Topic: The Dreaded Grey Area - What to Do?

If you are Er/PR+ and stage 1 and GRADE 1, that means you do not have an aggressive tumor. You cancer is very slow growing. With the bilateral surgery, your onc could recommend just endocrine therapy, which is Tamoxifen and when you are post meno, aromatase inhibitors like Femara and Arimidex.

The only thing that may give your doctor pause is your young age and your "intermediate" onco score. They may want to be extra cautious to  make sure any and all cancer cells are destroyed by some type of chemo.

Gray areas are the worst. We have enough to absorb and learn. Sorry you have to deal with this on top of everything else.

hugs

g 

I had same pathology.1.5 IDC, ER/PR+, HER2- Stage 1 Grade 1, with a microscopic second area.  I had a left mastectomy, and the surgeon was very encouraging.  He didn't think I'd need chemo.  Oncologist also said no chemo, even put me on Aromisin while oncotype testing was being done.  Mine came back 23 with a 15% chance.  I am in my 50's.

At that point it was left up to me (though onc. said now he would recommend chemo).  I decided to do the chemo, (CMF) and my husband and children were happy I did. 

I finished 15 months ago and honestly to this day I sometimes second guess my decision.  I also read where the advantages of chemo are small, etc.  But I must say, on those days when the fears arise, I am always happy I did all I could to prevent it coming back.

Write down your questions, do on-line research, pray if you are so led, then follow your instincts.  In the end, this is a decision you have to come to on your own.

Best wishes to you as you continue this journey. 

I have the same pathology, 1.5 IDC, ER/PR+, HER2- Stage 1 Grade 1.  I'm almost 60 and post-menopausal.

Don't forget that wonderful thing, the second opinion.

Neither oncologist I consulted even wanted to run an Oncotype test, because they were so sure of what the results would be.

Both told me that they wouldn't recommend chemo, that the potential side effects simply weren't worth 4%.  I've a history of serious drug reactions, and will be having a knee replacement soon.

I was told that lifestyle changes - i.e., losing weight and exercise, would provide as much protection as chemo. 

That's my experience, for what it's worth.

Just be sure that you feel comfortable with your decision. You are the only one that matters.

Keep us posted.

Sue

StillTracy, none of us can answer your question for you, as you know.  You are in one of the worst possible situations--not knowing whether chemo will do you more good than harm.  It's too bad we can't all be put into cryopreservation or something, and wait for the results of the TAILORx clinical trial, which is supposed to put all this to rest.

My 1.8 cm IDC was ER+ PR- HER2- (well I guess you can read that in my sig line).  I had Oncotype testing done, and my recurrence score was 26.  That gave me a 17% chance of recurrence, and chemo would reduce that by about 1/3 (to around 12% chance of recurrence).

I tried to prepare myself ahead of time so that I would know what Oncotype score would motivate me to choose chemo (if given a choice).  I figured that a score less than 18 would be safe...well, not really safe, but at least the risk of recurrence was fairly low, and the benfit of chemo was also low.  Anything above 30, of course, meant I was chemo-bound.  My "grey zone" was between 18 and 30, which (not ironically) corresponds to the "intermediate risk" zone as defined by Genomic Health for the Oncotype test.

As my first oncologist put it, "We just don't know what to do with scores in that range."  That's why there is a big clinical trial underway to test whether women with intermediate scores (actually, the trial is testing scores between 11 and 25) benefit from chemo.  If it were 10 years from now, we'd know the results.

In the meantime, with a score of 26; a tumor that was almost 2 cm, Grade 2, and  PR- (although ER+); and my oncologist proclaiming that I was "not old"...I am getting chemo.  My chemo regimen is Taxotere & Cytoxan (recommended by my 2nd onco after I fired the first one because of a personality conflict).  I just finished my 3rd of 4 treatments (at 3-wk intervals) this past Wednesday.  Chemo is "hard", but it is definitely do-able.  Each chemo regimen has its own profile of side effects and long-term complications, so be sure you get answers to all your questions before you make a decision whether to have chemo and what regimen to get.  IMHO, a good oncologist will make a recommendation but will then discuss your personal circumstances and medical history to be sure his/her recommedation is appropriate for you.

otter

Thanks to everyone for their replies.  At the moment, although the consensus here seems to be chemo positive, I am leaning towards Tamoxifen only.  I really feel like I need to get back to a normal life for my son, my fiance and myself, and I hope I won't have any regrets.  I'll keep you posted on what I decide...thanks again for all of the support!