Will 30% of Early Stage (1-IIIA) go on to metastasize??
Comments
-
http://www.practiceupdate.com/c/43073/1/1/?elsca1=...
Rate of Distant Metastases in Women With Breast Carcinoma and an Oncotype DX Recurrence Score <18
TAKE-HOME MESSAGE
- This was a single-center, retrospective study. The authors assessed the rate of development of distant metastases in 1406 women with early-stage ER-positive, HER2-negative breast cancer who had low recurrence scores on Oncotype DX testing. Overall, 1361 patients (97%) received endocrine therapy and 170 patients (12%) received chemotherapy. Only 6 patients (0.4%) developed distant metastases over a median follow-up of 46 months. The absolute rate of distant metastases among patients aged <40 years was 7.1% (3 of 42 patients) versus 0.2% among patients aged ≥40 years.
- The rate of distant metastases over 5 years in women with early-stage ER+/HER2− breast cancer and low recurrence scores is 0.4%, although younger women have a higher rate of distant metastases.– Jeremy Jones, MD
0 -
https://www.statnews.com/2016/08/24/breast-cancer-...
When DNA and medical tests disagree about breast cancer risk, which to believe?
0 -
Going back to Doc's wages etc. and slightly off topic but, this is a website where you can see if your Doc receives payments from Pharmaceutical or medical device companies - a nice supplement to their annual. Perhaps good information (or perhaps not
for those with a 'suspicious' mind? Just be aware that even the lunches that the reps bring in count towards the total.....https://projects.propublica.org/docdollars/
0 -
Kay wrote, "I've read that every hospital in the USA is able to keep its doors open because of it's oncology unit."
This addresses hospitals, not doctors, I did not have chemo, but had surgery and radiation. The amounts my surgeon and radiologist billed for my treatments were quite reasonable compared to the amounts billed by the hospital surgery center and hospital radiology center. It's not the doctors, but the hospitals that profit in a major way from cancer treatment.
0 -
Thank for the info on dose dence ac+t. 6dd was what I received two yrs.ago. I still have problem with neuropathy in hand and feet.
0 -
Thank for the info.
0 -
labelle....most hospitals only receive a fraction of what they bill. My message is simple. We all need to avoid generalizations and simplications. And , my best advice is to first look at pubmed, the NIH's clearinghouse for journal studies.
0 -
Going off topic again - what is happening with the outrageous cost of the EpiPen is pretty disgusting IMO. I don't think you convince me that the bottom line is not about greed versus the critical access by patients to a life saving anaphylactic drug.
http://www.pbs.org/newshour/rundown/mylan-may-viol...
0 -
BosumBlues I have talked to breast cancer survivors that need to exercise that live in tough inner city hoods. Sure there are parks and malls but they are all too dangerous to even powerwalk. I know I wouldn't want my kids (if I had kids) playing in those areas. Their lives are in danger Chicago Tribune Linky
0 -
Lago, it’s not just that there are no safe places to exercise in ghettos & barrios. So much of our big cities are "food deserts," defined as places where one has to go more than a mile (often on foot because public transit is too expensive) to find fresh produce and unprocessed meats & fish. For most of these kids, the closest they can get to a non-junk-food lunch or dinner is bologna or PBJ on white bread, canned veggies, soup or chili. (Starch, salt, fat, sugar and chemicals). And that’s if the stores are even token “groceries:” most are “corner stores” that sell chips, snack cakes, cookies, candy bars and soda pop. In fact, this is also true of deep-Appalachia hamlets.
0 -
Doctors also receive a fraction of what they bill unless you are paying cash. If they have Medicare mostly pts or worse Medicaid/Cal then it's really not much when you think of all their education, malpractice insurances.. Insurance has caps on what they get called allowable. I worked for a high end popular surgeon who was one of the pioneers in minimally invasive knee and hip replacement surgeries for 10 years. Medicare allows roughly $1500 a joint. But he bills much more so he can get the maximum allowable by insurance. He's doing better now that he is out of network with majority of PPOs but you'd think this guy would be richer than he is, and he deserves it having worked hard studied hard. And ever wonder why they are overbooked? That's why. To make up some for what insurance puts a cap on. And he gets no money from pharma. As with all professions, there are dirty people in all. Who they are you don't always know but to group them all together is simply wrong. Just like saying all cops are dirty every time someone was shot by cop where's there's a question about it..
Also just to add, when the economy sucks docs like dermatologist and plastic surgeons are hit. People don't go to the doc if they are hit hard unless it's necessary. Hence why certain specialists do well years round like my surgeon because you can't put off bad knees/hips once the pain and mobility has gotten unlivable.
0 -
lmenkin, I did chemo the first time because bothnMO and I were on the same page in wanting it. I have a big family history. We did oncotype after 3 rounds to help us decide between 4 or 6 rounds. The oncotype was 16. I am glad I did what I did or I forever would have asked"what if"? My recurrence was local and regional, and was less thsn28 mi thx later. I recurred at the site of the original tumor, just under the skin, and also in the soft tissue under the pec muscle... There was no breast tissue at all present there. My oncotype was 40 that time (only tested one of the tumors). i did chemo again with the recurrence
0 -
BCO recently retweeted this infographic on Twitter.
0 -
KBeee...thanks for sharing ..I am so up and down on chemo or no...I just read LVI should do chemo..I am so crazed reading everything about who should and who shouldn't.
I am meeting with my MO again on Wednesday He said my LVI gives him pause. That's gotta be in the yes column I guess. So hard for me to make this decision.
0 -
cp418, your article at the top of this page is for patients with an oncotype of less than 18 so that headline is really skewed. There are also tens of thousands of patients that don't even get an oncotype. It's those kind of articles that make lay people think it's rare to metastasize.
0 -
lmencken - At the end of the day, WE aren't doctors. I too spend hours trying to educate myself as much as possible, but eventually you have to trust someone. Get two, or maybe even three opinions. Maybe make one of those at an NCI Cancer Center if one is close to you. Make a list of questions. Take a friend or partner with you to take notes - or record the appointment. Then settle on a doctor you believe you can trust and go forward. I do believe that health care is a partnership between the patient and the doc and both sides have valuable input, but you still have to trust the doc of your choice. If you're uncomfortable with the doc the road will be harder. Good luck.
0 -
bosumblues,
This dedicated teacher thanks you. I am so lucky to go to work and do what I love everyday
0 -
lmencken, where did you read that lvi should get chemo? Everything I read and my MO and second opinion MO said indicated that they just don't consider lvi in the decision.
0 -
Molly50..honesty I've read sooooo much that I didn't keep track but most of what I see is that it's not a great thing and can affect prognosis...I see that it should be considered in young mode negative patients. Bottom line is one needs to decide whatever happens in the future..you need to be comfortable with your decision now if it is left to us. That's what I am going with. There is no black/white answer for this.
Thanks Minus Two amd Bosum Blues!!
0 -
lmencken, I totally agree with you. No looking back after the decision is made. I just think the doctors really don't know if it has any bearing on future spread of the cancer.
0 -
lmencken, It is such a hard decision and no matter which you make, know you made the best decision you could with the information you had at the time.
I think second opinions are good from NCI centers, but my experience at a really good one is that their recommendations will be purely numbers based. When I had my recurrence, the doc at a very well known, well respected cancer center told me it was just a simple local recurrence because my surgeons must have left some behind. He disregarded the pathology change, time to recurrence, would do no further testing and simply recommended radiation and an AI. My gut told me otherwise, and my gut has never been wrong. My local doc told me I am an individual, not a number, and we need to look at my unique case. He told me he felt that my cancer was absolutely not behaving as it should, recurred quickly, recurred in multiple places, etc. He strongly recommended chemo which was my preference and did oncotype to help confirm. It was 40! When I messaged that info to the doc at the big cancer center, he agreed with our decision to do chemo. So my take is that a second opinion is important, but use the information from both doctors to make the decision that is best for you. Ask them what specifically about your unique case makes them recommend chemo or no chemo. If they say. "Research shows xxxx" then ask if their personal experience supports the research because you are a person, not a number. Specifically ask them whether the LVI will be adequately addressed with radiation, and how much risk it poses. Best wishes. I know it is a hard decision
0 -
Karen, how old were you at first diagnosis? If in your 40s or even 50s, I think it was reasonable to opt for chemo if everything else indicated you were probably on the favorable side of a coin toss. An ODX score of 16 in a pre-, peri-, or even recently menopausal woman is closer to the gray area of 18+ than it is (I hope) in a 10-years-postmenopausal 64-year old like me--my MO made it clear that she believed that for me any theoretical benefit from chemo would be greatly outweighed by the risks it would pose, many of which risks are magnified and tougher to survive in older women (especially with comorbidities such as asthma and multiple antibiotic allergies). I also had no family history, negative genetic test results, no LVI, and one component of my Grade 2 Nottingham score of 6 was a mitotic rate of 1, which means slowest-dividing.
Sometimes you have to get into the path report with fine tweezers and read it in the light and through the prism of the patient’s own unique life factors.
0 -
kayb I too agree MDs work hard for every dollar…and they don't make as much as they used to. You want to make money better luck in the financial industry.
0 -
ChiSandy, I was 43, and that weighed heavily on my decision... As did having 3 kids at home. I tolerated it we'll both times and would not change anything
0 -
Lmencken, also keep in mind my tumor was strongly ER and PR positive and I had mastectomy plus a lot of radiation to make sure that the cells were killed.
0 -
People in the financial industry are not taxed at lower rates unless they are in the upper levels of income…and that's all folks in that upper level
0 -
I dunno.. I can dig it out, but I've read that some chemo actually makes room for the cancer stem cells to flourish. My gut tells me (as a 41 year old) that if I chose chemo, I'd end up with a more aggressive cancer than if I chose hormonals only. KBee, I can't say that is or isn't what happened to you. Perhaps that early chemo you did simply made it come back sooner and more aggressive. I disagree that because you are young, you should go the chemo route. it ALL depends on your type of cancer/tumor.. and what your heart is telling you.
0 -
http://www.nature.com/onc/journal/v33/n36/full/onc...
lisey...perhaps you were referring to this...
0 -
KBeee...wow..I wish I had your gut! So glad you pushed on! I originally had a good gut when an OB- Gyno told me my lump was a muscle pull or defect..my lump was high near pectoral..and I then went to my regular Doc who sent me right over for a stat mammo.
Now my gut is waffling back and forth. I will take your advice with me when I talk again to MO Wednesday. I just hope I can make a decision then. I am notoriously bad at it. He did tell me that chemo was like a bunch of knives waving around everywhere and the hormone pill was like a gun. He said don't take the hormone meds lightly..it's still a beefy treatment.
0 -
Voracious... Yup.. that's one of them that I remember reading. Honestly, We just don't know if chemo kills off the stem cells. If chemo doesn't kill the Cancer stem cells, then it's actually opened the door to less competition for food (sugar) for said stem cells. It all depends on the particular type of cancer. In may case, I truly believe chemo would have made my cancer more aggressive. I'm glad I'm sticking to hormonals. My hope and prayer is that IF it returns, we will be in a new age where we see how barbaric chemo is and we have completely targeted immunotherapies that are customized to our tumor genome..
Lastly, I took the kailos genetics test and have been reading about the ABCB1 gene and chemo therapeutics. Apparently, the ABCB1 enzyme is substantial for CMF and with my homogenious alleles, it wouldn't work well on me. This whole 'one size fits all' for chemo is like throwing jello on a wall and seeing what sticks. There are MANY ways chemo might hurt worse than benefit, whether it be cancer stem cells being resistant, or your own genetics.0
