Surgery alone for treatment.

Evie (screen name Hindsfeet), who I corresponded with for years starting with her first DCIS diagnosis in 2007, went with surgery alone for that first diagnosis and her subsequent localized recurrences, including an invasive HER2+ recurrence. Once she developed mets, she opted for other treatments.

She has passed away so sadly she is not here to respond to your post. As ElaineTherese said, HER2+ is aggressive. I really don't know if in hindsight Evie would have chosen to have other treatments earlier on versus the very aggressive treatments that she had once her cancer was metastatic.

I basically had surgery only, but my diagnosis is far different from yours. It's not true that recurrence is inevitable, the majority of women don't have one. However, the more aggressive the cancer, the more likely the recurrence and that's why more treatment is offered. It's always your choice, but personally if I had your diagnosis I would go for the recommended treatment.

Iamloved,

As SummerAngel said, it is not inevitable that you will have a recurrence.

Here's the thing with HER2+ cancers. When I first arrived here back in 2005, HER2+ cancer, being the most aggressive, had the worst survival rate. Since then, treatments such as Herceptin have become available and mainstream. Now when you look at the new staging criteria, based on pathological features and prognosis, HER2+ cancers are actually staged lower than HER2- cancers because the prognosis / survival rate is better for HER2+ cancers. But this assumes that the patient undergoes the recommended treatment.

It is unquestionably true that there are health risks from the treatments. The question is whether, for you, at your age and with your diagnosis, those risks are greater than the metastatic / mortality risk from your diagnosis, should you opt out of treatment. With HER2+ cancers, more than any other breast cancer subtype, the answer is more likely to be that the risk from the cancer is significantly higher than the risk from the treatments. This is why chemo and Herception are recommended even for the tiniest HER2+ cancers, whereas chemo would not be offered for cancers of an equally small size if the cancer is HER2-.

Here's an example. I don't know your diagnosis so I just pulled one of the pages from the AJCC Staging Manual to highlight the different prognostic staging for HER2+ vs. HER2-, when all other pathological factors are the same. The critical last column is not easily legible - the Stage for the HER2+ cancer is in this example is Stage IB; the Stage for the same cancer, but HER2-, is Stage IIB.

Have you talked to your MO about your risk level with and without treatment? If not, you certainly should. While not as good as a discussion with your MO, there are a couple of computer models that assess mortality risk with and without treatment. Your current diagnosis is a recurrence, so technically these models are not accurate for you and should not be used. However if you input your current diagnosis as though it was a new diagnosis, it will give you an idea of how much treatment may be able to reduce risk.

Breast Cancer Treatment Outcome Calculator With this model, I find that the pictogram is the best way to see the results. Where it says "display as" under the chart, select "Pictogram". Then in the boxes on the bottom left, you can input various treatment options and update the graph. The graph will then show the 15 year mortality rate, broken out by non-cancer deaths and cancer deaths, and will also show the number of people who are alive because they had the treatment.

PREDICT This model works similarly, and is also easiest to understand if you select "Icons" as the viewing option. Here if you select the full range of treatment options, you will receive information on the number of deaths due to other causes, deaths related to breast cancer, extra survivors due to trastuzumab (Herceptin), extra survivors due to chemotherapy, extra survivors due to hormone therapy, and survivors with surgery alone.

Again, because your diagnosis is a recurrence, these figures won't accurately relate to your situation, which is why a discussion with your MO is so important. However these models will give you a high level idea of what the mortality rate might be with surgery alone, versus the number of survivors thanks to the various treatments.

The decision is yours alone, and you have to make the decision you are comfortable with. You replied to my earlier post saying "As of right now I do not regret my decision but I am sure if I had mets it would be very different." As you make your decision, make sure that you understand your metastatic risk level, and the extent to which treatment can reduce this, so that whatever happens, you've made a decision that you won't regret.

If you are concerned about cardiac side effects of treatment, you may want to ask your MO if you can consult with a cardiac oncologist. My PCP is a cardiologist and had me do some labs for cardiac biomarkers after I finished Adriamycin. One of them was high and there were a couple of other red flags in additional tests they did. At about the same time, my oncologist got the post-surgical pathology showing my tumor to be triple-positive rather than HR+/Her2- as the biopsy had shown. My MO and PCP referred me to a cardiac oncologist to determine if it was safe for me to start Herceptin. He was able to identify the root cause and treatment for the cardiac symptoms, confirm that Herceptin would not cause similar issues and recommend a plan for monitoring me.

Herceptin is a godsend for people with Her2+ cancer and, while I completely understand concerns about cardiac effects especially given my experience, my understanding is that the effects from Herceptin are typically reversible and patients are closely monitored.