identify it as one associated with
significant multifocal presentation, which is a potentially unfavorable aspect,"
he said.
"In recent years, there has been an overall trend toward minimization of
treatment for women with this subtype, because these mucinous tumors are
considered to have an extremely favorable prognosis," Dr. Perkins explained in
an interview. In particular, there has been a trend away from using whole-breast
irradiation in these patients, so some patients receive no radiation at all,
whereas others are treated with partial breast irradiation, he explained.
"Our study shows that that about one third of these women have more than a
solitary lesion. This disease may be more multicentric than previously thought,
and this is the first time that this has been reported," he said. These new
findings suggest that undertreatment may be a "significant hazard for patients,"
he added.
It is important that the
pendulum does not swing too far.
"You have to be very careful about offering no treatment or minimized
treatment," he said. "In an era where there is a concern about overtreatment, it
is important that the pendulum does not swing too far so that we are
undertreating."
Claudine Issacs, MD, director of the Clinical Breast Cancer Program at the
Georgetown Lombardi Comprehensive Cancer Center in Washington, DC, who moderated
a press conference at which the findings were highlighted, added:
"Partial-breast irradiation is an investigational treatment and should not be
offered as a standard of care."
Large Series of Rare Tumor Type
Mucinous tumors are diagnosed in about 2% of all breast cancer patients, but
they are more common in older women. This subtype is found in about 8% to 10% of
women 70 or years or older, but in fewer than 0.5% of those 35 years or
younger.
The M.D. Anderson team reviewed the charts of 264 patients diagnosed with a
pure mucinous carcinoma from 1965 to 2005; the median age was 57 years, and
median follow-up was 14 years. "This is one of the largest single-institution
experiences with a relatively uncommon subtype, and it has a significant
long-term follow-up of patients," Dr. Perkins said.
The favorable prognosis is apparent from the long-term follow-up, as shown in
the table below.
Outcome After Long-Term Follow-Up



Outcome
5 Years
10 Years
15 Years

Overall survival rate (%)
95
97
97

Distant metastases-free survival rate (9%)
88
95
94

Local regional control rate (%)
83
92
85
On initial examination, only 10% of these women had a multicentric/multifocal
presentation. However, a detailed pathology review revealed a 38% rate of
multicentric/multifocal disease after resection, which surprised the team, Dr.
Perkins explained.
"We had previously been surprised by the decreasing age at presentation in
this population, and by the regression of favorable outcomes toward the lower
outcomes of other common breast cancer subtypes over time," he explained in a
statement. "This reinforces our commitment to interdisciplinary care and true
personalized patient treatment in this variant," he said.
There needs to be a move away from "the assumption that it may not matter
which treatment approach is taken because this is a favorable disease," he
added.
32nd Annual San Antonio Breast Cancer Symposium (SABCS): Abstract 4117.
Presented December 12, 2009.

I also opted for a fully radiated breast rather than joining a ne wstudy in Canada that only radiates the site of the cancer and does it 2x per day for fewer days...I figured...if you are going to radiate me, do the whole area and zap those cancer cells ....I had excellent margins (I had told them to take a nice big piece of breast thank you very much) and all the 'right things'....receptor positive etc..excelt it had lobular features which means a 50% chance it will be found in the other breast within about 14months, according to all the research I have done and my surgeon and oncologist and radiologist were all in agreement.....but I still did not feel like taking a chance and just radiating the area it was found in. So I opted for the tried and true method....

Barry, I wish you would reconsider having the MRI re-done. I had a screening mammo after I found my lump, followed by a diagnostic mammo and an ultrasound.  Nothing else was found until I had the MRI which showed an additional spot of IDC and a spot of DCIS. 

hey all had bilateral masectomy and immediate one step reconstruction Thursday evening. I am home now- suprised how painful this is on the chest. My sweet husband says I look great. The preliminary lymph nodes are negative so maybe I will be done with nightmare in a few weeks. The onco still wants tamoxefen so we will see.

take care and prayers to all

Ilovechocolate...I am curious about the one-step recon... Did  you have nipple sparing or just skin sparing?? And when they take out the breast tissue, they just then slip in an implant?? If thats the case, why do people go thru TEs? Does it depend on how much skin is there to use?? And when people do flaps, they take muscle to support the belly fat, what supports the implant to keep it in place? Or maybe because its synthetic it doesn't need support?