Chemo or Not?

oh gosh, that's a hard decision. I have no advice but maybe a bit of info/questions to help you navigate.

How strong is your ER+/PR+ on your pathology? The stronger, the more responsive to tamoxifen and AIs. What Grade tumours?

Just FYI, until a few years ago, Oncotype wasn't routinely used in my province and they made chemo decisions based on these guidelines:

"In general, if the cancer exhibits any or several of the characteristics listed below, the benefits of chemotherapy should be considered:

• Tumor >2cm
• Lymphatic and/or vascular invasion present
• Grade 3
• Weak ER and PR expression (Allred score 3-5; ER 1+ by IHC)
• Node positive"

http://www.bccancer.bc.ca/health-professionals/cli...

but oncotype really changes things. Their data seem really robust and it was explained to me that the risks of chemo outweighed the risk of recurrence if you got a low score.

Can you get a second (or third) opinion?

Chemo isn’t a picnic, but it is doable. Some sail right through it with minimal se. Others have problems. Your MO has the whole pharmacy to help you.

I’lldo it again if I have to, just so *I* know I’d done everything I could.

You can try running your numbers in the Predict calculator from NHS.


http://www.predict.nhs.uk/predict_v2.0.html

Moth, thanks for the link to PREDICT. Not sure if I am using it right, but it shows only 0.4 per cent benefit for adjuvant hormone therapy over five years, and 1.0 percent benefit over 10 years. I am 100% ER positive so the small hormone benefit surprises me.

With my diagnosis, all the benefit seems to be from surgery (92.1%,79.2% over 5 and 10 years respectively). Or am I reading this wrong? (age 69, 13 mm tumour, no nodes, assuming no chemo)

Also, I see that PREDICT is based on a study of 5700 women treated between 1999 and 2003. I wonder how much better the odds might be now with more recent treatments.

Finally, do you know if PREDICT assumes radiation treatment?

Loki, if you scroll down here http://breast-cancer.ca/chance-cure/ you will see a table of recurrence rates. This includes all forms of breast cancer recurrence, not just IDC.

Interpreting this data is challenging; thanks for any light you can shed.

I am seeing my surgeon tomorrow after lumpectomy on Feb. 26. Will ask her about Oncotype testing, also survival rates. I too am wondering about chemo yes or no.

lean1982- I had a hard time getting the dr to commit to any numbers which was very frustrating. I did make the decision to do chemo-4 treatments. My Oncotype was 29 ( 2 points from high) and my med Onc essentially considers it in the high range. My 10 year recurrence rate is pretty high and I don’t want to regret not having treatment. I looked at my age, biopsy and test results as well to make my decision. There is no guarantee either way but .....chemo is the only way to get at any cancer cells that have already “escaped” the area and do anything about metastasis. Radiation is local treatment only. As I have had some fairly serious side effects ( hospitalization for fever and neutropenia and hand-foot syndrome) along with being fairly incapacitated for s week each treatment I wonder sometimes though. I alsohad a lumpectomy not a mastectomy. It’s not an easy decision. I’m not sure that helps. I see it as a very personal decision- different for each of us. try to get all your questions answered so you feel you are making an informed decision.

Loki. Thank you so much for your reply. You did all possible, carefully and courageously.

I am in Vietnam where does not have oncotype test for me. My Ki67 30% is so high and that make me scared. However, I believe that is a pure tubular carcinoma with 100% positive ER and EP, which not need a chemo for treatment.

How about your Ki67 and percent of ER, EP, Loki?

chemo was suggested because oncodx was 34. I did 4 years first on anastrozole and then exemestane. I stopped due to side effects. I am 7 years no recurrence. I still see my oncologist every year.