Onc. Rec No Tamox-- Anyone in a similar situation?

Welcome Newyear13. I dont fit into your category but I am sure someone will come around who does. It also may be helpful to post this on the stage 1 thread or IDC thread. Im glad they caught it early. Hugs

According to the 2012 NCCN breast cancer treatment guidelines for tubular and mucinous breast cancers, node negative, < 1 cm NO adjuvant therapy is recommended. Between 1 cm and 2.9 cm the guidelines say to "consider adjuvant therapy."



Have you had the Oncotype DX test? Although it isn't part of the NCCN recommendation for our rare types of BC, if you are ER + ... You can request the test. It will tell you your chance of distant recurrence at 10 years.





Good luck!

Hi newyear.  I see this is your first post; welcome!  I hope that you find lots of help and support on these boards.  

It makes sense to me that you are not doing radiation - there's nothing left to radiate; and no chemo also makes sense for a small, node negative, grade 1 tumor.  But, I find it unusual that you have not been encouraged to take tamoxifen.  If you look at the standard of care as defined by the NCCN guidelines for BC treatment, all with invasive BC should do endocrine therapy.  Since you're pre-menopausal, this would mean tamoxifen.  Have you met with an oncologist? Or, just your surgeon?  I would insist on having a meeting with a medical oncologist who treats a lot of breast cancer patients.  Also, did you get OncotypeDX testing?  The oncotype test looks at genetic markers on the RNA of a tumor and predicts how likely it is that the cancer will recur and how effective chemo might be.  The test is specifically for node negative, hormone positive patients and is standard of care.

I don't know where you are, but if you had your surgery at a local hospital, you might want to travel to a hospital that has a big cancer center and have a consult with one of their oncologists. 

Good luck to you!

According to the NCCN Guidelines, hormone therapy is NOT recommended for anyone who has an invasive tumor that is 5mm or smaller in size and no nodal involvement.  See page 72:

http://www.nccn.com/files/cancer-guidelines/breast/index.html#/72/

For Tubular and Colloid breast cancers, as VR has indicated, the guidelines are different.  For these cancers, hormone therapy is NOT recommended for anyone with a tumor that is smaller than 1cm in size with either no lymph node involvement or with no more than 2mm of lymph node involvement.   See page 76:

http://www.nccn.com/files/cancer-guidelines/breast/index.html#/76/

newyear, based on this it seems that the recommendation of your doctors is consistent with the current treatment standards. It is, as your doctor explained, a risk vs. benefit assessment. Since your risk from the breast cancer itself is so low, the benefit you'd get from Tamoxifen is also very low (a 50% reduction of a very small number is going to be a even smaller number). Even though there is only about a 1% - 3% chance of serious side effects from Tamoxifen, with such a small benefit, in your case the risks would outweigh the benefits. That's the rationale behind the recommendation and the guidelines. 

Lemon... To add clarification.. Did you have tubulolobular BC? That is a mixed diagnosis? IDC with tubular features is considered "pure" tubular BC. Again, the NCCN guidelines for "pure" and "mixed" tubular are different. "Mixed" tubular and "mixed" mucinous follow the general IDC guidelines.