after the mastectomy

Hi, Eileen. A lot of factors play into the chemo decision. It's unfortunately not just a case of cutting the cancer out and being done with things. Here are some things of the things the oncologist and you need to weigh:

1) Your receptor status--ER/PR and HER2.

    If the tumor is ER/PR positive, you can be treated with hormonal

    therapy such as tamoxifen. 

    If the tumor is HER2 positive, it is a more aggressive type of cancer, and

    you will need to take a targeted therapy called Herceptin. It is                    administred via IV like chemo.

    Triple negative tumors (ER/PR neg, HER2 neg) always get chemo. There

    is nothing else available to treat them systemically. 

2) The grade of the tumor--1, 2 or 3 on the modified Bloom Richardson 

    scale.

     A grade 3 tumor is aggressive and will need chemo. Grade 1, probably

     not. Most tumors are grade 2 (intermediate), and are sort of a grey 

     area.

3)  Your age

     Premenopausal women pretty much always end up with chemo. We've

     got a lot of decades to go. I was 38 at diagnosis, and my age was a

     big factor in my decision to do chemo. A post-menopausal woman in her      60's or 70's may decide the risks of chemo outweigh the benefits and         may decide to go the hormonal treatment route.

4)  The size of the tumor

      A lot of oncs use the general rule of thumb that any tumor over 1 cm 

      gets chemo. I would guess that the fact that you have multifocal bc

      will be a factor that pushes your onc to recommend chemo for you.

5)   Lymph node status

      Positive lymph nodes get automatic chemo. Yours were negative.

      However, keep in mind that 30% of metastic bc jumps the nodes and

      travels through the body via the blood stream (the stat is from Dr.

      Suan Love's Breast Book). 

6)   Oncotype Dx

      This is a genetic test available to women who are Stage 1 or 2 with

      negative nodes. It gives a number that estimates risk of distant 

      recurrence and death from bc. Most women seem to fall into the grey 

      area on their scores, so sometimes this test doesn't help. But it's 

      worth doing, because a very low or very high score can help with

      the decision making process.

7)   Adjuvant Online

      This program is an online tool your onc can use to give you percentage

      benefits numbers for doing chemo, chemo/hormones, hormones alone, 

      etc. S/he will plug in various chemo regimens and come up with a

      percentage. If you have an Oncotype Dx score, that can be plugged in,

      too. Usually, most oncs use a 4% benefit from chemo as a decision

      driver to do the chemo.

Hope this helps a bit. Sorry about the weird spacing in the paragraphs--couldn't get it how I wanted it to look.

Please relax....nash has given you some good advice.  Try to have the Oncotype DX test.  This procedure was not available 4 yrs ago (YES...4 YEARS AGO!!) when I was diagnosed with a node negative, highly ER+, clear margin tumor, however my cancer was a classic lobular, not a mixed tumor.  The Oncotype will give you very specific details regarding "your" situation, and an accurate recurrence score.

My tumor was over 1 cm, so I was advised to take chemo.  That was the "RULE" back then.  I survived chemo, and I'm doing fine today.

Please feel to PM if you have questions.

Best wishes!