IDC Stage 1, grade 3, ER+, PR+, HER2/neu -, lymph node neg

I didn't want chemo either, I had stage 1 grade 2 (almost grade 3, just one more point would have pushed me to grade 3, (I was 7 on the grade (8-9 is a grade 3) my tumor was over 1 cm (1.5cm), and even without the oncotype results, usually chemo was recommended for that size. My oncologist was very matter of fact and just showed me the recurrence percentages with my BC, and that he would just do 4 rounds of chemo if I decided to do the chemo...but he left it up to me...

as i was waiting for my oncotype results, I did a lot of thinking and researching, I found a lot of BC comes back even with chemo and other treatment...the med onc. wanted me to be in a trial...and the study was using the oncotype...the real truth is that it is not known if chemo is beneficial for those who fall in the mid range (that is you) and the trial would throw some women in the mid range to do chemo and tamoxifen, and then some of these women to just do the tamoxifen..I opted out of the study because I didn't want anyone making the chemo decision for me.

but I struggled with the decision and told myself if the oncotype came in the mid range middle 24-25 I would do the Chemo...but the more I thought about it, I decided I would only get the chemo if I was in the high range over 30.

Mind you I really thought my oncotype score would fall at the end of the mid range (25-29) or over 30. ultimately I prayed and felt that I would only get chemo if I fell in the high range....over 30. this is the only group that they are sure of that chemo is beneficial to.

 the mid range 19-29 they aren't sure the best way to treat. that is why the trial study is being done.

Years from now, we will have the results from this study.

In the end the medical oncologist called me personally and told me chemo would not benefit me at all, I had scored a 7....and that he didn't think he had seen any score that low...

It is a hard decision, especially if your breast care team recommends strongly one way or the other...

Talk to others, pray a lot and look for answers...I will pray for you as well.

I have just finished radiation therapy and the next recommendation is tamoxifen, that is a decision I'm working on and I'm leaning more to at least give a try.

Good Luck and

God Bless!

Amber

I also had IDC stage1, grade 3, ER+, PR+, HER2/neu-, lymph node neg.  I was diagnosed in Aug. 2004.  My onc. recommended chemo because of the grade 3.  I had a mastectomy so I did not need radiation.  They were not using the oncotype test at that time so I could only go by what the onc. thought would be most beneficial.  I had 8 treatments of dose dense CMF chemo.  I did not lose my hair, it just thinned.  I am now on Arimidex.  Given the grade 3 and the oncotype score I would do the chemo.  Ask about the CMF.  Hope this helps and good luck with your decision.

Lenore

monandeclan, my situation was kind of like yours and gramadeb's, with just a few exceptions.  My IDC was just a Grade 2, but it was bigger (1.8 cm) and was PR- (although ER+ HER2-).  My Oncotype score was 26, which was above my comfort level.

Both of the oncos I consulted recommended chemo because of the size of my IDC, the fact that it was Grade 2 (not Grade 1), the lack of PR receptors on the tumor cells, and my "young" age (56 ha ha!)..oh, and my Oncotype score.

I just received my last chemo treatment last week--4 tx's of Taxotere/Cytoxan, at 3-wk intervals.  Chemo is rough but it is very do-able.  My Oncotype score translated to a distant recurrence risk of 17% without chemo, even with Tamoxifen or an aromatase inhibitor.  Chemo supposedly reduces that percentage by 1/3, so my risk of a distant recurrence will be around 12%.  For me, that was enough to justify chemo.

otter 

monandeclan, with your dx and the onco RS, personally I'd be doing the chemo, but in the end it is your opinion and life that has to make that decision.

ONE thing I do want to say is that A/C is what I had.  I would recommend getting a second opinion if for NO other reason than that A/C I don't believe is the the gold standard for ER/PR + anymore.  I believe they are doing more TC as a result of the SE's that can occur with Adriamycin.  Most specifically heart myopathy.  There is a life time limit of how much they can give and they give much less than they used to, but still.  It's a powerful drug, they all are.

Consider other options if you can before committing to A/C.  Do the research of what's recommended and ask a lot of questions of your docs. 

Monandeclan, I'm going thru the same decisions. I was diagnosed on 4/25 too via ultrasound. Then I had my 1st surgery on 5/5. My path came back as IDC Stage 1, grade 2, ER+, PR+, HER2-, lymph node neg. All margins were clear except the inferior which had some 'non-invasive' cells. I opted to have reexcison on 5/19. Surprisingly, that path revealed a 4mm invasive tumor. I just had another reexcision on 6/9. Thank God, that came back completely clear. In the meantime, I was anxiously awaiting that Oncotype score. After the Monday's surgery, my surgeon went over the results. My score is 21. (I was kind of shocked as I was hoping for <17). She went on to say that I still am in the range of just surgery, rads and tamoxifen. When she called to gleefully report my clean margin resection, I asked if I should go ahead and schedule radiation. She hesitated and then said she wanted me to talk to the oncologist first since my Oncotype score is 21. (What? What happened to the convo after surgery?) I spoke to the oncologist yesterday and she strongly advised chemo. I don't want to do the chemo. She thought I was fighting it because I'd lose my hair. It's not at all about losing my hair. I just feel that since I'm on the border that chemo would be 'overkill'. I also am a little jaded since I've been dealing with family members going thru different cancers/chemo for the last 12 years. I don't like what I've seen. My mom wound up having chemo after chemo after chemo. Her situation wasn't the same as mine, but still, I feel that chemo is strong medicine to kill the cancer, but it also kills 'good' cells in your body. My friends and family that went thru it say they were never the same afterward. Again, I'm not against doing it - it saves lives. I am just not sold that it would really help me now. I want to ask the docs to just watch me extra closely, maybe do a broader spectrum of radiation and of course the tamoxifen. I am also considering ovarian shutdown. I again just feel like I need to 'save' the chemo for when/if I really need to do it. Maybe I'm totally wrong. I'm really confused right now.

Hi deborye - my biopsy path report came back as grade 2 - then changed to grade 3 after surgery. I am guessing you may be a grade 2- borderline grade 3.

Chloekat - I watched my sister battle cancer - not breast - but she had multiple chemos and I too was scared to death to go through chemo. But it was doable and they have changed the process so much from when my sister went through it. A lot of side effects she had are now alleviated with meds.

Deb

Thank you otter, I think your right, it must be Grade 2. The DCIS I mentioned was staged as T1b, N0, MX.  I thought DCIS was stage 0.  I see my onc again in Oct.  I will write this down so I can remember to ask upon my next appnt.

I am also going to check out that website.

Amber, deborye's tumor contains IDC (invasive ductal carcinoma) as well as DCIS.  She said it was "IDC 6mm DCIS 7mm, Stage 1."  Her tumor was classified as "Stage I" because of the 6 mm IDC.  If it had been only DCIS, it would have been Stage 0.

Chemo was not recommended for her because even the invasive component of the tumor (the IDC) was very small.  The other characteristics of the tumor that argued against chemo were the grade (2), the fact that it had hormone receptors (ER+ PR+) so it can be treated with an estrogen blocker, and it did not over-express HER2 (HER2-).

otter 

Amber, you're right--our sig lines are nearly identical!   I had a mast/SNB in February, so I don't have to go to "rads camp" next.

I read back aways and saw that your Oncotype score was 7. That's fantastic!  I was hoping for a low score, but mine was way too high at 26.  So, while you've been finishing your rads, I've been doing chemo.  I guess we're both getting done about the same time.  Are you on Tamoxifen now?

I just finished 4 cycles of Taxotere & Cytoxan, and the more reading I've done about that, the better I feel that I did decide to do chemo and that my onco agreed to TC.  (The original plan was to give me AC.)  Today or tomorrow I'm going to take my first tablet of my 5-year course of an aromatase inhibitor.  My onco wanted me to try Arimidex first, so that's what it will be.  For me, post-meno for 5 years already and with an ER+ PR- tumor, Arimidex was a good choice because of its ability to reduce the risk of recurrence pretty dramatically.  My onco says there really isn't a significant difference among the 3 aromatase inhibitors (Arimidex, Femara, Aromasin), at least from what they know right now.  What she said is in agreement with what I just read in the 2008 guidelines from the National Comprehensive Cancer Network (www.nccn.org).

How are you doing?

otter 

Amber, I have a terrible time wearing tops.  Well, it's not the tops that are the problem--the problem is the bras under the tops.  I still had a bit of swelling under my arm 8 wks after surgery, so I didn't go for a prosthesis "fitting" before I started chemo.  None of my bras fit very well then, because of the puffy tissue under my arm.

Once I started chemo, the Taxotere caused even more swelling and fluid retention.  At certain times and on certain days my mast incision and under-arm area would be tender and slightly puffy.  Wearing a bra just didn't work--it would fit OK when I first put it on, but after a few hours the band left an impression in the skin on my mast/SNB side. That's not good--it can lead to lymphedema.  So after trying ELEVEN different bras, I finally gave up and quit wearing one.  I still need to work on that issue.

I took my first tablet of Arimidex today and had ... no SE's at all.  Ha ha.  It's a bit early for SE's, I know.  I'm just trying to be optimistic about it, since it's the best strategy I have left to prevent a recurrence.

Glad to see you've finished rads.  Have a great time on your trip!

otter 

I hope someone can give me some insight-I am very confused and anxious. I have Stage 1, grade 3, ER +, PR+, HER2/nue -, lymph node neg BUT there is lymphatic vessel invasion. Much to everyone's surprise my oncotype is only 11 and showed that I will be very receptive to hormone therapy. I am also having radiation therapy. My dilemma is that I am getting mixed advice on whether to also have chemo. Using the histology (grade 3, vessel invasion) I would definitely have it-in fact one doc said he wouldn't have even done the oncotype, but the oncotype score is so low that the other said I wouldn't benefit from it. Am really struggling with this. Very unusual to have low oncotype w these factors. Anyone similar? Any advice or suggestions. Thanks.

plonyalmony, you have exactly the dilemma I had but worse!  My situation was very similar to yours, minus the vascular invasion but with a slightly higher oncotype (17).  I nearly went crazy trying to believe the oncologist who said I should skip the chemo -- but without being able to get my arms around how a grade 3 tumor came out to a 17, I just couldn't get there.  I even called Genomic Health to see if they could look at my details and tell me what was driving such a low score..   super estrogen receptivity?  a different take on the mitotic rate?  What??  But they weren't able to disclose anything but the final number and their numeric rating of degree of ER/PR receptivity, which seemed to be pretty much in the mid-range. 

What finally convinced me to go for the chemo was this study: 

Histopathologic variables predict Oncotype DX^TM Recurrence Score
Presented in part at the International Academy of Pathology meeting in Montreal, QC, Canada; September 16-21, 2006.
Melina B Flanagan¹, David J Dabbs¹, Adam M Brufsky², Sushil Beriwal³ and Rohit Bhargava¹

I found the abstract online but I think you'll need a medical library to get the whole thing.  It summarizes all of the traditional risk factors (pathology, histology, etc) of 42 patients at the authors' hospital, grouped by their oncotype results (Low/Med/High).  So it was possible to assess the extent to which I was similar to or different from the rest of the "Low" population that AS A WHOLE has low recurrence risk and supposedly doesn't benefit from chemo.  The telling thing for me was that I looked almost nothing like the Lows presented in this study (in fact I looked quite a lot like the Highs!).  Not one was grade 3 (I don't think any were even grade 2); their average age was 58 so they were generally post-menopausal (I'm 50 and still swimming in estrogen); etc.  My oncotype 17 translated to an 11% recurrence risk, but when I looked at this group it seemed pretty obvious to me that if somebody had to be in the 11%, it was a lot more likely to be me than them!    So that answered the question for me of whether I was comfortable with my risk (not) -- but still left open whether the chemo would help if I did do it.   The oncotype validation study says no, but why is that?  One reason is that oncotype Lows usually have a low mitotic rate, and chemo is not as effective in those cases because of the very nature of how chemo works (interfering with cell division).  But my Grade 3 (9/9) meant I had a high mitotic rate -- so it seemed to me that I might also be different from the typical Low in terms of how much chemo would help.  And in my case, at 50, there's a good chance it will push me into menopause, which I take to be another benefit -- the less estrogen the better.  So I laid this all out with a second oncologist and he agreed -- it was worth it to go for it in spite of the 17.  I'm through three rounds of TC now, just one more left and doing very well.  It's not pleasant, but it's certainly bearable, and at least I can sleep.  My three favorite pieces of advice were "Don't waste a bullet," "Your first shot is your best shot," and "You need to find the Path of Least Regret."    

hello i also have a similar dx. i am stage 1 but my tumor boarders stage two 1.9 cent.but the grade is 2/3 which is similar. i am taking tc . chemo i had my first tx. on november 17th.2008 i guess by now you have had your tx. as i see you posted this back in august. i am wondering if this tx plan is the gold standard in chemo tx. i was reluctant to have this also but i have 3 more to go.new technology in the medical field are popping up every month. my chemo tx is different from yours it is tc only 4 times. let me know what you decided and how it went for you. i wish you well