Help with Treatment Option!

Hi TaiTai,

Welcome to BC.org. Sorry to hear about your diagnosis, but welcome to our forum. I've gotten a lot of helpful information and support here, and hope you will too. I'm sorry to hear you were diagnosed at such as young age. I was diagnosed at 46 and thought that was much too young, so I can't imagine what you're feeling right now. And to get conflicting advice from the two tests and two doctors--that must be super confusing.

 I can't speak to your main question--which test is a better indicator. (my tumor was 5 mm and too small for the Oncotype test.) But I'll share some questions I would have in your situation and other thoughts, in case it helps. I'm not a doctor, so please don't take any of this as fact, but perhaps some "food for thought" or ideas to discuss with your doctors.

Have your doctors said how much you'll "benefit" from chemo? i.e. would it reduce your risk of recurrence from 20% to 12? Stage 1 BC doesn't benefit as much from chemo as Stage 2 or 3, because it's slow growing. I think my medical oncologist (MO) would give a similar recommendation as your first one. You and I have similar Dx, and my MO disrecommended chemo but strongly recommended tamoxifen. (BTW, I'm assuming you had a sentinel node biopsy and all the lymph nodes came back negative).

Your young age is a consideration, since you have a very long life expectancy.  My understanding is that women under 50 "benefit" more from chemo due to their long life expectancy. To the cancer doctors, 50 is considered young, so when they see you they must think you're super young. (just an FYI on their perspective)

One thing I've learned is that doctors have their own philosophies when making recommendations. Some are conservative with treatment; some are more aggressive. Some want to offer every possible treatment. Sometimes the age of the doctor influences his/her philosophy too. (but not always) We patients should consider our own philosophy too. Are you the type of person that wants a lot of treatment or little? Would you feel better knowing that you've done everything possible, even if the Tx might be overkill or perhaps create side effects?  There is no right or wrong, just what is right for you. For example, when I chose to have radiation treatment, there were several options. In my case, I wanted the one that would have the least risk of damage to my bones; the choice also had the longest track record, which was also my preference. But some patient prefer the latest-and-greatest or have other considerations. You can decide what's important to you.

Do you have a cancer support center near you? Mine had free counselors we could talk to. They won't advise you on the choice of treatment but might help you sort out the surrounding emotions so you are clear in your decision. When I talked to my counselor she said it's hard to make these decisions because we don't know what the future will bring. She said the goal--ideally--is to be content in your decision no matter the outcome. So the question is, how would you feel based on the following scenarios: if you decline chemo, and then have a distant recurrence? If you choose chemo and never have a recurrence? (you might also choose chemo and still have a recurrence; or you might decline chemo and not have a recurrence. No one knows.)

I'm not sure if any of this is helpful. But please know I'm thinking of you and will be sending warm thoughts are you consider this and make your decision. 

It is really hard to make these decisions.  I thought I was young at dx (age 45) but you are far younger than me.  Whatever you do, make a decision you can live with - with no regrets.  I had only a oncotype test and my score was 17 which is the highest number in the low recurrance category.  I also had angiolymphatic invasion present in my pathology.  This REALLY scared me.  It scared me enough to have the chemo.  The other reason I chose chemo was because I have a young child (my son was 4 when I was DX).  I wanted to treat things aggresively to be here to raise him.  I also knew I could use cold caps to keep my hair through chemo and maintain my privacy.  The caps allowed me to go through treatment without other people knowing and it allowed me to not have to tell my 4 year old son about cancer or chemo (I will tell him when he is older).    

I am in no way telling you that you should do chemo.  This was how I made my decision.  I am glad I did the chemo.  I know I did everything I could to beat this.  If it comes back then I will know there is nothing else I could have done. 

You may also want to review the NCCN guidelines for treating BC for your diagnosis and age. Often younger women do get chemo automatically just because of age.  If you are not sure, get one more opinion.  Maybe it will help you make the decision.

Best of luck!  Hugs!!

I would ask that your case be presented to the tumor board. That way, you will get many opinions.



Furthermore, annicemd started a thread Premenopausal, Stage 1, Grade 1, which I think is worth reading because there has been quite a few of us with similar tumor characteristics. I was premenopausal when diagnosed, but two decades older, so my treatment decision was a little easier.



I wish you well.

TaiTai, yeah, you're right. There's definitely not as much data for pre-meno women, which can be frustrating. And I see your tumor was <1 cm, like mine, which is on the smaller side of stage 1. (so, in theory, the risk for a typical stage 1 patient might be a bit overstated for us. But to be honest, at some point that feels like splitting hairs, since we're all trying to guess an unknown outcome.)

You definitely sound like you're in a much better place mentally than I was when making those decisions. I kept thinking if I only did more research I'd somehow find some magical answer and everything would fall into place. ha.

So, at the risk of introducing another piece of data (!) there's a website called cancermath that lets you look at possible outcomes with and without treatment.

http://www.lifemath.net/cancer/index.html

I'm an engineer so I wonder how they do their calculations, but maybe it can provide food for thought or conversation for your MO.

Sure, feel free to send me a private message if you'd like. I sometimes check the boards in waves (i.e. when something is up for me). 

voraciousreader, had an excellent suggestions with that other thread: " Premenopausal, Stage 1, Grade 1". I don't know how I forgot that.

Anyway, I'll be thinking of you at this point in your journey.  Rest assured that once you do make a decision, it will be the exact right decision for you, no matter what you choose. And...I hope you're able to get in some "distraction therapy" this weekend (go outside and do something fun, and not related to BC). Take care.