Why don't all breast cancer patients get chemotherapy?

as well as those who are er/pr negative but her2+. I was told that the taxol alerts the body of the dangerous cancer, then the herceptin paralyzes it while the body attacks whatever might be left. No options for anti-hormonal pills. Taxol and herceptin are both iv only at this time.

Determining which patients derive the most benefit from chemotherapy has been the goal of genomic testing. OncotypeDx, and some other less used genomic tests like Pam50, help do this for ER+ patients, by looking at tumor material and coming up with a recurrence score that indicates which individuals will be helped by adding chemotherapy to anti-hormonal therapy - which is also systemic and works throughout the whole body. Chemo works less well on those who are strongly ER+ and those patients may actually get more bang for their buck from anti-hormonal therapy such as Tamoxifen or one of the three aromatase inhibitors - Femara (letrozole), Arimidex (anastrazole), or Aromasin (exemestane). There are also some other genomic tests such as Mammaprint - which can be used for ER- patients also, but certain arrangements of hormonal receptors and Her2 status almost always require chemo and/or targeted therapy due to their aggressiveness, so for those patients the genomic tests are not used as often.

viewfinder - do you know what chemo regimen your sister is having? It seems that triple negatives either go with Adriamycin/Cytoxan/Taxol which is typically given in two different ways - dose dense Adriamycin and Cytoxan - 4 doses given two weeks apart from each other, then four dose dense Taxol, or the four dose dense AC, then Taxol weekly. Some patients do better with the weekly Taxol because they are smaller doses. AC can cause some more nausea than other regimens, but your sister's oncologist will watch closely and she will be given anti-nausea meds intravenously prior to administration of the chemo, and then she should be given more to take at home afterward. I would advise preventing nausea rather than trying to treat it once it happens. Finding the right meds to take at home can sometimes be trial and error. Let your sister know that she should report all side effects to her oncologist. I had a triple neg friend, who also had weight issues, and she did this regimen and did fine. She is single so I went with her to all of her infusions. She did require additional fluids the day after infusion with some additional steroid and this really helped her. Your sister's oncology center should offer her this if needed. If Adriamycin is to be given I would advise that your sister have an echocardiogram to assess heart health prior to starting, this is a risk factor with this drug, particularly if she is older. The other regimen some triple negs have is Taxotere/Carboplatin, given in doses 21 days apart. The addition of Carboplatin has more recently found to be helpful for triple negatives, but your sister's oncologist will hopefully make a recommendation for which regimen based on her clinical presentation. Some oncologists even add Carboplatin to the Taxol portion of the ACT regimen mentioned above in my post. I don't think determining in advance whether one might experience a specific side effect can be known - I have seen young and fit people suffer and older folks do just fine. I sat next to a lady when I was getting chemo who was in her late 70's. She had fallen shortly after her lumpectomy in a restaurant doorway and broken her hip - except for a time-out in surgery/rehab to fix the hip - she was getting chemo and was chipper and tolerating it without incident. She was an inspiration! Absent a specific co-morbidity that would prohibit a particular regimen - such as pre-existing heart disease and Adriamycin - it is a wait and see. Your sister will be closely followed by her oncologist for years following chemo, usually with appointments at 3 month intervals for the first year or two, then stretched out to 6 month intervals, and then to 1 year intervals. The good news for triple negatives is that after the 5 year point it is unusual to have a recurrence. That is nice of your daughter to go and help, I am sure she will be a comfort to your sister and you will be happy to know she is there with her.

Only "invasive" BCs, like IDC, may need chemo. "Non-invasive" BCs, like DCIS, don't need chemo cause they are non-invasive -- it doesn't spread beyond the breast. But it is a type of BC. At least, this is how I understand the difference.

Hopefully someone else can provide a better explanation.