How to decide?

Beesie: My oncotype score was 30. She said that put me at a 30% chance of distant recurrence. Chemo was recommended but not required so I turned it down. I really didn't want to take the AIs but my MO pushed me really hard on that so I agreed to give it a try. I couldn't tolerate the Arimidex so now I am trying the Aromasin. If I had had node involvement I would have done the Chemo. I've read that DIM does the same thing as the AIs and is natural and no SEs. I would love to see some independent studies on these drugs and the AIs vs. the ones that the pharmaceutical companies that push these drugs have. I just don't trust it. DIM is natural and can't be patented so the pharmaceutical companies can't make any money on it so they tend to push their drugs and discredit anything that is not "Standard of Care".

I'm in a study through the University of Arizona looking at the effectiveness of DIM supplements for women taking Tamoxifen. I don't know if I am getting the placebo or the real stuff but hopefully, down the road, other women will have more info to act on than we do now. I'm about half way through the 18 months of the study. I'll switch to AIs from tamoxifen just after I finish the study. Here's the link: 

http://publichealth.arizona.edu/news/2012/study-works-improve-breast-cancer-treatment-combining-nutrition-and-medicine

I am not taking DIM, which is a combo of veggies I eat anyway, because it is not advisable for anyone who is on a blood thinner (which I am) I guess it is too concentrated; all that vitamin K.

I am monitored monthly so if I have too many veggies, which thickens my blood, my dosage of Warfarin is adjusted.  It would make this too difficult with DIM.

Beesie: I've got to look at my path report but there was some question as to my HER2. At first they said it was borderline negative and then they said something about the Phish/fish test. I don't understand it. But they never mentioned herceptin at all. They only recommended the chemo, which I turned down, and the AIs. I can not and will not take the Tamoxifen due to a past history of blood clots. Also, I am post menopausal. I have been on the Aromasin for a little over a week now and so far I've only had a mouth sore and my tongue has a constant feeling like it's been burned. Don't know if anyone has every had that problem.

Chinney that article was so informative! Thank you!

Chinneymae, Fascinating article on DIM and estrogen that you posted! I never expected to get that thorough of a explanation on estrogen and cancer...ever! Most appreciated. Best to you in whatever you decide to do. Were right here with you!

Your feelings are mine exactly.

I want to know if there are studies with women that have such an small non aggressive tumor found early, what the real statistics are between recurrence if they use rads and/or drugs or not. Most information seems to lump many different stages and sizes together and they come up with how much better the recurrence rate is with traditional treatment.

I would like to know if anyone knows these statistics so I can make a better informed decision. I really do not want to pump my body with tons of what appears to be dynamite to kill a small bug.

Hi shira,

thanks for the answer. I was up at 3 in the morning writing because I could not sleep.

I did not get the oncotype result - I think it comes after the surgery. the aggressiveness of my tumor,-Ki-67b was at less than 3% and I told the doctor that if I were 70, I wouldn't even be here. It grew less than 1/2 cm in 3 years.

but now that I am here, my gut is that if I have a low oncotype, and all else stays the same, there are clean margins and no lymph node involvement, I would just as soon take my chance at the % of whatever, than go through so much drug and radiation therapy.

I was one of those that did not even go for mammography, and when I did find the lump 3 years ago and it was confirmed with an ultrasound and mommy, they thought it was just a lymph node, so the mammo did not save my life or even add years. only lately after I felt it grow did they do the biopsy, and even at that point the notes said that this is probably benign.

I am sure my doctor will probably disagree with my lack of treatment, even though she seems to be pretty balanced on explaining the severity. My husband is completely supportive - he is more into the lifestyle and alternative medical approach, I guess I just wanted to know if I was being completely irresponsible by not taking the "proven" regimen.

years ago when I had serious ankle surgery, I had severe pain which lasted months. I was given a drug Vioxx for the pain that I was supposed to talk 3X daily for months. I took a few pills here and there just when the pain was bad and not the rest. The doctor insisted it worked better if taken daily but I am not too good about those things. Lucky for me, as they found heart disease a serious side effect with long term use and have since pulled the drug.

something here feels the same. 5 years of drugs, side effects and possible secondary problems, for a condition you have cut out, even with the risk factor slightly higher, just doesn't feel right to me. all drugs are safe till they aren't.

anyway, if feel like I am rambling because i don't know anyone other than my husband that would support this decision, and if all indications stay the same, your advice and response has helped to clarify some of the issues. the rest is yet to be decided, thanks again and let me know what you end up doing.

I am curious if there are long term survivors that did not do the therapy either and feel it was the right decision

About radiation. Please look past the local recirrence statistics which are about 2% difference between the radiated and the unradiated. Look at the Overall SURVIVAL statistics. Scroll down to see there is no survival benefit. Benefit is defined as a small reduction in local recurrence.

This came from a breastcancer.org article:

[article accessed from the breastcancer.org web site August 17, 2010]



http://www.breastcancer.org/treatment/radiation/new_research/20060217a.jsp The article has been removed from this page since.

---------------------------------------------------------------------------------------------------

Radiation Benefits Women with Small Cancers After Lumpectomy



"After lumpectomy alone with clear margins, chances are that you are cancer-free. But your doctor will talk

to you about treatment you can have just in case some cancer cells were left behind.

In this situation, getting the best breast cancer treatment can feel like a balancing act: You want to do as

much as you can to get the cancer out and lower the risk of it coming back. But you'd like to avoid

uncomfortable side effects that might lower your quality of life.



In this study, the researchers wanted to see if there was a group of women who could get just hormonal

therapy after lumpectomy and skip radiation therapy. So they looked at a group of post-menopausal

women whose cancers are the type associated with the most favorable outcomes:



hormone-receptor-positive,

smaller than three centimeters, and

node negative.

If you're in this group, you have a very low risk of the cancer coming back.



As these results show, even women with a very low risk of recurrence can benefit from radiation after

surgery. This means that so far, no group of women has been found that would NOT benefit from whole

breast radiation.



Remember that no single treatment plan is right for everyone. If you want to do everything possible today

to lower the risk of ever seeing the cancer again, then radiation after lumpectomy may be a very important

step for you. If you have a small cancer that has been removed with wide and clear margins of resection

and you're more concerned about how radiation will affect you, you may want to talk to your doctor about

skipping radiation and just taking hormonal therapy. Your risk of the cancer coming back in the same area

is likely to be higher, but how long you live will probably not be affected.



Instead of having whole breast radiation, you can also talk to your doctor about the potential role of partial

breast radiation. Studies are now under way to test the effectiveness of radiation delivered just to the area

around the cancer. This is called partial breast radiation. Promising results after four years of using this

approach have led to a clinical trial that is now comparing partial breast radiation to whole breast radiation.

The trial is called the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39 study. Talk to

your doctor—you may be able to enroll in the NSABP B-39 study.



Juggling risks that may affect your life can be very uncomfortable. You need to talk to your doctors and

family, and consider all your options, to decide on the plan that's right for YOU.



The February 2006 Research News section was made possible by an unrestricted educational grant from

Genentech BioOncology.



Research News on Radiation Therapy

ASCO: Radiation Short Course Now Breast CA Alternative

ASCO: Value of RT After Lumpectomy Questioned

Post-Mastectomy Radiation May Be Underused

SSO: Post-Mastectomy Radiation May Be Overused

Shorter Radiation Course Matches Standard for Breast Cancer

More Research News on Radiation Therapy (25 Articles)



Reviewed study: "Radiation Benefits Women with Small Cancers After Lumpectomy" by M. F. X. Gnant and

others, San Antonio Breast Cancer Symposium, December 8, 2005, Abstract 8



Is this for me? If you have small, early-stage invasive breast cancer and are wondering if you can skip

radiation after surgery, you might want to read this article.



Background and importance of the study: Breast-conserving surgery lumpectomy followed by radiation—

has become a standard treatment for women with breast cancers that:



are small to medium in size (usually four centimeters—about two inches—or less in diameter),

are limited to one place in the breast, and

can be removed with clean margins.



Radiation to the whole breast after lumpectomy has been recommended for all women who choose breast

conservation (instead of breast removal, or mastectomy), regardless of the women's age. This "standard

of care" recommendation is based on many large studies that compared lumpectomy plus whole breast

radiation to lumpectomy alone. These studies showed that radiation therapy after lumpectomy significantly

reduced the risk of the breast cancer coming back in the same breast.



The studies also found that women with node-negative disease lived equally long lives after lumpectomy

alone or lumpectomy plus radiation. Women with node-positive disease had an increase in survival. The

main benefit from radiation is to lower the risk that cancer might return in the breast, requiring more

surgery and possibly other treatments.



Other treatments may be given after surgery. Hormonal therapy is a medicine given after surgery for

hormone-receptor-positive breast cancer. Hormonal therapy:



lowers the risk of the cancer coming back,

improves survival after surgery, and

lowers the risk of developing breast cancer in the other breast.

With all these different types of post-surgery treatments, it would be helpful to know who needs radiation

treatment and who might do fine with hormonal therapy alone. Several studies have looked at whether

hormonal therapy offers enough protection against recurrence after lumpectomy for women with small

cancers—eliminating the need for radiation. This could spare some women the inconvenience, side

effects, and cost of radiation.



The study reviewed here continues to look at this important question. Keep in mind that ALL of the women

in this study had relatively small cancers and no lymph node involvement. They then received hormonal

therapy and about half received radiation too. So this study does not address the role of radiation alone

without hormonal therapy.



Study design: Austrian researchers used the results of two studies conducted by the Austrian Breast

Cancer Study Group (ABCSG) to identify groups of women who had an extremely low risk of recurrence

(the breast cancer coming back).



All the women were post-menopausal and had breast cancer that was:



hormone-receptor-positive,

smaller than three centimeters, and

node negative.

All the women had lumpectomy followed by different types of hormonal therapy:



In ABCSG-6, 698 women took tamoxifen with or without aminoglutehimide (an old-fashioned kind of

aromatase inhibitor).

In ABCSG-8, 875 women took either five years of tamoxifen or two years of tamoxifen followed by three

years of Arimidex (chemical name: anastrozole).

About half of the women in each study were randomly assigned to receive radiation after lumpectomy and

before hormonal therapy. The other half had lumpectomy followed by hormonal therapy—without radiation.



Results: After about 10 years of follow-up in the ABCSG-6 trial, the cancer came back in



3.3% of the women who had radiation, compared to

5.2% of the women who didn't receive radiation.

However, this difference was not significant, meaning it could be due to chance rather than due to the

radiation.



After about four years of follow-up in the ABCSG-8 trial, the cancer came back in



0.24% of the women who had radiation, compared to

3.2% of the women who didn't have radiation.

This difference was statistically significant, meaning that it was likely due to the radiation and not just to

chance.



There was no difference in overall survival in either trial between women

who had radiation treatment and women who did not.



Conclusions: The researchers concluded that radiation therapy to the whole breast can help reduce the

risk of recurrence in women with small hormone- receptor-positive breast cancers, even if they receive

hormonal therapy after lumpectomy.

-----------------------end of breastcancer.org article----------------------

Radiation for early-stage women has a definite survival benefit, especially Regional Node Radiation for those who are node-positive. This survival benefit must be taken into consideration when looking at your personal risk for cardiac issues. If you have a strong family history of cardiac illness, already have cardiac issues, are over 50 years of age, smoke, have high blood pressure/cholesterol, then you must weigh the survival benefit of radiation against your personal risk. Talk to your treatment team.

http://www.breastcancer.org/research-news/20131023

Rita,

Your points are well taken. The problem that I see is that if a drug shows promise all through the lengthy clinical trials process, people clamor for it to come to market. To really look at long term usage, most drugs would have to remain on trial, after phase III for 10+ years. It really does pose a dilemma and but facing serious illness/pain are often willing to take the risk.

I have just completed 4 rounds of chemo that was brutal on my body and evey side effect possibe. My tumor was 3cm grade 3 and considered stage II with no nodes involved. I am 49 years old and have been postmentopausal for a year. I listened I my MO and did the chemo but not so sure I want to do the Femara that he has recommended. I am so nervous about the side effects. My MO mentioned tat this as important as the chrmo. I have been through enough and just want to lead a new normal life. Has anyone been on Femara?

side effects are effects. & as for hormones: what about birth control pills?