43 with a positive lymph node—chemo thoughts?

I am 46 and I was in similar situation, initially thought it was 1cm and during surgery said node negative, then ended up being almost 2.5cm with micro mets. Surgeon told me the micro Mets didn't mean chemo was certain but when I saw oncologist, it wasn't even a discussion. Their absolute recommendation was chemo because of the node positive. We did oncotype anyway but she didn't expect it to change her view. Said it would have to come in really low and that was not the expectation.

I had breast cancer 6 years ago also. Back then I was node negative, onco was in the grey area and oncologist said it was my decision on chemo - I did it as didn't want to face it coming back and regretting not doing everything I could.

Hi Kathbus,

I am also premenopausal with a positive node and oncotype score was obtained. I had 1/3 nodes positive but was told at .33mm that is micro. Others here have said that is macro, so not sure the difference.

My oncotype ended up being a 4 so no chemo and I was started on Tamoxifen.

I have a consult with RO on Thursday. I am praying I will not need it as this will only delay my reconstruction further. But I will do what is needed to held fight off this crap from returning.

Kathabus, It depends on the Oncotype and your mental state. I was determined to be aggressive. I was very concerned when I had 2 positive nodes, 2 mm and 3 mm, macro is 2 mm and over. I was also very concerned that they didn't take out more nodes and that I might have more positive nodes. For you they only took out 1 node, so you could have more positive nodes. Sloan has a node calculator. I still had a 17% chance of more positive nodes. And I read about another person pushing for the ALND with micromets and she did have more positive nodes. I was pre-menopausal at 54. I predicted I would be in gray area, and I was right. But ILC is usually low, so I don't know where you will end up. Do you know your miotic score or KI-67? They are good indicators, along with ER status. But you are also young, and they tend to be more aggressive with younger patients.

As noted by Beesie, tailorx is for node negative. The node positive swog study has much less data and is older postmenopausal women. I got both reports because they submitted me as node negative first. The score was the same, but the recommendations are different. There is an ongoing trial that won't be completed for several years. Node negative will show numerical results. Node positive reports will not due to lack of sufficient data. It just says "no apparent benefit". My oncotype was 15. I went for 3 opinions because I didn't want to look back with regret. MY MO said I don't know what to do with you, second nci center doc said No chemo, Sloan Dr. said YES to chemo for the reasons stated above. NCCN guidelines even say the range from 11 to 18 is really undetermined for node positive. Sloan recommended cmf because I was in the gray area and it had less permanent side effects. Sloan also recommended ovarian suppression and AIs over tamoxifen.

Regarding radiation and chemo, I was told they are completely independent of each other. One is for local recurrence and other is for whole body. They said yes to radiation right away for me due to LVI, so didn't get another opinion on that. Don't know what they would have done without LVI, but I would have been upset if they didn't do radiation due to my node paranoia. NCCN guidelines state that for 1 to 3 macro nodes either ALND or radiation should be considered. Chemo was more difficult to determine, but LVI played a part in that decision also according to Sloan Dr.

KezNYC, did you do CMF and radiation with the first Dx, or second? Are you with Sloan, they are big on CMF? My evaluation was done by Bromberg with Sloan. I loved her, but stayed with my local MO. But I keep seeing people who did CMF and had a recurrence.

Hi JRNJ, yes I am also at Sloan and I did do CMF after the first dx and lumpectomy (negative node) and radiation. I had just been assigned to their ‘survivorship’ plan after 5 years clear when the second dx came back. Initially the surgeon said it was the same cancer back but the oncologist said it was a new occurrence that happened to be right in same area. Not sure what to believe on that one. So now they are hitting it harder with AC-T (and I had to have a mastectomy as they can’t do radiation twice in same place). I was on Tamoxifen for 5 years so worrying this grew anyway. I plan to have my ovaries removed once I get through this.