To chemo or not to chemo
I’m 46, stage 1a invasive breast cancer, 1 tumor less than 2cm, ER+ HER2- had a lumpectomy with clear margins and clear lymph’s. All genetic testing was clear – no mutations. Oncotype score came back at 22 though, which puts me in a gray area for chemo. I’m at the point of decision making. Anyone have similar cancer and willing to share thoughts, decisions, factors that influenced your decision, outcomes, etc? I’m struggling with putting my body thru chemo for what feels like a low risk recurrence but my doctor is strongly suggesting I consider doing chemo to further minimize my risk.
I was 59 when I was diagnosed with stage 1a invasive ductal breast cancer and DCIS. 1.4cm tumor. Had a lumpectomy in Dec, 2017 with positive margins so had additional surgery January 2018 to obtain negative margins. Lymph nodes clear, so was genetic testing. Oncotype score came back at 30, which put me at a 20% chance of recurrence with no chemo. Doing chemo lowered my recurrence chances to 8%. I did the chemo because I really didn’t want to take the chance of the cancer coming back. Only side effect from chemo was the fatigue and hair loss. Also had radiation because of the positive margins. Am now on Anastrozole to block estrogen production as my cancer was ER/PR+ HER2-. Have not been bothered by side effects. Good luck with your decision, it is a hard one but one you have to live with.
I was in the same boat as you are now. I was 62 when diagnosed with 1a IDC and DCIS, Er/Pr+, HER2-. I had an Oncotype DX test which I was told I was aiming for 18 or below to avoid chemo. I came right in at 18 and my Onc. said yes you can get by without chemo. and just do a hormone blocker for 5 years but in doing chemo. it will decrease your recurrence risk so I opted to go with it and for the most part I was fine. As it turns out there was a 2nd area of IDC and an area of LCIS all in the one breast so was happy I chose to go with the chemo. I also did 28 radiation treatments and last summer completed my 5 years of an AI. You need to gather all the pros and cons and hopefully that will help you make the decision you feel is best for you.
You are right to do your due diligence and get as many answers as you can. Second, third opinions. I’m not certain if there are immunotherapy options available? Also, I’ve heard great testimonies for digital thermography, especially as effective early screening for breast cancer. It’s affordable and may give you peace of mind if you choose no chemo. Personally, I opt for no chemo given the choice. I’ve not had breast cancer however, I’ve had lung cancer. Many, many, many research avenues I’ve read say: quality v. quantity time. I agree. Why subject your body to heinous treatments to get a few more months—wouldn’t it be better to enjoy a less side-effected life? That’s one scenario. Only you know how you feel. Certainly all of us would like to go back to “square 1” before diagnosis, but that’s not reality. And too, I’ve read for lung cancer—which is rarely detected early—would the person feel better living not knowing he, she had the cancer growing rather than knowing and making all the horrendous decisions and living through them? Tough call, but rational none the less. As well, people can be “cured” and are.
Was your stage 1a breast cancer ductal, lobular, or mixed? If it is ductal chemo would probably be suggested by most oncologists. Lobular breast cancer does not respond well to chemo. There is a new study out stating that chemo is suggested for lobular bc if your onco score is >30.
It was ductal but had broken out of the ducts and is considered invasive ductal. I will be doing hormone inhibitor therapy and I’m feeling like that will be similar in some ways to immunotherapy but I will ask the question! And I will look into thermography as well – thank you. Other than regular mammo/ultrasound my onco is telling me there’s really no other way do achieve early detection without being symptomatic. Her feeling is that PET scans, MRI’s and such give a lot of false dx and lead to unnecessary surgeries and stress but I’m not totally convinced yet. If my onco had been 19 she would not have recommended chemo but a score of 22 puts it on the table
I was diagnosed in 2017 with stage 1 grade 2 lobular and ductal features – ER/PR/Her2 positive. I didn’t hesitate to do bilateral mastectomy with 5 rounds of Chemo. no radiation was needed. I’m have 5 yrs on a hormone blockers. I have the genetic test come back positive or a new gene – ATM which increases the risk of breast cancer and pancreatic. no way to tell if it “caused” my b.c. For me it was not an option to be aggressive with the cancer. I wanted to do and will do anything I need to keep lower my risks and hopefully never experience cancer again. I never once questioned my doctor or felt like I needed another opinion. However, if you have any doubts or unanswered questions you should seek more information – you’re the one going through this. Be informed and accepting of any decisions you make. Best wishes.
I’m 42 and was diagnosed last March 2018 with IDC 2.5 cm ER+ Her2- stage 2a with two nodes involved. I also had the ATM gene come back on my genetic test as a VUS (variant of unknown signifigance) and my oncologist said they don’t have any information about that gene yet and if it caused my breast cancer. My Oncotype came back at a 23 and I was also in the gray area for whether or not to do chemo. My doctor told me that I would have a 5-7 % better benefit against recurrence if I did chemo. With my pathology tumor grade being a 3 and wanting to be as aggressive as possible I opted to do chemo. I also did cold capping durning chemo and was able to save my hair. The only negative side effects for me were fatigue and weakness.
Chemo or not to chemo are not the only two choices. Every two years starting at age 62 I would discharge blood from right nipple. I would then have surgery to supposedly remove the offending duct. 2 times the tissue showed no cancer but a lot of atypical cells. Finally at 68 the dr took tissue from the nipple and that came back positive for Stage 1 DCIS. 6 years, at least 6 mammograms and sonnagrams and waiting. My cancer was never detected without surgery. My choice was a double mastectomy. No chemo and no radiation and no pills. I am healthy and happy and able to continue to work. My mother fought breast cancer for 11 years. I just wanted it out and gone. I was back at work in one week. Please consider all options when it comes to breast cancer. My choice may not be the right one for all but it just needs to be considered.
I have the exact same Oncotype score, stage 1a invasive ER/PR positive her2 negative, less than 2cm, not in lymp nodes, yet mine is lobular and the doctors did not suggest chemo, only radiation and then Aromatase inhibitor. I just started radiation last week. Maybe you can get a second opinion?