Treatment of Stage I (5mm) TNBC all 5 lymph nodes clear

I had a 3mm TN tumor and numerous microinvasions diagnosed after a mastectomy for DCIS.  I received three opinions from MOs. 

The first was from my MO at a top comprehensive cancer center. She said I did not need chemo but some of her colleagues thought I should be offered 8 rounds of CMF. 

The second MO whom I know to be very aggressive with chemo said not to do chemo. He said he would  tell his wife the same thing. He thought the risks of chemo far outweighed the benefits in my case.

 The 3rd MO is a world renown breast oncologist in Europe. He said that normally chemo is not prescribed for tumors under 6 mm in size pursuant to current guidelines. However, he said with triple negative, he recommends chemo for 5mm tumors and also recommends it for 4mm tumors. So, my tumor was 1mm smaller than the size for which he would recommend chemo.  (Only the largest tumor is counted when staging the cancer.).  Because he said I did not need chemo, I ended up not doing it.  He emphasized that he lowers the threshold on chemo where the tumor is TN because chemo is all we have to treat TN. Herceptin doesn't work and Tamoxifan doesn't work. So for that reason, chemo becomes more important as the only available treatment. 

As you can see, your wife's tumor is large enough that the European MO would treat it. I think there are U.S. MOs who would agree. 

Those of us with tiny TN tumors fall in a grey area. There are not enough studies to provide definitive guidance. Also, the oncotype test doesn't work for triple negatives. There is another test called mammoprint and perhaps that would be helpful to your wife regarding whether she needs chemo. 

Given the grey area, your wife may want to get a second opinion on chemo. 

I wish you and her the best. 

I had a 6mm tumor on ultrasound, but after my lumpectomy the pathology report measured it at 1mm. I figure some was removed from the core biopsy. I had radiation only. I'm now 2 1/2 years out, probably in the best shape I've ever been in. Adhering to a healthy anti inflammatory, alkaline diet, but still allow some wiggle room  for deserts and red wine. I received 3 opinions, one from a top oncologist from Stanford University who specializes in Triple Negative Disease. He did not recommend chemo. Vitamin D, healthy diet and exercise were recommended by all.