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Apr 15, 2018 12:46AM
obsolete....first off, the answer to your question is quite simple. Your treatment and prognosis are based on the most aggressive cells, whatever the cells might be. Furthermore, genetic testing will also come into play as well.
Now, if there is opposing info, such as cargirl’s situation, our pathologist friend at MSK said, there is really no best answer with respect to treatment. She then went on to send VR a very interesting study done by some of her colleagues. The study explains that today there are a number of genomic tests that study different breast cancer genes and are all validated and yet might come to different conclusions with respect to risk. The study is called Comparing Breast Cancer Multiparameter Tests in the OPTIMA Prelim Trial : No Test is More Equal Than the Others. So basically, as a study population, you would expect as a group, patients will fall into a very neat line. And yet, you will still have outliers...that is, single patients who will score low risk on one test and high on another. Furthermore, the percentage of patients who fall out of the norm with respect to these genetic tests is equal to the same percentage of patients who pathologists’ tumor grades vary...that is...where one pathologist might grade a tumor as a grade 1while a second pathologist might grade that same tumor as a grade 2. So, while different genetic tests are looking at different genes, different pathologists are seeing different grades. In both cases, there is up to a 30% difference...that is 30% of genetic tests will disagree with respect to the same tumor and 30% of pathology reports will grade differently.
So what does a patient do? There is no correct answer. But thankfully, as our pathologist told me, there are tumor boards to help. Are there arguments? Yes. But luckily not often. She believes the system in the U.S. is a good one where there is great cooperation and understanding. She also likes that in the US there is a great deal of specialization, so everyone is trained well in their own specialty, becoming expert at what they do.
Now, turning to mucinous bc. She agreed with what I have been saying here on this thread for years. Genetic tests are not as strongly validated for mucinous as they are for other types of breast cancer. So, a good pathologist and MO are what is needed when deciding what course of treatment is necessary. While it would be nice if every mucinous patient scored a 15 on the Onoctype DX test which would further validate the test for mucinous bc, unfortunately, there just aren’t enough mucinous cases to make the test that strongly validated. So getting a higher, or perhaps a much lower number shouldn’t stand in the way of making treatment decisions,.,,
Next topic....men and breast cancer. Even rarer than mucinous is for women. And, our researcher called my attention to yet another study about men’s breast cancer. They are working on another important study that lmade the synapsis’ in my head explode (that’s an expression that my son’s father in law uses to describe truly amazing info). Can’t dive into that topic yet, but stay tuned....
And finally, I would be remiss if I didn’t mention that I told all of our researchers how much we appreciated their work. i told them that they are doing noble work and not to get discouraged. I explained even if they study things and things do not prove what it is they want to prove, even those negative findings are as important. I explained knowing what isn’t is as important of what is or what might be.
Sooooo....I will continue to keep them and all of you in my thoughts and prayers as always!
Oh...and I got some great news this week. I saw my MO for my six month check up and I will graduate now to annual visits AND.....I no longer will be taking letrozole. After eight years, 3 years of tamoxifen and 5 years of letrozole, and the first three years taking ovarian suppression, I am finished! Yay! Reading the NCCN 2018 breast cancer treatment guidelines, it seems that for mucinous breast cancer the treatment guidelines have eased since I began treatment back in 2010. I am very comfortable with the decision based on the guidelines. Closely reading the guidelines for tumors between 1 cm and 3 cm, a patient should consider hormonal therapy. Back in 2010 it was recommended. Small difference in the wording, but nonetheless a big difference when it comes to treatment.
Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)