Should I have follow-up chemo & radiation?

The reason that chemo and Herceptin are recommended for HER2+ cancers is because these cancers are so aggressive. Survival rates for HER2+ cancers used to be among the worst; now, thanks to Herceptin plus chemo, survival rates are among the best.

The most concerning risk from any invasive breast cancer diagnosis is a metastatic recurrence, i.e. a recurrence outside of the breast. This is the most serious risk from an HER2+ cancer. A mastectomy has no impact on metastatic risk, so it in no way replaces adjuvant treatment (chemo + Herceptin) or reduces your metastatic risk if you choose to not take adjuvant treatment. A mastectomy may however allow you to avoid radiation, because radiation is a localized (breast area) treatment.

All that said, what you need to do is understand what level of metastatic risk you face without these treatments, and how much your risk will be reduced with these treatments. You have a small tumor, which might not present an overly high risk, even being HER2+, but only you can decide if you are comfortable with the risk level without treatment. And of course you have to weigh in your risks from the treatments themselves. It's not an easy decision, but it's a decision only you can make because the risk for each of us is different based on our pathology and personal health history, and the way we look at risk is different for each of us.

What you might find helpful is the PREDICT tool, which provides you with an estimate of your risk with and without various treatment options. I'd suggest that you select "Icons" to view the results, which is the easiest to interpret:

https://breast.predict.nhs.uk/tool

Hi!

I'm also HER2+, and did the "works" -- chemo, surgery, radiation, targeted therapy, and hormonal therapy. My oncologist says that HER2+ cancer is most likely to recur in the first 2-5 years after active treatment. By the way, having clear nodes does not mean that your cancer hasn't spread elsewhere, though it is the case that cells often settle in the nodes early in the process.

If you were to do chemo, you'd want to avoid Adriamycin + Cytoxan because this regimen can cause permanent heart damage. However, the other chemo regimen for HER2+ breast cancer, Taxotere + Carboplatin (usually given with the targeted therapies, Herceptin + Perjeta), is not a walk in the park. TC by itself may not have much impact on the heart, but Herceptin can (often temporarily) lower your heart function. I had quarterly heart scans (every three months) during my treatment to make sure my heart was holding up. It did, and I'm here six years later.

My next door neighbor (also HER2+), who had a pre-existing heart condition, made it through four infusions of TCHP before her heart situation worsened. She had her lumpectomy, and seemed in the all-clear as of last June. In fact, she regained her heart function in February 2021. However, her cancer has come back and it's in her nodes. So, she's going to have a mastectomy and axillary lymph node dissection (ALND), which will remove all the Levels 1 and 2 lymph nodes.

It's a crap shoot. Have you been tested for genes associated with breast cancer? That would also shape how aggressive you want to be. ((Hugs))

Gretchenbuddy, the thing is, breast cancer can spread through blood and through lymph and it can spread as a single cell - invisible to any scans. It can park itself in another organ and wait and then come roaring back as metastatic disease. Grade 3 means your tumor is rapidly dividing and growing. We do not have a great understanding of metastasis at a cellular level yet but there are indications that in some cases, the spread occurs immediately. In fact some models suggest that in some patients, the cancer seeds itself in multiple places at inception.

As Beesie said, mastectomy will not prevent metastatic recurrence, which just to be clear, is a terminal diagnosis.

HER2+ and Grade 3 are both factors that would make chemotherapy standard of care because the benefits of the chemo outweigh the risks. I think in your case you would want to consult with cardiology and determine what cardio protective steps you can take. There may be diet and exercise interventions that might become increasingly vital right now. There are also medications which can lesson the effect of some of the chemo drugs on the heart. I think key will be getting a good team of experts to develop your care plan and monitor you closely to provide best treatment.

best wishes!