triple positive, node negative, and microinvasive--now what?
Hi.
I posted before when I was not sure if I had microinvasion and now everything is confirmed. I wondered if anyone is +++ and miccroinvasive out there. I think that my MO will not recommend further treatment beyond the mastectomy but I wonder if anyone else has been through this. I feel like the recent articles I've read say that T1mic should be treated more like a T1a-c cancer (which would mean chemo and anti-Her2) but I don't get the impression that the guidance has caught up with that. I've been seeing doctors at an NCI institution and it seems like they won't do anything not on the books. Do I get a second opinion? I am hoping for any kind of wisdom here.
Happy Holidays to you all!
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Hi @lemonwedge, There seems to be a bit of controversy with your diagnosis. Because you are also ER+ treating with endocrine therapy is often considered enough.
If you are not convinced that you should skip treatment for HER2+ get a second opinion somewhere else. You might get the same advice but you don't want to be wondering in the future if you did the right thing. All the best.
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Thanks for this @maggie15
This is a helpful article!
I guess I thought it would be clear but you are right, there is controversy around my diagnosis.
My MO did mention tamoxifen, but she also said it would only reduce my risk of recurrence by 1% —and it comes with its own side effects. I don't think I fully appreciated HER2+ when I was talking with her, but I've read more now.
Thanks for the insight about getting a second opinion. I think my biggest challenge is what kind of information I need to feel OK with moving forward.
Take care!
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Hi lemonwedge,
Can you go back to your MO, and ask her to explain to you in a bit more detail the rationale for recommending (or not) each treatment for your specific case, since you know more now, and are better prepared for that conversation? Going through the benefits and risks of hormonal therapy, chemo and anti-Her2 targeted therapy, separately and combined.
If tamoxifen will not reduce your risk of recurrence, what will? Does that apply also to other hormonal treatments (eg ovarian suppresion + AI) or just tamoxifen? And what is that risk? Is it negligible or significant?
I would start by that, and likely also ask for a second opinion somewhere else, for your own peace of mind. I did that when my MO recommended treatment, not because I didn't trust him, but more as due diligence, for my own peace of mind.
LaughingGull
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Hi @laughinggull,
Thank you for this. It has been really hard to get clear on how to make the next steps. I can absolutely schedule another appointment with my MO asking those very questions. I re-read the visit notes from last time and she said she would not recommend chemo or HER-2 therapy if my nodes were negative and that the risk for distant recurrence was 1-2%, so tamoxifen would be my main option. She said tamoxifen would reduce my risk by less than 1%. I think that I am trying to understand how HER2+ affects all this. The studies on microinvasive BC just don't have enough people to draw many conclusions on outcomes and prognoses (in my opinion), especially when you are looking at +++.
It seems like getting a second opinion would do a world of good. I would like to go to a very famous place close by, but when I called them they said they don't offer second opinions, and I'm not ready to move my treatment over there without meeting them first. Did you do a distance second opinion?Thanks!
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Hi lemonwedge,
My second opinión was in person but i could have done it remotely if needed. I just wanted a second pair of capable hands reviewing the plan and answering my questions.
Best of luck,Laughinggull
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@laughinggull Thanks for this. Yes, it seems like a couple or a few sets of eyes on one's information would feel more reassuring .
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@lemonwedge I'm curious what you ended up doing for treatment? I have high nuclear grade DCIS with microinvasive BC, and I'm also +++. I have seen a surgeon and opted for a lumpectomy and sentinel node biopsy, but that isn't scheduled until mid-February. She mentioned I'd see a radiation oncologist and medical oncologist after surgery.
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@luluvee I had BMX surgery with clear margins, so I won't need radiation. So far, I'm sticking with not pursuing additional treatment. Tamoxifen's potential side effects don't seem to make sense for my risk of recurrence, but I'm still feeling unsettled. I am thinking about asking if it would be possible to take 10 mg tamoxifen every other day instead of the full dose. I read a ton of articles on microinvasive bc and I am just not sure if it makes sense for me to do chemo and anti-HER2 therapy. I hope your surgery goes well and that you get a clear plan. It feels more complicated to me that is in a bit of a gray area!
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