Greetings! Sorry about your diagnosis, but you've come to the right place! I was diagnosed in April and am already on the other side. :-)

In answer to your question about radiation, your treatment will depend on the rest of your biopsy results (did they tell you if you are ER/PR positive or negative, HER2 positive or negative, and what grade you are?) If you haven't got one already, ask for a copy of your biopsy report. All of those things, the size of your tumor as well as whether or not you have node involvement will determine your treatment. And then what surgery you choose - lumpectomy vs. mastectomy, can also determine whether or not you might need radiation. Your doctors should discuss all your options with you. Make a list of questions to take with you to your appts and write down the answers as well as any more questions that come up because it is a LOT of information to absorb all at once. As far as how long you have to make a decision, that could depend on how aggressive your cancer is. If it is slow growing, you probably have some time to think things over and do some research.

I am ER+/PR+/HER2- (which is the best combo to be, I think), my tumor was fairly small and even though I had 1 involved lymph node, it wasn't an auxiliary node so doesn't really count. I chose to have a BMX with reconstruction (my girls had long since seen better days and I actually wanted to get a new set of perky ones) so I didn't need radiation. My Oncotype DX score came back very low so no chemo for me either. As it is, I only need hormone therapy and the side effect from it so far have been incredibly mild. I was very lucky and I hope you will be too!

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Are Small Breast Cancers Good because They Are Small or Small because They Are Good?

Donald R. Lannin, M.D., and Shiyi Wang, M.D., Ph.D.

N Engl J Med 2017; 376:2286-91June 8, 2017DOI: 10.1056/NEJMsr1613680

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Data from the Surveillance, Epidemiology, and End Results registry show that smaller breast cancers, like many of those detected by mammography, are disproportionately biologically favorable in natural history.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

SOURCE INFORMATION

From the Department of Surgery, Yale University School of Medicine (D.R.L.), Yale University School of Public Health (S.W.), and Yale Comprehensive Cancer Center (D.R.L., S.W.), New Haven, CT.

Address reprint requests to Dr. Lannin at the Department of Surgery, Yale University School of Medicine, P.O. Box 208062, New Haven, CT 06520, or at donald.lannin@yale.edu.

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MEDIA IN THIS ARTICLE

FIGURE 1Biologic Characteristics According to Tumor Size.

FIGURE 2Breast Cancer–Specific Survival among Women 40 Years of Age or Older, According to Tumor Size and Biologic Features.

Primary Care

Written by Tricia C Elliott MD, FAAFP

As the molecular structure of breast tumors continues to become more evident, and with the significant increased use of mammography for breast cancer screening in women ≥40 years of age at average risk, the overdiagnosis and overtreatment of breast cancers appears to also be occurring. Previous studies estimate the overall rate of overdiagnosis for invasive tumors is 22%.

Lannin and Wang determined the impact of biologic factors such as grade and hormone receptor status, along with evaluating mean lead times in three prognostic groups for best and worst survivals: biologically favorable, biologically unfavorable, and intermediate.

Prognostic Group (based on biological factors)

	Favorable	Intermediate	Unfavorable
Grade 1	ER+/PR+ ER+/PR- ER-/PR+	ER-/PR-
Grade 2		ER+/PR+ ER+/PR- ER-/PR+	ER-/PR-
Grade 3		ER+/PR+	ER-/PR- ER+/PR- ER-/PR+

ER=Estrogen receptor status

PR=Progesterone receptor status

They focused primarily on the characteristics of favorable and unfavorable tumors, and correlation with the size of the tumor. In women ≥40 years of age with small tumors (under 1 cm), many of these were favorable tumors. The larger the tumor, the greater chance it is unfavorable. Findings show that tumor size also depends on the biologic factors of the tumor, not solely on when the cancer was detected. Many small tumors with favorable biologic features do not progress to large tumors within a patient's lifetime. Large tumors may preferentially develop from small tumors with unfavorable biologic factors. Tumor size and biologic factors influence prognosis.

Mammography has been very good for detecting tumors; however, with the overuse of mammography, we are detecting many tumors with favorable biologic features and may be overdiagnosing and overtreating certain cancers that may benefit solely from excision (without chemotherapy) or watchful waiting. Also, as age increases over 40 years of age into age 70 and 80, the overdiagnosis of favorable, small tumors increases significantly. Overdiagnosis can cause unnecessary anxiety and fear in patients.

As primary care clinicians counseling our patients on breast cancer screening and detection, multiple factors can contribute to a shared decision between clinician and patient. When a tumor is detected, tumor size and biologic features may be factors in the decision-making process. Stage, size, age, and biologic factors matter and may help avoid overdiagnosis and overtreatment in patients. Many small breast cancers may be good because they meet the favorable biologic profile, and they may be small because they are favorable. More studies are needed to help develop future guidelines for clinicians and patients.

Thank you for your posting. I was diagnosed Monday IDC, >2cm ER+/PR+, I can't remember about the HER2, but I was told it's a good cancer to have (if that's at all possible). Meeting with the surgeon on Tuesday and I can't meet with the oncologist until 7/17. I am hoping no radiation. I am 44, husband left me in December, and I had an unplanned hysterectomy in March when I went in for a Davinci Procedure to apply a sling under my urethra d/t stress incontinence. I'd had two previous surgeries to remove endometrial scar tissue and the surgeon had to remove my uterus and fallopian tubes because of the three fibroids that made it the size of a large grapefruit. Here we go!

Hi Matryoska,


I was very terrified of RADS because I am a redhead with very fair skin and of course I googled and saw horrible burns and leathery skin. I fear having a mastectomy with reconstruction because I've seen horrifying before and after photos. I've always been self conscious of my body and anorexic and bulimic for most of my life. I understand my breasts don't define me, it just upsets me, grosses me out, and pisses me off. Ultimately, I'd rather be alive!!!!! A co-worker of mine reassured me she had radiation and her only side effect was being tired. I know all cancers, treatments, reactions, and side effects are different. My husband has actually been incredibly supportive of me and admits he's scared too. Even though we are not together living as husband and wife, its comforting.


I do not yet know what my options are. I meet with the surgeon tomorrow and surprisingly, I was called by the oncologist's office and met him today. The co-worker also recommended him. I felt very comfortable with him, Not only did he explain my HER2+ meanings (not good /quite aggressive) but he ordered labs, genetic testing due to family history. He explained that they are not there just to treat me and give me medicines, they are here to help me through the experience. That was quite reassuring. He explained that my tumor is 2.2cm and 2.5cm is the cut off for certain types of treatments. He did tell me I will be most likely taking Herceptin . I'm glad he seem eager to 'get the ball rolling' even though he didn't really have much to work with.


As of now I meet the surgeon tomorrow, BRCA 1&2 blood draws after, a head CT on Thursday due to my headaches which are new, and an MRI on the 19th. I meet with him again on the 20th to go over a plan of action. I am not alone in this. thank you all for your posts.

Donagingernurse- totally get where you're coming from with the fair skin and rads. Rads are pretty standard if you opt for only lumpectomy-you can never be sure you got it all even with clean margins. Being a nurse I know youve seen plenty of bad MX outcomes with and without recon. I will say however that MX and recon has come a long way in a short amount of time. If I entered your ER I'd bet you'd look at my chest and say 'it looks like she may have a very faint scar descending from her nipple-she maybe had breast augmentation. But they don't look like there's an implant in there..." I had BMX with immediate natural tissue recon using the DIEP flap procedure in Feb. the end result is breasts that look like the ones you went into surgery with (unless you want them to be different), they are soft and warm, and they move with you and age with you just like the originals. Just like any other surgery, you have some good outcomes and you have some not so good outcomes. Immediate recon helps increase the odds of a good outcome versus delayed Recon. Having a surgeon who does this type of recon at minimum one time a week with a lower than average failure rate also helps the odds. I guess at the end of the day all I'm saying is don't rule out MX with recon so soon in the game if you truly don't wish to have rads and your MO agrees that BMX would mean you could avoid rads. To learn more about this option from the top center that does this type of recon (the center for restorative breast surgery in New Orleans, aka NOLA -women travel from all over the world to have their recon done here for a reason including me) check out their website:

www.breastcenter.com

I had the same experience, etnasgirl. I'm fairer than fair - if I even think about going outside, I start to look like a lobster. As a child, I was the little girl on the beach wearing a T-shirt over her bathing suit.

I, like Donagingernurse, was worried about my skin's reaction to my 33 radiation treatments (which I finished last Friday). I got a little red but nothing terrible, certainly not painful. No blistering, no peeling. I did get a bit of a rash but it's already going away.

MJ

Ready2bedone,

Did you have a palpable mass or was your BC first detected on a screening mammogram?

Thank you for your help!

Thank you so much. I definitely will consider that.

I have some questions if that's oaky; were you initially diagnosed with one type, it was treated and then another type came back? Did you have BRCA testing? I'm seeing that you had been diagnosed, but surgery was six months later. Is that normal? In this forum, I'm seeing many women's profiles showing a dx and surgery (often MX or BMX) within a month and a few being stage 1 &<1cm. Technically, I found out within a four day window from mammogram to dx.

This is quite difficult to swallow at times, but for the most part, I'm trying to stay positive about this because it's treatable.

Thank you for the feedback. I see my oncologist tomorrow, and we'll go over a course of treatment which may be TCHP(as he previously mentioned). I haven't yet received the genetic testing but I will. It seems chemo is 12 weeks / 6 series of the TCHP chemo or longer. They are seeing many scattered cysts in my left breast, but nothing concerning at this point although they are dense. I also still have ovaries and I'm not sure if I should have them removed as well. I'm just trying to educate myself as best possible, and being a nurse, well.... can make it worse.

I will take it day by day, eat right, exercise, and be honest with my MO, and others on my team. I am concerned I will be too weak or sick to work so I took some tips from the top 20 things to help with side effects. In additional to that, I don't have any family in state and my husband left me, and I'm behind in the mortgage.... which I only have 13 years left on.

Are you happy with your reconstruction? I have fairly large breasts 40C. In a perfect world I'm hoping that the tumor is so small and can be removed (its at 6:00). And if all goes well just have reconstructive surgery after I'm healed and hopefully free of CA. BUT BOY DO I KNOW it doesn't work out the way we want. I have a co-worker who had a case similarly to mine, 17 years ago she had it in the same place, went through chemo, lumpectomy, rads and tamoxifen for 5 years and its been fine. I am going to see her oncologist and he made me feel very comfortable explaining that I am not just a case, they are there to help me in every way through this entire process.

I stop before a panic attack is about to fully encompass me and STOP!! Just take it day by day. It's scary at times so I say many positive mantras and pet and cuddle with my fur babies- that helps a great deal.

dcblue as a triple positive, you oncologist will most likely suggest chemo. Come and join us on the triple positive thread...

Yeah - it starts to get "really real" at this point.

There are lots of lists on this site for what to bring. Most important for me was a soft sweater or shawl - they have warm blankets where I go but it's always cold. I took a book and my Kindle so I could pass the time reading or playing games. Also took the laptop a few times thinking I'd watch something but never really did.

They had snacks and drinks and even provided a bag lunch, but you should bring anything particular that you might want to eat or drink. My husband would go out and get subs for us. They just didn't want any hot foods there.

The time goes by pretty quickly. I've rarely been able to sleep with so many people coming and going. Each time they hang another med they have to check your name and DOB. And the volunteers would be checking in with me.

Just be sure to take your meds as ordered. I was on steroids (day before, day of, day after) to minimize SE's. I also started Compazine for nausea the following day and continued that just twice a day for a few days "just in case" - never had a bad problem.

Probably the worst SE that can be helped is the constipation and then the diarrhea. I also developed severe gastritis. Hopefully your MO's office has given you a list of what you can take and when to call.

When you're in the midst of it - it can seem like forever. It really will go by fairly quickly. And don't worry about the faith. Some find theirs and some lose theirs and some just have a big question mark. It's all okay!