Mom's oncotype is 46 but she wants to refuse chemo

ailihe - You are in a difficult position.  An oncotype of 46 that is not HER2+ is a very agressive ER/PR+ cancer.  I'm guessing it's not HER2+ because TC is suggested, not TCH.  Correct?

Here's the problem I see w/o chemo.  She may not be able to tolerate the AIs.  Then she is w/o any systemic treatment, really important for such an agressive cancer.   The dosage of chemo is given based on body size.  This is one of the rare times that treatment is not one-size-fits-all.  So for once your mom would be getting an optimal dose, unlike with most pills where dosage is based on the size of an average person (usually a man).  Chemo can be given very slowly to allow the body to adjust to the meds. 

Her MO needs to make it very clear to her what the chances of a distant recurrance are.  If mine was 20% with 5 yrs of tamoxifen (or AI) w a 30 oncotype, then at a 46 w/o chemo and possibily no AI (this has to be considered if she refuses or cannot handle the meds), her chance of distance recurrance may be worse than the flip of a coin.  Treatment for this is much worse than 4 TC.  

If your mom still refuses (certainly her right) after getting more information, it might be wise for her to see a counselor who specialized in cancer treatment to help determine exactly why she is refusing treatment.  Something else might be at play here.   

If your mom fully realizes her chances of recurrence...fully realizes that she could start chemo and stop if the side effects got to be too much...i.e. she is making an educated rational decision to forgo chemo.  Then my humble opinion would be to honor her choice and love her up and move on.  I know it's hard because you want your mom to "do everything possible", but she's the one who needs to be comfortable with her choice.  

Hugs to you and your mom.  

alilihe- It is very understandable that your mom is afraid and scared of the chemo side effects because I'm sure she has heard/read enough stories of people having a terrible time with chemo and no one can predict how she will react to the chemo.  However, there are things one can do to ensure one maintains a sense of control over the situation.  For instance, before I started my chemo, I was given a cancer cookbook that guided me as to what to eat the day before the chemo treatment and the day afterwards and how to eat when one is experiencing the chemo side effects.    My oncologist and her staff continually encourage me to contact them as soon as possible when I have questions about my chemo and when I'm having side effects.  To them, the sooner I call, the sooner I can get help.  From my personal experience, I, too am very sensitive to medications and the idea of putting more medicines of any sort isn't something I want to do.  However, here it is necessary and all I have to do is call my doctors for help when and if I'm having a reaction. 

I think the fear of the unknown and not being in total control over the situation with chemo may be more frightening to her than anything else.  I know its difficult to understand how someone choses to not have chemo which will last only a few months for the opportunity to extend one's life for much longer.  I know you love her dearly and hope she will realizes the true impact she has on her life and the lives of others when making her decision.  Wishing you and yours comfort and peace as she makes her decision.

Flipping the coin, your mom has a 69% chance of it not coming back. Chemo is odd....my friend breezed through one of the harshest treatments for her Stage 111c breast cancer. She managed 11 years before it came back and is now on chemo which is more difficult for her now but is willing to take to keep alive. Another friend is 6 years cancer free deciding against all adjuvant therapy for her Stage 11a, grade 3 breast cancer. Knowing all the information, one must then respect another's decision about treatments. It is difficult.

Chemotherapy does not cure cancer. I agree with her...enjoy good quality of life and enjoy. I refused chemo, did radiation, had some Herceptin and told onc to jump in a lake if he really thought there was any real clinical evidence that aromatase inhibitors were beneficial. I have very high grade BC and have been around for many years. Don't let her get poisoned if she is intelligent enough to realize it doesn't work. Let her make her own decision.