What should be my next step?

My biopsy confirms that I have Invasive Mammary Carcinoma in my right breast, which is hormone receptor-positive (HR+), HER2-negative, and a high Ki-67 proliferation rate of over 80%.
Can someone tell me more about that Ki-67 number? Is it normal? Also the doctor initially said it was only one centimeter but the report shows invasive so I’m confused. Grade 3. I don’t know the IMC. Consultation is scheduled in 10 days which means treatment or surgery is no where near to being scheduled. I’ve been trying to be seen sooner or at least start Tamoxifen now? But I’m confused whether this is severe or not because US both small but has a high proliferation rate. What do you think the recommendations will be?
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Hi @nunelus
Sorry for the reasons that bring you here, but very glad you found us.
What we have all learned quickly once dxd, is that breast cancer has SOOOO many different 'pieces' to it, which are very confusing. The good news is that it sounds like your cancer was caught quite early since it sounds like it is 1 cm. The high Ki-67 and Grade 3 indicate that it may have an aggressive biology. Don't panic! Even grade 3 cancers, don't grow bigger overnight….they still grow relatively slowly, especially when caught early.
One of the hardest things for all of us is the waiting game. We all want to just get through it. We all feel better once we have A PLAN.
My dx was somewhat similar to yours, but my tumor was a bit larger. I can tell you my treatment just as an example. I had a mastectomy, but that was based on it being my 2nd time on this adventure and on the location of the tumor. A lumpectomy was also an option. With a lumpectomy, often radiation is also done. With a mastectomy, I also had reconstruction. Some people opt to go flat. After healing from my mx, I started chemo. Chemo was indicated based on the results of an ONCOYTPE test. You might want to ask about having that test done, though depending on what country you live in, it may or may not be available. A lot of things go into the chemo decision. With my 1st dx, it was determined not to be needed. So, you really have to talk to your MO and they will likely recommend whether or not you they feel you need chemo. After chemo (if it's needed), or shortly after surgery (if not), they will likely start you on either tamoxifen or an aromatase inhibiter (AI). You can only take an AI if you are post-menopausal or are taking drugs to make you post-meno. Those are the basics. There are other drugs that might be included (Zometa for me), but it all is really so individual based on your breast cancer. I should also note that some people have chemo prior to surgery, but that is usually (I think) done when tumors are larger.
It is hard to do all the waiting. Take a deep breath. You will get through this. We are all here to allow you to vent and ask questions.
Take care.
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I’m sorry you find yourself here. Yes, there is a lot of waiting when it comes to the initial phase of dx and treatment. The good news is that, as Mandy pointed out, is that even a grade 3 tumor is slow growing. Breast cancer feels like an emergency but the reality is that it is not. Although others may have had similar diagnoses, please wait until you see your oncologist before taking tamoxifen or trying to guess what treatment might be. I know this is difficult but don’t worry about compromising your health. Please wait for your oncologist to tell you the next steps.
“Also the doctor initially said it was only one centimeter but the report shows invasive so I’m confused. ” The size of the tumor does not tell you if it was invasive. What is your confusion? Take care
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The time in between diagnosis and first meeting with an oncologist is HARD.
I never learned my ki67 - my treatment center doesn't test it/use it. They us the oncotype test to predict the usefulness of chemo because someone can have a cancer that seems like it would be slow growing/small/non responsive to chemo, but can turn out to have a high oncotype, or vice versa. The reason for the oncotype is because the medical profession learned that not even experienced doctors can make as good predictions based on clinical/biopsy info alone, and how much less so can we, lay people on bco, make a prediction, you know?
The beginning of cancer treatment is information trickling and it feels like you're always waiting for the next result that could change everything. It is difficult.
As far as I know, it is not common to use hormonal treatment between diagnosis and surgery, but there is an interesting article about it from BCO (https://www.breastcancer.org/research-news/neoadjuvant-hormonal-tx-vs-neoadjuvant-chemo) and it would make sense to ask your oncologist about.
These ten days may feel like ten years, but they will come to an end. There's very little for a patient to do during this time, which is just even more crazy making. If you feel the need to do something, it might be a good time to research your insurance benefits, including for second opinion options if you end up wanting one (totally optional, I did not), and taking care of things like dental cleanings, hair cut, etc, things that you might not feel like expending time/energy on once the treatment ball gets rolling. Also reaching out and finding people in your community who have been there and can be a source of support for you.
Hang in there!
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I'd like to add, schedule fun things while you wait. Go for walks with family or friends, take day trips to a scenic spot, have a weekend trip if circumstances permit. Go to a fun concert or an art museum or botanical garden. I did fun things between appointments and tests and scans and surgeries, and it's the those things I remember from that year.
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^^^ What Alice said. Planning and partaking in fun things is a great way to distract from all the waiting. My first cancer diagnosis was at the height of the pandemic so I was limited in what I could do. But when I was diagnosed last year with a 2nd cancer we went to local festivals, hiked in parks and met up with family and friends. Oddly enough I have good memories of last year and the bad stuff has (mostly) faded into the background.
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Yes, even invasive (also known as infiltrating) breast cancer can be very, very small. It is called invasive when it goes through some changes and moves beyond the duct or lobe (depending on whether your cancer is ductal or lobular). Non-invasive breast cancers, DCIS or LCIS, remain within the duct or lobe so it is location, not size, that makes it invasive. Take care
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@nunelus Just checking in on you. How are you holding up?
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