Chemotherapy necessary - OR - anti-Hormone therapy -OR- both?

I didn't see you had 5 positive nodes that is probably why they are pushing chemo. I believe oncodx can be done for 2 nodes positive, not sure. I still think AI drugs are best against your type of cancer, they will most likely recommend them. I'd want to start ASAP.

PSW - I'm sorry that you're newly diagnosed but glad that you found this board. Your post doesn't include the grade of your tumor, the percent ER or PR positive or the Ki67%. These are all factors that your MO may have taken into consideration when making his recommendation. They are important parameters along with the number of positive nodes and sub type that should be considered. The oncotype test is only approved for tumors with 1-3 positive nodes. There are women on this board who opted to use only antihormonals and those that decided to get chemo, complete radiation and take an AI or Tamoxifen If you are unsure about your MO's recommendations, I would highly recommend getting a second opinion, if possible at an NCI designated cancer center. Locations can be found at this link.

http://www.cancer.gov/research/nci-role/cancer-cen...

You may find it helpful to solicit advice from other women but ultimately, what's important is that you are fully comfortable with your treatment plan.

I think that the most stressful time is when you are trying to decide on your treatment plan. I wish you the best.

i had 7 positive nodes out of 14........I only had hormone therapy as was 95% ER pos and also 85% prog pos.........I am 4 years 2 months from diagnosis........I waited until I knew what was right for me and that I would not regret later. I am still fine with my decision despite a couple of recent cancer scares, both of which were ok in the end as turned out not to be.......

Chemo does not kill cancer stem cells, and these are the dangerous ones in terms of metastases, your doctors gave you a very simplistic version....

You really are at the worst point..........take care......

I would recommend registering at the NCCN's website and reading the breast cancer treatment guidelines. Besides a second opinion, if you are still unsure, request that your case be presented to a tumor board.

That said, the NCCN's standard of care does recommend chemo for tumors whose characteristics are like yours. Unless you have pre existing conditions that the risks of chemo might outweigh the benefits, physicians will recommend chemo. "Going by the book" protects you and THEM. That is also why there is a Standard of Care. Ultimately, it is your choice.

I wish you well.

PSW - Oncotype is not usually done if you have more than 3 positive nodes as the assumption is that chemo is needed, and the test was actually designed for node negative patients. Mammaprint is a similar type of genetic assay test, but it is very likely that with node positive disease that your recurrence risk will come back in the high category. Insurance may not cover the test (approx. $5,000) due to the number of positive nodes and standard of care being chemotherapy for this patient profile. As to the question of whether you need chemotherapy - nobody really knows - but your cancer proved it was already on the move with half of your removed nodes positive. Only you can make the decision about how much risk you are willing to undertake, both from chemo and from not doing chemo. I also just wanted to clarify - Prolia is actually not a bisphosphonate, but rather a monoclonal antibody bone strengthener. Generally, due to the cost, you need to start on a bisphosphonate like Actonel, Boniva, Fosamax or the IV Reclast and be unable to use them before insurance covers Prolia - it is a considerably more expensive drug. Some have been lucky and been approved for the twice yearly subcutaneous injection of Prolia without first having to go through the bisphosphonates. Aside from some trials, and forward thinking oncologists who are prescribing anti-hormonals prior to surgery, it is the normal treatment chronology to follow surgery with chemo, then radiation, then hormonal therapy. Best to you!

Hi PSW:

The Genomic Health website includes the "eligibility" criteria for Oncotype for invasive disease here, indicating those with hormone receptor-positive, HER2-negative disease, and either node-negative or from 1-3 positive nodes are formally eligible:

"Eligibility" for Oncotype (Invasive disease): http://breast-cancer.oncotypedx.com/en-US/Professional-Invasive/OncotypeDXBreastCancerAssay/PatientEligibility.aspx

The Agendia website is not quite as clear about eligibility for MammaPrint, but it can be inferred from the discussion of the validation studies for MammaPrint on this page, which mentions studies which included patients with "Up to 3 Positive Lymph Nodes (LN+)":

Eligibility / Validation for MammaPrint: http://www.agendia.com/healthcare-professionals/breast-cancer/mammaprint/

The recent MINDACT trial of MammaPrint included patients with 0 to 3 positive nodes.

I am a layperson with no medical training, so do not hesitate to inquire with your treatment team to obtain expert confirmation and case-specific medical advice. Also, while you should feel free to discuss things with your nurse navigator, it is important to keep in mind that she also lacks the training of an expert medical oncologist, and for definitive advice on such a specialized technical question, you should also ask the medical oncologist.

For other node-positive patients with up to 3 positive nodes:

Despite these formal "eligibility" criteria from the commercial test providers, patients with up to three positive nodes should specifically ask their medical oncologist about how current consensus guidelines from ASCO and NCCN view these tests in the node-positive setting and specifically in patients with their exact nodal involvement.

BarredOwl

If you do decide to go with the chemo, you will get through it. It's not fun, but you just have to take it one day at a time. For me, the first few days are fine, then on day three the side effects kick in. They lasted anywhere from 4 days to 9 days, then I felt weak but so much better. Then you have about a week of feeling pretty good. Then you start it all over. After it was all over (I did five rounds, one each 21 days), I recovered after the last 4- 9 day period, and only got better and better, able to get back to all my normal activities after 2 to 3 weeks. I am now almost 3 months out and my hair is growing back (still very short, but at least I'm not completely bald anymore). I don't have any of the digestion problems, skin dryness, or other side effects. The only one that has remained, but to a lesser degree than when on chemo, is the neuropathy in my feet. Now it just feels like a slight numbness. Kind of like you need a massage to increase blood flow to the feet, but massaging them doesn't make it go away. I'm getting used to this and in the big picture it's really not a big deal. The only time it is annoying is when I walk or hike for miles, and my feet just feel a little more tender than they would normally after walking some distances. I figure, if chemo does what it's supposed to do, to improve your chances of being cancer-free, these side effects are so minimal, and very worth the inconvenience. Best of luck.

I had one ILC and was recommended chemo with oncodx of 34. They were concerned since my pr was less than 1%, but er 95%. I doing great, I did 4 years AI.

PSW, all these decisions are awful for all of us. In my case my oncologist did NOT recommend chemotherapy as my Oncotype result was at the lower end of intermediate and I only had isolated tumour cells in two nodes. However I realise you're not eligible for Oncotype DX test. Although chemo is sometimes not so helpful for ILC, I would think in your case with 5 nodes affected and a large tumour it would be worth doing. Best wishes for all your treatments and keep posting on relevant threads because the knowledge and empathy of others here is fantastic.