Recurring breast cancer 4 woman who didn't need Chemo.

Oh yes, the Neulasta shots!!! My late husband was a diabetic and was on dialysis for many years and those blasted shots were forced on him for no reason we could fathom and thank goodness when we changed PC's they were stopped - I had chemo for my BC and never was offered nor did I need a neulasta shot - my blood counts were terrific throughout (must have been the Easy Mac diet I was on - seriously!) - anyway seems to me there was an article in the newspaper a few years back about the shots and dialysis clinic owner in California and some kind of payment scheme (or scam) - I see the ads every night on the newscasts however - gotta love the drug companies!

How can anyone respond to you without information about your diagnosis. Please fill out the diagnosis section of your profile, or expect nothing of substance from members, who, BTW, are NOT doctors. Just saying.

MaryToU,

My gynecologist that delivered my babies comes highly regarded in my community. He told me that he wanted me to get 3 separate opinions from breast surgeons and 3 separate opinions from medical oncologists. I also got 2 opinions from rads oncologists and 2 plastic surgeon opinions.

Then and only then did I make informed decisions on doctors and recommended treatment. Getting a second or third opinion doesn't mean you are trying to find a doctor that will agree with you. For me it was find the right fit and rapport as well as finding a doctor I had confidence in. I found that the doctors I chose all had progressive thinking and the latest most up to date information on treatment. I am thankful that we live in a country that allows to to choose and seek out individualized care.

I pray you will find all of your answers. It is such a difficult time while we wait.

Iit was believed that if I had a mastectomy I would not need rads. That quickly changed when I had a close surgical margin that was sitting on the chest wall. Chemo was because of my pre-menopausal age, high grade tumor, an oncotype score on the high end of intermediate and a strong family history. I went with everything my doctors suggested. Not because I don't have a mind of my own or an opinion, but because I believe in their education and expertise. And I have children that I want to see get married and have children of their own. I am willing to throw everything at this and pray I don't ever have to deal with it again. If I do then I will throw everything at it again.

Best wishes and many prayers

cp418 - I think this is an important issue. Maybe we need to give it a thread of its own and/or raise the issue with the moderators and the rest of the community?

Two things: Personally, I need to know who I am talking to with a diagnosis and treatment stated. If you don't put your stats, won't talk to you. Don't want to say the wrong thing to the person without a posted diagnosis. Just my opinion. Secondly, the question that started this conversation was about chemo for a Stage 2 diagnosis. With a pharmacy education all I can say is that positive lymph nodes used to automatically trigger chemo, and have for the last 30 years. Even if clear lymph nodes were removed after the affected ones, chemo was standard of care. If you choose not to do standard of care (chemo) you are taking a chance at the craps table. At Stage 2, Grade 2, with hormone positive receptors, you are probably looking at radiation up to 30 treatments, followed by Tamoxifen or an AI. Those are not considered the big guns, just guns that might stop the bc from progressing. With the new results from the SOFT study, ovarian suppression and AI are shown to be superior during the first five years of treatment compared to Tamoxifen. Long term studies need to be conducted to see if this remains true 15 to 20 years down the road.

MaryLou, also, you won't really know anything specific until after your tissue from the mastectomy is evaluated. The biopsy and tissue from mastectomy could be slightly different. Sometimes, the staging and grade will change as pathology reviews all information, and any test areas. Also, most likely no rads for you (depends on what the size of your bc area is) but I have seen women with recurrences on the mast side have radiation.

From Breast Cancer.org:

After mastectomy

Radiation therapy may be recommended after mastectomy to destroy any breast calls that may remain at the mastectomy site. During breast removal, it's difficult to take out every cell of breast tissue, especially the tissue behind the skin in front of the breast or back along the muscle behind the breast. Usually any leftover breast cells are normal. But because it's possible for some breast cancer cells to linger, there is a risk of recurrence in the area where the breast was. Based on your pathology report, your doctor may recommend radiation therapy if you've had a mastectomy.

These factors are associated with a high risk of recurrence after mastectomy. Radiation may be recommended if any of these factors are present:

• The cancer is 5 centimeters or larger (the cancer can be 1 lump, a series of lumps, or even microscopic lumps that together are 5 centimeters or larger).
• The cancer had invaded the lymph channels and blood vessels in the breast.
• The removed tissue has a positive margin of resection.
• One or more lymph nodes were involved.
• The cancer has invaded the skin (with locally advanced or inflammatory breast cancer).

Based on these risk of recurrence factors, about 20% to 30% of people are considered at high risk of recurrence after mastectomy. Radiation would be recommended to help reduce this risk by up to 70% (for example, a 30% risk may be reduced to just under 10%). Treatment is given to the area where the breast used to be and sometimes to the lymph node regions nearby.

Some people have a moderate risk of recurrence. They're in the "gray zone" because the cancer has characteristics that increase their risk, but not to a point where the risk is considered high. For example, you might have a 4 centimeter cancer. You and your doctor need to carefully consider your unique situation. Some people in the gray zone want to know they have done everything reasonable to treat the cancer, to avoid or reduce the risk of ever having to deal with it again. Others in the gray zone may decide not to go through with radiation therapy after a discussion with their doctors.

I would add that the SOFT study also showed a benefit with OS plus an AI for women under 35. The cohort that did just as well with just tamoxifen skewed a bit older.. i think the average age was 46. I was 38 at diagnosis which is why I am choosing the SOFT protocol...I feel I am closer to those under 35 stats even though I did not need chemo.

Regarding ovarian suppression, for those who would like to learn more and to consult the original SOFT and TEXT studies, I have the following bookmarked. The first two ASCO documents are a 2014 Guideline and recent 2016 Update, the latter of which was issued in light of SOFT and TEXT.

ASCO 2016 Guideline Update: http://ascopubs.org/doi/full/10.1200/JCO.2015.65.9573

(Free PDF version available under PDF tab; See also, Supplement tab)

ASCO 2014 Guideline: http://ascopubs.org/doi/full/10.1200/jco.2013.54.2258

SOFT (Francis):

Main Page: http://www.nejm.org/doi/full/10.1056/nejmoa1412379#t=article

PDF version: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1412379

"[R]esults of the planned primary analysis in SOFT comparing adjuvant tamoxifen plus ovarian suppression with tamoxifen alone after a median follow-up of 67 months"

Supplementary Appendix to Francis: http://www.nejm.org/doi/suppl/10.1056/NEJMoa1412379/suppl_file/nejmoa1412379_appendix.pdf

TEXT/SOFT (Pagani):

Main Page: http://www.nejm.org/doi/full/10.1056/nejmoa1404037#t=article

PDF version: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1404037

"[P]rimary combined analysis of data from TEXT and SOFT comparing adjuvant exemestane plus ovarian suppression with adjuvant tamoxifen plus ovarian suppression after a median follow-up of 68 months"

Supplementary Appendix to Pagani: http://www.nejm.org/doi/suppl/10.1056/NEJMoa1404037/suppl_file/nejmoa1404037_appendix.pdf

Re Lobular disease (ILC): BIG 1-98:

Filho (2015): http://ascopubs.org/doi/full/10.1200/JCO.2015.60.8133

(Free PDF version under PDF tab; See also, Supplement tab)

ASCO Post Article re BIG 1-98, "Benefit of Adjuvant Letrozole vs Tamoxifen Is Greater in Lobular Than in Ductal Breast Cancer": http://www.ascopost.com/News/31718

These documents are not a substitute for current, case-specific, expert professional medical advice. However, they can help to inform discussions with your medical oncologist ("MO"). It is easy to misunderstand such highly technical documents and whether and how their guidance should be applied in the individual case. Guidelines represent snapshots in time, and there may be appropriate exceptions to what is provided for the general case. There may be additional, more recent studies and/or conflicting studies. Therefore, if a publication influences your decision-making in any way, it is essential to confirm your thinking with your MO.

BarredOwl

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[[[EDIT: Since the above results and Guideline Update were published, additional results are now available:

SOFT/TEXT: Francis et al. (2018), "Tailoring Adjuvant Endocrine Therapy for Premenopausal Breast Cancer"

Main Page: https://www.nejm.org/doi/full/10.1056/NEJMoa1803164

PDF version: https://www.nejm.org/doi/pdf/10.1056/NEJMoa1803164

Supplementary Appendix to Francis (2018): https://www.nejm.org/doi/suppl/10.1056/NEJMoa1803164/suppl_file/nejmoa1803164_appendix.pdf ]]]

Hi VoraciousReader:

The paper you just quoted to and linked to is an "author manuscript" submitted to NIH, and was published in final form in the New England Journal of Medicine (NEJM) as the article by Pagani "TEXT/SOFT (Pagani)" that I linked to in my prior post.

BarredOwl