Studies on the effectiveness of chemo and radiation

In my experience, Caralex, each of my doctors was very, very clear about my pathology, and about my risks of recurrence (local and distant) with and without radiation and chemo.  In general, radiation reduced my chance of recurrence by about half, and taking an anti-hormonal reduced it by half of that.  Chemo would only have had a 2-3% effect, so my onc advised against that, but would have gone ahead with it if I wanted to.  Both my BS and RO indicated that radiation would be very much in my best interest, but that I could, basically, take it or leave it. Based on what I've read on these boards over the past couple of years, I think it's pretty rare for a doctor to get pushy, and then it is usually where there is some sizeable risk in delaying treatment.  In other words, they will not judge you.  They will advise you on strategies that they believe will keep you healthy, based on your personal pathology..  Your job is simply to be certain you are making an informed decision, based on the real facts (not those outdated ones I brought to my diagnosis).  Have you been to the other side of these boards (www.breastcancer.org) and clicked on all the tabs?  You'll find the latest stuff there.

Caralex I live in British Columbia. My surgeon gave me a choice of surgical treatment, mastectomy OR lumpectomy followed by radiation. The lumpectomy with radiation was considered a treatment package. I assume your case is the same and that by choosing to have a lumpectomy (if that is the case) you have already indicated a readiness to have the radiation.

Regarding radiation treatment and size of tumour (question#1) In Canada radiation treatment can be easier if you have a small tumour and your pathology allows you to do the short course radiation regime. I was quite surprised after reading about radiation treatment in books and on BCO that I would only be required to have 16 doses of radiation spread over three weeks and one day. My tumour was a grade two 1,6 cm. Quite doable. Small tumour size did not save me from a chemo recommendation though as cancer had spread to a lymph node. I could easily have refused chemo if I wanted to, my onc even gave me a big hug as I questioned the need to have it, probably one of the reasons I ended up trying it as I did not have the feeling it was being forced upon me.

Anyway as others have said best get yourself through surgery first and wait for pathology results before trying to make decisions about what might never have to happen.

Kathy

The benefit radiation adds to a lumpectomy is statistical improvement by stage and maybe grade, if I recall, but certainly not personal  My Oncotype score, based on my very own tumor's genetic profile, gave me a chance of recurrence of 15% if I did no further treatment after radiation, 7% if I took tamoxofen for five years, and 5% if I were to add chemo.  To me, 15% after lumpectomy and radiation was a huge and scary number, so I am so very happy antihormonal drugs are available.  I can deal with 7%.  The side effects of chemo did not warrant going for the extra 2%.  If I were younger, with young children, I'd probably have gone for it

I haven't been on here for a while, so I'm just catching up.... It's been three months since the surgery. I have an appointment with my oncologist at the end of January. Still looking disfigured. Still agonizing over how unhappy I am with the results. Part of the issue is that the tumor was 1.5 cm (at it's largest point), but the surgeon removed 6 cm x 4.5 cm x 1.8 cm of tissue. As a gal with smallish boobs, this was A LOT of tissue. I think that he removed that much because I was pretty vocal about not wanting to do any follow-up radiation, which is pretty much considered MANDATORY as far as standard medical practices are concerned. I should have kept my mouth shut and pretended that i was planning to go along with the established protocol. Right before the surgery, I did play along and pretend I was going to follow through with the expected treatment path. Meanwhile, apparently, quite a high number of women are unhappy with the outcome of a lumpectomy. In my case, the size of the tissue removed relative to the size of my breast would make this more of a somewhat conservative mastectomy rather than a lumpectomy.

I don't believe doctors do give you all the information that's available. Part of it is economic. Part of it is the inability to keep up with all that's going on. Part of it is an unwillingness/inability to fathom that natural alternatives could be at least part of the treatment plan. No doctor EVER mentioned stress reduction, nutrition, effective sleep, D3, or any of the wealth of possible treatments or co-treatments that have historically worked wonders in other countries.

Furthermore, the pharmaceutical companies have too much influence. For example, has anyone worked with a doctor who will admit that both the World Health Organization and the American Cancer Society classify Tamoxifen as a "human carcinogen" because it is technically a xenobiotic chemical inherently toxic and biologically alien to human physiology? In fact, my one sister had an "issue" with a mammogram recently (she has never been diagnosed with any kind of cancer) and her doctor wanted to put her on five years of Tamoxifen WITHOUT DOING A BIOPSY or any other assessments to determine if she actually had cancer. Plus, she has a long history of endometriosis, so the risks of endometrial cancer are even higher for her than in the general population.

I'll need to have some reconstructive work done at some time, because I don't want to look this way for the rest of my life. Of course, I'm at the point where it is difficult for me to trust anyone. If anyone has any comments or suggestions regarding particularly good surgeons in the eastern Pennsylvania region, I would be eternally grateful! :0)

Well all I can say is that I had a small tumor, 1.5 not even a 2cm tumor, had it excised with clear margins, however my Oncotype we 36, so I opted for chemo, just ready to do my last one, Jan 16, only had 4, yes they were brutal, I think the Neulasta shot you get the following Monday is worse than the chemo itself, my god that stuff makes my body hurt for days. Anyways, I know alot of women who have survived chemo, it leaves your body, and you do heal from it. I'd rather take the insurance than wonder later if I could have prevented any recurrence if it comes down the road. At least I know I did everything I could, next I do rads and then take the aromatease inhibitor for 5 years, So it goes. My heart goes out to anyone who has been stricken with breast caner. Love to you all. The Bible has helped me cope, I know this sounds corny, but it has.

I would agree that Dr. Chou would be a good choice.  I've heard only good things about her.  I would also trust any of the plastic surgeons at Penn.  I used Dr Steven Kovach for my reconstruction (Plastic Surgeon) and Dr Brian Czerniecki as my Breast Surgeon.  Both men were wonderful.