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iTanya
iTanya Member Posts: 5

Hi everyone. My name is Tanya. I'm 35 (live with boyfriend, no children) and was Dx with IDC a month ago and have undergone a lumpectomy (8.28.07) and still seeking opinions on treatment and which route to take. I have a number of options including doing nothing, Tamoxifen, chemo, radiation or a combo of. I feel lucky that my BC was found very early and it was very small (3mm). The margins after surgery showed no cancer cells in the outlying tissue-thus where I get the option of not doing anything except follow ups with the Dr. every 3 months for MRI's and Mammograms.

I met with my 1 Oncologist for the first time, yesterday. I will be meeting with another Dr. (as soon as they call me back with the appt. date!) soon to discuss possible treatment options and his considerations on what I should do. My surgeon says do nothing, my 1 Oncologist says Radiation + Tamoxifen and possibly chemo or just Tamoxifen alone + and is recommending a bone scan.

I keep hearing over and over, it's about my age. Because of my age, we should try a more radical treatment plan because the chances of it coming back are higher than if I were 5+ years older. Doing nothing, my recurrence rate says 18.7%. By doing some sort of treatment whether it be radiation, Tamoxifen and or chemo, it will greatly reduce to the possibility of under 3%. (My pathology info should show in my sig line)

Lots of things to think about. I am not so sure I've even felt the shock of the breast cancer, let alone be focusing on a treatment. I'm rather numb still. It's all happened so fast.

[edit]: My breast cancer was found by mammogram. Since I turned 35 this year, my gynecologist recommended that I have a baseline mammogram done this year, so that when I am 40, they will have something to compare changes to. 

I have questions obviously...

1. Has anyone chosen no treatment and how are you doing?

2. How do you come up with a choice to make with all of the options and how do you know what's right for you?

I know I have a billion more questions, will ask them later. Thanks for reading my post :)

Comments

  • nash
    nash Member Posts: 2,600
    edited September 2007

    Hi, Tanya, and welcome. Sorry you had to join us, but it's a great group of ladies here.

     One comment I want to stress is that with the lumpectomy, your local recurrence rate without radiation is something like 40%, even with clean margins. If you don't opt for a mastectomy, it is very, very important that you radiate the lumpectomy site. I don't think there are very many docs who would let you go w/o the rads.

    As far as chemo goes, it's a tough decision, because all your prognostic factors are excellent except for your age. Have they ordered Oncotype DX for you? Sometimes that score can help with the decision process, although most women seem to fall in the intermediate score area, which doesn't help with the chemo decision much.

    I assume they've plugged the chemo and hormone treatment decisions into Adjuvent Online for you?

     How big was your tumor? Some oncs say anything over 1 cm automatically buys you chemo, even with negative nodes.

    I chose to do chemo, rads, tamoxifen. I was 38 at diagnosis this June, and had a 2.7 cm tumor of an aggressive subtype, and a very strong family history of cancer, including my mom with Stage IV bc. So those were my bad prognostic factors. My good ones were oncotype of 18, hormone positive, HER negative, no nodes. So I was right in the middle of good/bad. I talked to 3 docs, and each one recommended chemo. Two recommended ACx4, one recommended TACx6. Big difference between the two as far as toxicity. I chose FACx6, which is a compromise between the two.

     I thought long and hard about just doing hormones, especially because I have lobular cancer, which is some studies have shown to be chemo resistent. However, given how many decades I have to live still in theory, I wasn't comfortable not doing chemo. I have two young children, and if I do have distant recurrence in the future, I want to feel like it was inevitable, not that I should have done chemo. My mom did chemo the first time around, and progressed anyhow, but her cancer is very aggressive, HER+. Sometimes it doesn't matter what you do, the cancer is stronger. She's been on chemo for 5 years now.

    It's a really, really hard decision. I wouldn't be comfortable doing nothing. In your case, I think most docs would say rads and tamoxifen at the bare minimum. 

     Hope this helps a little bit. Hopefully some more gals will be along soon to chime in. Good luck with everything!

  • minkyfloss
    minkyfloss Member Posts: 9
    edited September 2007

    hi tanya. im also new here. kind of. a year ago i was diagnosed with breast cancer and i was on this site everyday. in all honesty having people 2 share all your problems with got me through the toughest time in my life so youve come to the right place. x

  • BethNY
    BethNY Member Posts: 2,710
    edited March 2008

    My two cents-- you can't do nothing.

    I think that option is just opening you up to get breast cancer in the future.  And, you're right-- it's all about your age.

    With such a small tumor and clear margins, presuming you are ER positive, you should definitely take Tamoxifen.

    If you wanted to be more radical I'd go for rads and tamox, but b/c your tumor was so tiny, radiation might do more damage then good.  You should meet with a radiation oncologist to determine this.

    You have to think about your future risk for cancer in the same or other breast. 1-2% per calendar yr of your life. 

    If I were you, I would jump on the five yr tamox. badwagon ASAP.

    You sound really well versed, and I'm glad youre getting second and third opinions. Also, as far as your surgeon that tells you to do nothing, Um-- he should stick to cutting and sewing, and leave fighting the cancer to the oncologists. Just my opinion.

    I was dx at age 26, and chose to do the most aggressive treatment possible, b/c of my tumor characterisitics, and being very high risk for recurrence. 

    Three years later, I am happily about to turn 30, and cancer free-- living a great life.  As I know you will too!!

  • iTanya
    iTanya Member Posts: 5
    edited September 2007

    Hi everyone, thank you for your comments and feedback! Sorry I couldn't respond earlier, but I was at work all day. Minky, thank you for your welcome! Yeah, sorry to meet you gals "under these conditions", but am glad there is a place like this to come to, to talk about this and ask questions and learn from others.

    I hear ya on the "do nothing" scope. While it's a nice thought, I do realize that it's probably not the safest/best route, even though I've been given the option. Thus why I am seeking alternative opinions.

    I can't remember what tests they have ordered with my slides from surgery. What I do know is they can't do this one test that looks at chromosomes of the cells, etc. because there was not enough tissue left over to do it. My tumor was 3mm. Very small. 

    I get so confused about all of the medical terminology and what means what and which tests are which and which ones give you this score or that result. I asked for a copy of my pathology report so that I could try to make sense of it all the abbreviations (ER, PR, HER, etc.) and I could figure out how to talk about my cancer with others. I know I'm not the only one that has gone through the cofusion, that's why I am still learning.

    I have my 2nd opinion October 4th down at Massachusetts General Hospital with a highly recommended Oncologist. I hope he can shed some light on all of this and break it all down. I am certainly curious to hear his treatment plan options.

    BethNY - are you taking Tamoxifen? Your thoughts? I worry about "how I will feel" being on it. I am ER+ as well as PR+.nash, how about you? How do you feel day to day on it?

    Right now, I am trying to learn and soak in as much facts and  information as possible. Breast cancer and treatment can be a bit complex, esp. when you are younger. Standard of Care is one way, but when you are under 40, it all changes!

    Thanks again for your replies. I'll get back here tomorrow after a good night's sleep. [Yawn]

  • TashaG
    TashaG Member Posts: 14
    edited September 2007

    Hi Tanya,

    I must say that you sound like you are on top of things.  Please listen to the girls and err on the side of caution.  I had a very very aggressive cancer and was in chemo so long...I had to remind myself what life was like without chemo.  You will get through this.  You seem really strong and its a good thing that you are getting the hang of the "lingo" it helps you understand the doctors explanations.  It appears from your notes that you have a fairly non-aggressive form.  I will add you to my list of prayers and feel free to im me if you have any questions or just need a shoulder...tashagraves@yahoo.com

  • nash
    nash Member Posts: 2,600
    edited September 2007

    Tanya--I won't start tamoxifen for a while. I'm getting my second chemo round tomorrow. But I think the side effects of tamox vary from person to person.

  • iTanya
    iTanya Member Posts: 5
    edited September 2007

    Thanks Tasha! I hope you are doing well. Are you finished with chemo at this time?

    I think my biggest concern with Tamoxifen is possible weight gain. I mean, I read it in the side effects and immediately, I put on 5 lbs! LOL!

    Nash, hope you're feeling ok, esp. on chemo right now. Keeping you in my thoughts.

  • BethNY
    BethNY Member Posts: 2,710
    edited March 2008

    The side effects vs. having the ability to prevent a future cancer... you have to figure out which is more beneficial to you.

    Try the pill- give it at least 3 months.  Many side effects can subside in that time.  In your case- b/c it doesn't make sense to do rads, or chemo, tamoxifen would be all you have to take a shot at cancer NEVER coming back.

    If you have to walk an extra mile every day, then so be it-- you'd only be doing your body good.

    lots of luck with the new doc.

  • iTanya
    iTanya Member Posts: 5
    edited September 2007

    No no, I know. I'd put my life before a gained pound anyday. It's on my mind though. Just like the hot flashes, the menopausal symptoms. I'm hoping I wouldn't experience those too much.

  • nash
    nash Member Posts: 2,600
    edited September 2007

    Thanks for the well wishes, Tanya. Good luck with your decision making--I know how hard it is. Keep us posted on what you decide to do.

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