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Sep 6, 2013 10:41AM
I probably shouldn't jump in, but I've been reading the recent discussion and wanted to mention that in the 8 years since I was diagnosed, I've seen a lot of changes in the NCCN Guidelines as new research has come out.
Violet, to your comment, "I just did NOT KNOW /realize that some BC patients that are Stage 1 (a) grade 1, with no node involvement, Her 2-, could be recommended chemo..." the fact is that back 8 years ago (and in fact much more recently than that), chemo was recommended to ER+/PR+/HER2- Stage I women based on the size of the tumor. If I remember correctly, the guidelines said that for those who had an invasive tumor that was greater than 0.5cm - 1cm in size, chemo could be 'considered' and for whose who had tumors larger than 1cm, chemo was 'recommended'. So prior to the availability and testing of the Oncotype test, a lot of Stage I women were prescribed chemo - including many (probably most) with grade 1 tumors that were larger than 1cm in size. The Oncotype test represents great progress in that now it's better understood that many Stage I women don't benefit enough from chemo to make it worthwhile for them to be exposed to the risks and side effects.
Another recent change is just the fact that now there is a Stage IA. Until a couple of years ago, there was only 'Stage I' with no "A" or "B". Any nodal involvement, even micromets, automatically moved the patient to Stage II (or higher if there were more nodes affected) - and that possibly meant more treatment. But research showed that women who have micromets with invasive tumors that are 2cm or smaller in size have a long-term prognosis that is more similar to that of women who are Stage I with no nodal involvement, vs. those who are Stage II with more nodal involvement. That led to a decision to shift those with micromets down to Stage I, and the splitting of Stage I into IA and IB so that the women with micromets could continue to be monitored and tracked separately.
Those are just two examples - both relevant to this discussion - of the many changes that I've seen made in the 8 years since I was diagnosed. The NCCN Guidelines are a dynamic ever-changing document. As new research comes in, often there is first a notation and reference without an actual change in guidelines, but then as the research is firmed up and/or confirmed, the guidelines are changed. So when people complain that no progress is being made and that breast cancer treatments haven't changed for years, I shake my head because I've seen so many changes.
Dx 9/15/05, DCIS-MI, 6cm+ Gr3 DCIS w/IDC microinvasion, Stage IA, 0/3 nodes, ER+/PR- “No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke