Choosing treatment for HER2+ BC post-lumpectomy

I personally would throw everything I could at it. The thing is you just never know what side of the statistics you are going to fall, and IF it came back then you would kick yourself and wish you'd done more initially - that's when it could be too late. I understand your mum has an underlying condition (diabetes) so I don't know how that affects the treatment she could have. Nobody can tell you that somebody is cured, not even the doctor. I know plenty of people who are now fine, some of whom had a high chance of recurrence, and I know a few people who had every chance of being cured and it came back. Maybe you should seek a second opinion.

Follow your gut instincts and what feels correct to *you*. (Or her, as it were..)

I was DX at 32. I am an 18 month survivor. I chose a double mastectomy because I highly considered foregoing chemotherapy. I did try chemo, and discontinued it after 4 rounds. I also D/C'd herceptin.For *me*, I realized that my quality of life on chemo was awful, and nothing they offered worked for my symptoms. I am a Nurse, so I was aware of the limitations that were par for the course.

I decided that if I did everything they wanted and it recurred anyway, I would be very mad that I continued chemo/herceptin. I had 2 blood transfusions, hospitalizations from nausea...etc.. It was dreadful for me, and I still have some lingering effects.

I am one to say that it is a totally valid choice to decide that you do not want to throw the book at it, so to speak. I wish that I never had chemo, even though I know the risk of recurrence would have been higher. I have decided that IF I were to recur, that I may not choose chemo and would seek hospice care to ensure quality of life.

I did attempt to do all that was medically advised, but I could not handle it. I think that people who chose to forego certain treatments, regardless of risks, should not feel badly for choosing to forego the standard of care.

It sounds nuts, but the assumption that trastuzumab (Herceptin) "works better with chemo" is unproven. It is complicated, so even some medical providers don't fully explain that to patients. What caused this problem is that for far too long, the clinical trial system and medical providers stuck to an ethical concept that every alternative to chemo that was offered as part of clinical trials then had to be given with chemo (whether or not it would have worked better than chemo if used alone), just because chemo made a statistical improvement for a small subset of people with breast cancer. That created the situation of overkill, where many more people then were exposed to a system that unfortunately reduced the immune system response (which finally only recently is being understood well enough to be investigated more fully as a better alternative to chemo).

It is hard as a newly diagnosed to sift through the history of standard treatment to be able to make concrete comparisons.

A more accurate way to sum it up is that chemo works better with trastuzumab (because it is the trastuzumab that made a real difference). The addition of chemo makes a difference only in a very limited group of patients.

All of this has resulted in "protective" treatment in the short run because of the additional benefit of chemo for that limited group of patients, but has resulted in failing to explore the treatments that worked better without chemo, and resulted in the compounded messes involved with having to give steroids, higher risk for infections, massive costs of chemotherapy, etc. that occur in the long run for the much larger group of patients that get no benefit from doing chemo.

A.A.