Topic: "Cured", or Not Just Yet?

There are a ton of us who have chose to undergo adjuvant treatment even being stage 1 with zero node involvement.  Since you are in the US see if your surgeon sent a sample of you IDC to have the onco. score done.  This test can give you an idea to see if chemo. would be of any benefit to you. 

BTW, yeah for no nodes..

Are you post-menopausal? Ovarian suppression was (and maybe still is) the standard of care in Europe for stage 1.

I was/am Stage 1, twice. The first time around the docs were nudging me toward chemo, but a 2nd opinion at UCLA suggested as long as I did some hormone blocking, I'd probably be fine (97% survival at 10 years.) I was premenopausal then. Ultimately had the ovaries out and did AI drugs. Stopped AIs after 4+ years, and a year later got another Stage 1, other breast. No hint of needing chemo, just back on AIs.

It's pretty much the standard to go on a hormone blocker for systemic treatment after a Stage 1 diagnosis. Though I know of many women who do just fine on nothing. We have no perfect way of knowing whose cancers will get nasty and whose won't. Did you have an oncotype Dx test done for your risk of recurrence?

Anne

'59babe,

All the answers you've received here are very good, but there is still an elephant in the room that no one has mentioned.  Well, perhaps two elephants.  You said this:

"My surgeon told me after more weeks of healing, I will need to consult an oncologist about follow-up, "adjuvant" treatment of some type. Fine, but does a Stage 1, 0/10 nodes gal, who has very little breast tissue left, really *need* to have more treatment? I had just not heard of that before. Does anyone know of similar situations where someone is told they need follow-up after taking this kind of surgery plunge and coming out all but cured?"

Your surgery was "local" treatment.  Its purpose was to remove the main (primary) tumor, plus any neighboring breast tissue that might have been invaded by stray tumor cells. If you'd had a lumpectomy + rads, the purpose of the radiation therapy would have been to kill those stray cells. You also had your other breast removed, which will reduce -- but not eliminate -- the chance that a tumor will develop on that side.  (It is not possible to remove all the breast tissue with a mastectomy; so there is always some risk -- albeit tiny -- that a tumor can recur in the residual breast tissue.)

Your lymph nodes were negative, which is good news--it means it's unlikely that stray tumor cells escaped from your breast and migrated to other areas of your body. Unlikely, but not impossible.

Surgery is the "mainstay" of breast cancer treatment.  But, it does not kill tumor cells that might already have escaped from your breast and established residence in other organs. And, it is possible (though not common) for tumor cells to escape from the breast and skip past the axillary lymph nodes.  That's the purpose of the "adjuvant" treatments -- to kill, or prevent the growth of, tumor cells that had already escaped from the main tumor.

Your tumor was ER+ PR+, so most likely you will be advised to take a drug that will block the effects of estrogen in your body.  Those drugs -- tamoxifen for pre-menopausal women or an aromatase inhibitor for post-menopausal women -- are usually taken for 5 years. That timing might change once longer clinical trials are completed.

The other "adjuvant" treatment, of course, is chemotherapy.  Since your tumor was ER+ but HER2-, chemo is less likely to be in your future. That's because chemo is less likely to be of benefit to you than if your tumor had been ER- or HER2+. Most of the time, ER+ HER2- tumors are less "aggressive" and less likely to have metastasized than ER- or HER2+ tumors.

That's not always true, though. Some ER+ HER2- tumors turn out to be unexpectedly aggressive, and chemo would provide a substantial benefit to those women by killing cells that had already escaped to other organs.  One way to estimate the "aggressiveness" of BC is by looking at the "Grade".  Yours was intermediate -- not high, but not low either.  Another factor is age (time until/since menopause).  You are pre-menopausal; and that can mean you are at greater risk of a recurrence than if you were older and post-menopausal.  A med onco would use factors like those -- and also, perhaps, an Oncotype DX test -- to estimate the risk that your cancer will recur, either locally or as distant metastases.  That will allow him/her to make recommendations about chemo and hormonal therapy.

Finally, the second elephant in the room:  Most oncologists don't use the word "cure" anymore, when talking about breast cancer.  Although the majority of women with early-stage, well-differentiated BC will be "cured" with surgery, it is nearly impossible to tell which women those will be. Oncos use whatever tools they have to try to figure that out.  That means some of us will get chemo, and many of us will get hormonal therapy, even though we didn't really need them.  So, yes, you might say our oncos are playing it "super-safe".

otter 

Otter -- thanks for your informative and well-written post. I agree that it is probably better to err on the side of possible over-treatment, than to take the major risk of possible under-treatment. I had not even thought to use the word "cure" until one of the nurses in my surgeon's office used it back before my biopsy, not referring to me or anyone specifically, just saying that "many of them (early-stage cancers) are very curable". Perhaps a better choice of words would have been "treatable" or "controllable". Anyway, I appreciate all the info you have shared. 

 Holtbolt -- thank you too for sharing your perspective. Yes, our dx does seem similar, and there are probably quite a few other women on these boards with the same dx. I am going to do whatever treatment it takes to ensure as much as possible that there are no bad cells left, and prevent a recurrence.

Glad to see your chemo is behind you and that you are apparently doing well. Was it tough to go through the chemo you had? Did you suffer many side effects? I may be offered chemo (as well as hormonal therapy) with or without an Ocno score, but I will try to keep the big picture in mind when going through it, and as you say, be happy that the prognosis is good. You do the same!