Treatment plan for IDC

Hi Magic,

We have similar diagnoses. I was diagnosed April '16 at age 27 with stage IA IDC. 0.9cm tumor in the right breast, no lymph node involvement (T1bN0) ER+, PR-, HER2- , Grade 3. I had a double mastectomy due to BRCA1 mutation. I did not have radiation, but if I didn't have the BRCA mutation and had chosen a lumpectomy instead of mastectomy, I would have had it, as to my understanding all lumpectomy patients get radiation. I had chemo, which was 4 rounds of AC (Adriamycin & Cytoxan) which I had every 3 weeks. After chemo I started hormonal therapy, and will be continuing that for the next 10 years. I get a monthly injection of Lupron (Ovarian Suppression) and take Letrozole (Femara) daily, which is an Aromatase Inhibitor. This course of treatment was selected as being the most aggressive for my case, and I am currently doing fine. I haven't heard of the term Antimetabolites before, but most of the drugs in the list you provided are for metastatic or more advanced disease. I would ask your doctor about Ovarian Suppression and an Aromatase Inhibitor. None of this is without side effects, but each case of cancer is different and is worth a discussion with your Oncology team about what the best course of action is for you. Get multiple opinions if necessary. Best of luck to you!

Hi magic, and welcome to Breastcancer.org,

We're sorry for the reasons that bring you here, but really glad you found us. As you can already see, our Community is a helpful support system, full of members always willing to share thoughts, experiences, and advice. We're all here for you!

Thanks for posting and we look forward to hearing more from you again soon!

--The Mods

With Grade 3, a tumor >1cm (yours is 1.5) and PR- your cancer is more likely Luminal B and already more aggressive than a Luminal A (Grade 1 or 2 and ER/PR+). Add to that your youth and you will almost certainly be prescribed chemo. OncotypeDX is usually reserved for those in a “gray area” (e.g., Luminal A but >1cm, or 1-3 positive nodes); and Grade 3 combined with tumor size and PR-status takes you out of that “gray area.” Tumors tend to be more aggressive in premenopausal women, and since you are only 35, more aggressive still. That doesn’t mean it can’t be stopped in its tracks.

Poodles is correct—if you elect mastectomy you probably wouldn’t need radiation, especially since you’re node-negative with clear margins. But some mastectomy patients need radiation if the tumor was close to the chest wall or the “axillary tail” (the short extended area below & perpendicular to your armpit).

At your age, you would normally get both Tamoxifen and an ovulation-suppressor (e.g. Lupron or Zoladex)—unless you elect to remove rather than suppress your ovaries, in which case you would skip Tamoxifen and the ovarian suppressing drugs and go directly to an AI. The higher your risk profile, the longer you would be on some form of endocrine therapy (and since you’re pre-and-not-peri-menopausal, that probably means Tamoxifen until you go into natural or chemical menopause (either from the ovarian suppressors or chemo itself) and then switch to an AI for at least 5 years after that, regardless of how long you were on Tamoxifen. Those who start directly with an AI may be able to stop at 5 years only if they are older, postmenopausal, and considered low-risk (at least for now—some say at least 6, some as many as 10 yrs, some even say lifetime).

But at your age you are better able to tolerate chemo, strong endocrine therapy and radiation than are we oldies.

HI I am triple neg IDC so I can't really help about the hormone therapy etc...but I did 8 rounds of chemo 4 of AC then 4 of taxotere...I will be having a double mastectomy with expanders on April 17th...then radiation for 5/6 weeks...its not always true that you don't have radiation with a mastectomy. My MO said that newer studies show there are more benefits to having radiation even with a bmx, clear margins, small tumor...higher survival rates over years...so just don't be surprised if they say you should have rads too. (My tumor is not close to my chest wall etc)

Good luck!!

You need the Tamox. along with the Zoladex (if you get Zoladex) because they are two different classes of anti-hormonal drugs with two very different functions. Zoladex is designed to shut down your ovaries so they don’t make estrogen. But your body still makes estrogen, even without ovaries. Fat cells and the adrenal glands both make an androgen, and the liver makes an enzyme called aromatase that converts that androgen to estrogen. So even on Zoladex, or after ovary removal, your body makes estrogen which the tumor cells can access.

That’s where Tamoxifen comes in: it blocks the tumor cells’ estrogen receptors so that the tumor cells can’t absorb the estrogen they need (or at least get less than they needs) to divide and thus grow into a new tumor (primary or recurrence). But it doesn’t stop either your ovaries or your fat cells & adrenals from making estrogen.

Aromatase inhibitors (AIs) are the drug of choice for postmenopausal women. They prevent aromatase from turning those androgens into estrogens. They are not only more effective against recurrence for postmenopausal women, but safer—Tamoxifen can cause blood clots, and because older women have a higher cardiovascular risk than younger women, those blood clots are more dangerous for older women. It can also accelerate cataract development (not a big deal, as cataract surgery is easy & very safe and usually gives almost-perfect vision even if you didn’t have it before getting cataracts; and raise the risk of uterine cancer in those who still have a uterus and retroperitoneal cancer (highly aggressive with a poor prognosis) in those who’ve had a hysterectomy. This risk is also much higher in older women.

But Tamoxifen + ovarian suppression is the treatment of choice in younger women—not just because their arteries are usually in better shape and less likely to be occluded by a clot—but because AIs have their own side effects that mimic those of aging, especially bone weakening. One GOOD side effect of Tamoxifen is bone strengthening.