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Q: treatment
Hi Michele: Is the cancer in your lymph nodes, or not? This would impact highly on whether or not you'd do chemo, in my opinion. Also, are you having a mastectomy, or lumpectomy? I honestly don't believe doctors prescribe chemo based on fear of a malpractice suit. But as you say, the Oncotype shows you're in a gray area; you're just above the "chemo won't do you too much good" category, and just into "chemo may help, but it may not." I'm sure you all feel on the fence about this—you, the doctors, your sister.
If you don't yet know your lymph node status, I'd wait on making a decision. If you have no lymph node involvement, that would probably tip the scale towards no chemo; in the lymph nodes, a tip towards doing chemo. That's my opinion. But, as with all decisions regarding breast cancer, it's YOUR cancer, and the decision has to be your decision: not the doctor's not your sister's. YOU need to do what feels best and right for you. It's tough to figure out what that is, but ultimately, that's what has to happen. Good luck - PJH
Sorry, Michele - On re-reading this, I see you say you're stage 1, which means no lymph node involvement. If I were you, I'd simply ask your doctor to lay out the statistics for you: radiation and hormone therapy, vs. chemo (and probably hormone therapy). What would be the risk of recurrence for each of those, given your diagnosis? Then, given your stomach issues and obvious reluctance to do chemo, I'd compare the two. If there's only a very small reduction in recurrence risk for chemo vs. radiation/hormone therapy, you might be comfortable with that. Anyway, again - good luck. PJH
The purpose of chemo is to kill any cancer cells that have escaped your breast. That's why the treatment must affect your whole body. The tests the doctors have done so far apparently don't offer clear statistical evidence on the benefit of chemo compared to the risks, so it really is up to you. I don't think fear of lawsuits would be the primary governing reason for the doctor's recommendations because I know people who have sued doctors because of the side effects of chemo. Don't decide against chemo just because of your history of stomach problems. There are many new drugs that help control nausea. You can stop chemo if the side effects are too much for you.
I understand your dilema. I am very anti-chemo and my doctors are trying to force me through 6 monthsd of it even though I have no evidence of it spreading. It's a decision that only you can make, and it's a hard one. Don't just settle because some doc told you that you have to do it. Personally IMO I think all oncologists tell you you must have chemo even when you don't actually need it. Oncology is a billion dollar industry. As Phillis said, if it hasn't spread there isn't much need for it. A lumpectomy or mastectomy with radiation should prevent recurrence.
As for you Oncotype score - well 3 1/2 years ago I was dx with stage 2a IDC. I had a lumpectomy, mastectomy and 2 months of chemo (4 sessions). 3 years later my plastic surgeon found a recurrent tumor in my chest wall - same exact spot my original tumor had been. My oncologist ran an oncotype on my tumor from 3 years ago. It gave me a recurrence score of 21 - which truly is a gray area. You can see where it got me, though I will say everyone's cancer is different. Mine came back because my AI (Femera) failed to prevent my estrogen from binding even though I am post-menopausal at 34. I had a complete hysterectomy.
Now I am fighting not to do chemo, but I cannot find a single doctor yet that will just give me tamoxifen. Even my current doc knows I don't want chemo, then when he forced me to cave he rx'd 6 months though he had nothing to medically back up the recommendation, so I refused. One doc said radiation only, another said chemo only, the last said both. I went through radiation this summer which wasn't bad - but my point is they are all going to try to sell you on their specialty. What I can recommend is finding a doctor you are completely confortable with - discuss your thoughts and opinions and see what the two of you can compromise on.
Good luck to you!
Angi
Angi, I'm sorry if I said something to suggest that someone didn't need chemo. While it may be true that you don't need chemo if the cancer hasn't spread, there is usually no way to know for sure whether it has spread or not. I had a friend who didn't have chemo because her doctor was certain he "got it all", but 10 years later the microscopic bits of cancer that he hadn't found had grown into the tumor that killed her. Doctors make their recommendations about whether chemo is needed based on statistics for a particular type of tumor and how often that type of tumor metastasizes. Because I had an especially aggressive type of cancer, I subscribed to the "use the biggest hammer now, so we don't have to come back later" theory. However, I do understand that people whose cancer might be less aggressive may be willing to risk the chance there are undetected cancer cells roaming around their body to avoid chemo, which has its own set of risks. No one wants to have chemo they don't need, but there is usually no way to know for sure.
Michele.. with an Oncotype of 22.."gray area"..a physician is obligated to address it.. it isn't because of law suits.. he would like to be very safe and do chemo..just in case.. although that has no guarentess.. he is willing to let you participate in the clinical trial also as an option... but he can't say do nothing...he wants to treat you....it is very scary..yes, angie had a oncotype of 21..had treatment, and it still came back..that scares me..I had a oncotype of 8 and didn't do chemo , I had a double mastectomy though..and am on tamoxifen..and I am still scared...good luck.. let us know what you decide..pick an oncologist..( I went to three)..and be straight with him or her..don't hold back,..they should be used to it.
I'm sorry Phyllis - I think I took something you and PJ had said and mixed it up causing it to come out wrong in my attempt to write as fast as my mind rambles through thoughts.
I meant no disrespect to you, nor meant that anyone doesn't think chemo is needed. I was merely trying to express my opinion that chemo and treatment in general is up to the patient and no one can make the decision except them. Everyone should learn about their cancer so that they can make the best possible decision. I was just expressing my opinions and experiences that it certainly seems that most doctors will push their agenda on you and no one truly knows if it's for them to cover their butt from malpractrice or to pad their wallet with the money they make off of you. Everyone's best bet is to become better educated and be their own self advocate.
I did not mean to offend you if I did.
Angi
hi michele. my name is nanette. im a 45 yr old stage one breast cancer survivor. it will be 2 yrs ago in june. this is really not gonna help your question. i was given a masectomy of my right breast. i wanted both removed, as my mom died of breast cancer at 59 yrs of age. the dr said no. the nasty thing said no, i believe. because i have state insurance paid for by us tax payers. i have ALOT of out of pocket insurance. prob more than someone with blue cross. i was NEVER offered chemo or radiation. just tamoxifen. one day one of the drs comes in my room and says "why didnt u get radiation". i was floored and said "cause no-one asked me". now im so scared about my lack of treatment. i wouldnt have gone with chemo, as no lymph nodes were involved, but, with my STRONG family history i may have gone with radiation. i dont even know my dx or grade. but, i will ask now. thx i wish i could help you. God Bless nanette
Angi, I wasn't at all offended. I agree with you that doctors will tend to offer the treatment they know the most about. Surgeons tend to offer surgical solutions; oncologists tend to offer chemo and related medicines, and radiation oncologists tend to suggest radiation. I don't personally ascribe this tendency to a desire to pad their income, but to the narrow medical specialties that are so much a part of today's medical practices. I happened to be a person who needed all three, and I was pleased that my doctors communicated with each other at every stage of my treatment. I realize that doesn't always happen as well as it should. Patients need to educate themselves and ask a lot of questions. In the end, the treatment decisions need to be the patient's. I just wanted to clarify what I meant if it wasn't clear.
Hi Michele,
I think you get a second opinion on this before you go ahead and get chemo. You are in a gray area. You have to make a decision that you feel comfortable with, this because you have to live with that decision. But being stage 1 I believe you are at low risk with you oncotype. I was stage 1, low grade 5mm idc and they didn't even offer chemo all they said was radiation and tamoxefen. See if you can just go that route. Good luck with your decision.
I was stage 1. 2 sm tumors my oncologist said radiation he wasnt so sure about chemo so he sent my tissue (boob) to have genitic testing done. When he got the results he told me that chemo would only give me a 2% gain. Yippie no chemo for me! So if your not sure about this Dr get another. I would want solid answers. When you trust your Drs you will hear the right answers. Best to you..
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