chemotherapy or not

Don't worry about it too much right now, just gather information which is why you are here, (so good for you!)

I am also trying to make that decision about chemotherapy and I have an oncotype score of 16 but one lymph node involvement that was 3 mm. As I understand it, if it was 2 mm or less they would not be recommending chemotherapy to me. Once you get the score they may have a different view but also your age would be part of the decision as well. In my case, two oncs have recommended I take part in a trial where I could be put in a group having chemo & hormone treatment or just a group with hormone treatment. And the third said I should do chemotherapy. Its a tough decision.

Good luck!

cenerentola72 - The Oncotype test score should help you decide. I never had it done, so maybe you could ask your oncologist to do it. You living in Perugia is making me crave Perugina chocolates. I've been to Assisi 20 years ago but didn't make it to Perugia.

Cenerentola - I wanted to chime in. Some doctors here in the US do not do the oncotype testing to node positive cancer because they essentially assume that you need the chemo because the cancer has already escaped the tumor site so to speak. My mom had a 0.5cm (5mm) tumor - stage Ia - no node involvement. She was told she did not need chemo, and the chemo would not help her. She went to Stage IV in 8 years. Fortunately, she has been Stage IV for over 13 years now (and lived much longer than the initial oncologist had predicted - two years), but she regrets every day that she has not forced the doctors to pick the aggressive treatment route. There would have been no guarantees that she would not have progressed to Stage IV even with the chemo, but at least she would not be regretting today that she did not do everything possible to fight it. I was 40 when I was diagnosed last year; and I too have two small children. I always made my decisions based on the assumption that my chance of recurrence may be 100%. Individually, for each of us, we either have a 0% chance of recurrence or a 100% chance of recurrence; these tools, such as oncotype, are JUST tools. There is a margin of error in them; and in some instances, a tumor that comes back low recurrence risk on oncotype has come back high recurrence risk on a different test performed. As a young woman with a young child, you need to think about hitting this cancer as aggressively as possible. I was node-negative but had a very high Ki-67 and very high Oncotype; so, for me the choice was very easy. I understand that everyone has a different approach and needs to make the decisions for themselves. I had one of the hardest chemo regimens - dose dense AC plus 12 rounds of Taxol. Even that was not bad. I think many people hesitate about chemo because they think it will be awful - it seriously was not that bad. And even it is the most awful thing imaginable, it is still better than losing your life to this disease. And there are other chemo alternatives - maybe you can do the CMF regimen which some practioners call the "chemo light". Once you go to Stage IV, the cancer is still treatable but no longer curable. I would not want any woman (or man) fighthing this disease to have my mother's regrets. Living with Stage IV disease is not easy. It is hard and painful. (This is the cold hard truth). She had 8 surgeries for broken bones - for some sites, she had to have surgeries twice. She had to have surgery TWICE on her entire spine (each lasting over 12 hours and extremely high risk). She had both legs broken (pathologically - meaning due to the cancer) several times. Bottom line is that I wish each and every one of you the best; and I hope you never have to deal with this disease again. And if you are Stage IV - I hope, wish and pray for a cure every single day.

Cenerentola,

I wish you all the best with your decision.

Cenerentola, No one can tell you what you should or shouldn't do - and they shouldn't. It is your decision and your life. All we can offer is our own personal experiences and decisions we made. There are no right or wrong decisions if they are ones you make with the information you have. A 3 is a very low Oncotype score; mine was 11. Of course the test isn't fool proof - there is no such thing when it comes to the C word but it does provide you an indicator, albeit a bit flawed, of just how aggressive your cancer is and based on what doctors know what the percentage is of a recurrence. Keep in mind the Oncotype test is done on your particular tumor - no other factors are considered like family history, etc. Again it isn't infallible but for now it is a test a lot of Oncologists are using to determine treatment plans so as not to overtreat women. I for one am grateful for it. My tumor is deemed non-aggressive, smaller than first thought and is one that would not benefit from chemo. One thing to keep in mind once you decide don't second guess yourself or look back. You are the one making the decision about your life. Good luck and keep the faith. Diane

hi all- I searched out this sight because I'm also struggling with this. I had no lymph node involvement Dbl MX nov 5 with nipple/skin sparing surgery. All good then BAM oncotype DX results come in. 18 is my score. So I'm 46 with two kids 20 yr old and 6 yr old. Dr. Already said I'd be taking tamoxifen for five yrs which will bring the number down ( need to do more research on this haven't grasped the whole thing yet....maybe never will) then they said with chemo the numbers would be even lower. Sooooo confused. Need more info, any suggestions? Oncotype DX 101 or oncotype DX for dummies?! Help!

There are circumstances when chemo is clearly not advisable, but when there is a doubt, I would do chemo (which is what I did). It is not fun; but it is temporary, a couple months out of the whole rest of your life; which you want to be very long and completely cancer-free!

The + nodes and age would be of concern to me but follow your heart!

Nancyjeanne1967, Oh I have so onc hopped! I had 4 opinions before I settled on the last onc.  I even requested to switch since I didn't click with the first one I saw at the big research hospital.  I ended up going with the one I was switched to.  So I saw 2 at the big research hospital, one at the local clinic, and one at the VA (I am a vet so would qualify to have my treatment there).  Oh and my cousin has been a practicing onc for 30+ years and asked his opinion too.  I ended up going with the one who listened to me and who was doing his own research.  He is at the big research hospital associated with the University of WA.  He is doing a lot of research into pregnancy related BC and I want more kids so that is a great bonus.  But ultimately I appreciated the way he answered my questions and that I didn't get the standard of care response to everything.  I am an individual and am not content simply to survive this cancer.  I have other dreams and goals!  Plus your onc is the one that will follow you for the rest of your BC journey (course you can always change) - not your surgeon or radiation onc so it is more important that you have mutual respect.  So meet with the other oncs and see what they say (or don't say) and evaluate their resource structure as well (I liked that everything was in the same building and I only coordinated with one scheduler for all my tests/chemo/apts). 

Also remember that you are the one to live with this so do your own research and read up on others experiences here...course everyone is different but as an aggregate it will teach you better than dr google will.  And come to your oncs office armed with questions (especially your next opinions as you can compare and contrast what they say).  Soemtimes it seems like they are robots spitting out the same thing and other times they have very different opinions.  You need to be your advocate here and push your docs when you don't understand or fully agree with something. 

However, I will say that while I did chemo (TCx4 and had an oncotype of 31 and 1xpositive node so not sure if test is even applicable), I don't think it always the best thing to do.  While the oncotype test is a tool to reduce overtreatment by identifing those women who will not benefit from chemo, it is not foolproof.  However, neither is chemo.  Many women threw the kitchen sink at their cancer and still had it metastisize and others never did chemo and are cancer free.  There are so many variables and so much unknown.  And chemo comes with its own risks (both long term and short term).  Nothing about this journey is easy....but no choice in that matter.  The best thing I can tell you having just finished chemo is to do what you feel in your gut is right and then don't look back.  And only you can decide what your gut is saying....best of luck and pm me if you want.

Chemo is 100% a personal decision. I caught a lot of grief from my doctors (especially my pushy surgeon) 12 years ago when I refused to undergo chemo with Stage 1 BC but I stuck with my decision and treated my cancer successfully with Tamoxifen, Zoladex, and diet changes. Unfortunately for me I am BRCA2 positive so I developed a new cancer on the opposite breast. Chemo was again recommended to me before I even had surgery this time. I meet with my oncologist tomorrow to set up my treatment plan but have no plans to do chemo at this time. Luckily for me, my oncologist is pretty open to my questioning personality by now! The main thing is to be confident in your decision and not look back. Attitude plays a role in everyones treatment IMO so if you feel you are doing what is best it makes a difference.

My mother is having STAGE II A tumour , 0/15 lymph nodes , ER strongly positive -90% , PR -70 % , HER 2 negative , Ki - 67 score - 5 % , grade 2 tumour ,  tumour size 2.7 cm. She is diabetic with Coronary artery disease  ( 50 % stenosis in LAD ) She underwent modified radical mastectomy with axillary lymphnode dissection. Her surgical margins are clear. Since Ki -67 score is less than 25 % and she is having comorbidities, her medical oncologist advised her only Femara 2,5 mg /day x 5 years and no chemotherapy . She has to take Inj. Zometa every 6 months and bio  D3 vitamin daily. Chemotherapy benefit is less in Luminal type  A cancer . its indicated only  when grade 3 tumour , lymph nodes > 4 or mets , recurrence risk based on oncotype Dx assay is  30 % or 18 -30 % . Chemotherapy acts on rapidly proliferating cells . Her proliferation index is 5 % ( Ki 67 )- so not so aggressive . Moreover she is on statins ( lipid lowering drugs ) and metformin for diabetes . New research shows people with diabetes on metformin and statin have less chance of metastasis as statin reduces RANKL - a protein requird for matastasis. Despite all this information, still its very difficult to say how cancer will behave as you correctly mentioned in your post. Its a difficult decision for chemo though i am a medical professional ( interventional cardiologist ). But still i believe what my medical onc says and will go ahead with femara tablets only.

Hi josgirl totally agree with you. Every person is different and there are multiple variables involved. What may work for someone might not work for others. We have to balance the risks and benefits of chemotherapy .