When is Chemo recommended?

I am also ER+PR-HER2- with a 1.8cm cancer. My Oncotype was 23, so my MO recommended chemo. I also have 2 pathological gene mutations, so I'll also be having a BMX after chemo.

Hi Beth, You kicked butt for 10 years so I'm sure you'll do it again this time. I totally get the confusion the internet can cause as I'm in the same boat being new to this. What I know is surgery can change the dynamics a bit. I was diagnosed with a 2.2cm IDC tumor but after the vmx the IDC was 1.2 and the other part was DCIS cells. So I went from a stage 2A to 1A. My grade in the biopsy was 2 but after bmx was a 3. My nodes were clear. Because of the size was smaller my oncologist said we should do the oncotype test. He did tell me that the grade 3 was most likely going to cause the test to come back with a number high enough to warrant chemo but I was game to get more info. He was right. I came back a 42. The scoring is 1-100. So your situation could change a bit too. It is the oncologist who will get approval from your insurance to do the onco test. Read about the test prior to your visit. Your surgeon will send you the pathology report from the bmx ahead of your visit. As for tamoxifen I don't know if you have to be PR+ but that fact should be on drug's website . Best wishes and a speedy recovery to you!

Hi Beth,

So sorry that you find yourself in this predicament. I just want to say that I had a similar cancer - ER+/PR-/HERZ-, but my cancer was much bigger - 2cm. I did go through chemo and then did 5 years of an AI (just reached 5 years this week!) . I was very hesitant to have chemo and ended up getting a second (and third!) opinion. They all said that I should do chemo primarily because my Oncotype score was 26 (mid range) which indicated that I had a reasonably high proliferation rate (which means chemo can help) and the fact that I was PR- suggested that I might or might not get as much benefit from anti estrogen therapy.

So, you might want to get a second opinion to help you gain more information /comfort with whatever decision you make in the end. I glad they caught this cancer early and hope that you get whatever information you need to help you decide what is best for you.

Best Wishes

Beau

Hello Everyone, 

I'm sorry I'm so late to the discussions in the group. I had my surgery back on June 20th. My surgeon was confident that I would have only radiation. Pathology showed ER+, PR inconclusive, HER2+. However, when I met with the medical oncologist for the first time she had a couple of concerns and had the pathology redone. Everything was the same except I was PR-  Nevertheless, the margins were clear and the sentinel node was clear. Being completely in the dark, myself, (who among us who have never gone through this knows very much) I listened to what she began to say. As an aside, someone else commented that it always felt like the Dr. was talking about someone else, surely not me. But me it was and so I listened. She was saying she felt slightly uneasy and wanted the very best for me and suggested rather than going directly to radiation she'd like to do an Oncotype test which would help to determine the likelihood of recurrence. 

She explained that my tumour (even though it was no longer inside me, remained forever 'mine') would be sent to California, the only place in North America that does this test. An Oncotype test studies the tumour at a molecular level and analyzes some 600 identifiers. It took about two weeks for the test results to come back. She was, to say the least, surprised at the test results. Despite a pathology that appeared just about as good as it gets, my Oncotype score was 30 indicating that the tumour was much less 'friendly' than the pathology indicated. After consulting, independently, with each member of my treatment team, to a person they recommended chemotherapy. It was not the news I wanted to hear but it certainly was what I needed to know. I want to do everything I possibly can now to try not to have to go through this again. The decision was that rather than a full round of 8 treatments, I'd have only 4. Afterward, there will be 5 weeks of radiation. And then 5 years of Tamoxifen. 

I have 7 sisters (1 deceased from colon cancer, which never needed to happen, but that's another story😓) and a mother, of course. Zero BC in family history. I just happen to be the 1 out of our collective 9. 

I asked and have been scheduled for genetic testing to see if it will illicit any clues as to why me and if my daughter or two granddaughters are at a high risk. 

I'm currently two days out from my 3rd round of chemo. My oncologist is a brilliant 35yr young lady who keeps me focused, uplifted, positive and who has and answer and a remedy for every side effect I'm experiencing. 

Dauna

Hi mvspaulding,

My surgeon left the kind of surgery up to me. He said that because my tumour measured 1.8cm that mastectomy wouldn't be his first choice. He did say that if I opted for a bilateral mastectomy there would be no need for chemotherapy and he further believed that it would mean a very short course (15 days) of radiation. The biopsy report was stage it was in Stage 1C. He confided in me that he didn't quite understand the 'C', explaining that generally after Stage 1B it becomes Stage 2A. 

He went on to say my after care wouldn't change whether I chose breast preservation surgery (he prefers that term to lumpectomy) or mastectomy. And that if he cloned me and put ten of me in one room and ten of me in another, and one group had breast preservation, over mastectomy, the survival rate would be exactly the same. Given that scenario I chose lumpectomy. 

Herceptin was never mentioned or discussed. And remains a word with which I'm unfamiliar to this moment. What is its function in the treatment?  My surgeon said that he wouldn't guide my treatment other than to perform the surgery I chose. 

I was extremely confused, about what my after care and treatment plan might look like because I was still in such a cemented state of denial and fear I couldn't even find my voice. As an additional note, I have Epilepsy with full grand mal seizures but also pseudo seizures under times of extreme stress. I spent, at first, a good deal of the time 'separate' from the discussion and was more of an onlooker in the corner of the room. A real life version of 'a fly on the wall'. I would be freezing cold, my feet bounced on the floor continuously and for short periods of time was rendered mute. It was my husband and Ativan that would bring me back to the discussion so I could make decisions. 

In retrospect I wish I'd met with the MO prior to making any choice. I just needed the invader out! I did such a good job of floating along on the River of D'nial that I never truly felt like a Cancer patient until I had no hair. 

Sorry for that tangent. When my Oncotype test came back my MO said if the score was 31 there would be no discussion her firm recommendation would be chemo. As I said mine was 30. After he consultations and recommendation I asked her my gold standard question, adjusted to age, 'If I was your mother, what would you want me to do?  Without hesitation she said I'd want you to have the chemo I'm recommending. And I'd promise her as I'm promising you that I'll get you through it. 

Any other questions that I may be able to answer, from my limited experience, for you, I'm happy to do so. 

Dauna

Dauna,

Really no need to apologize. The Herceptin is given if you are HER2+ so that's why I was confused. It sounds like our tumors and receptors are exactly alike. I am concerned that my score will come back on the higher side as well. If I have to do the chemo to beat this beast for good then I will. Thanks so much for your response.

they should be back next week sometime. Thanks.