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Topic: Chemo or No? HELP

Forum: Young With Breast Cancer —

Connect with those under 40 who have been diagnosed.

Posted on: Jun 13, 2016 11:04AM

WifeMomTeacher wrote:

I am 29 years old diagnosed April 22. Mastectomy May 12. Diagnosed Invasive Mammary Carcinoma 3.5 cm, clear nodes and clean margins. Grade 1. ER and PR positive. My Oncologist had been leaning towards chemo if my Onco score was over 10, due to my being 29. It came back 14. I don't know what to do. I worry if I don't do chemo I will worry and not be able to live with myself if it comes back. I worry about being overly aggressive and causing more harm than good if I choose chemo. I understand 14 is low, and chemo may give me very little benefits, but how accurate is this testing for a 29 year old? The average person diagnosed with breast cancer is 36 years older than me. I don't know what to do!!

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Jun 13, 2016 02:19PM ml143333 wrote:

I certainly can't tell you what to do and I was diagnosed at 45 not 29, but I threw everything at it that was offered. My thinking was that if I did the BMX and chemo and then femara that if it did come back, I would have know that I did everything I could at the time to prevent it.

It is a big decision.

Mandy Dx 7/11/2014, IDC, Right, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 8/27/2014 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left); Reconstruction (right) Chemotherapy 10/17/2014 CMF
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Jun 14, 2016 03:09AM - edited Jun 14, 2016 03:11AM by LM070917

I would be inclined to go with chemo, but that's just my opinion. Being so young, we always hear there is the higher risk of it being aggressive. 3.5cm is a fair size and I would be worried. Chemo is an insurance policy, not to say it always works, but then you did everything you could. Diet and exercise also go a long way. I've heard people who keep up with exercise, experience a lower risk of recurrance. I was Dx at 34

Dx 9/18/2015, IDC, Right, 6cm+, Stage IIIA, Grade 3, 2/14 nodes, ER+/PR+, HER2- Chemotherapy 11/1/2015 AC + T (Taxol) Surgery Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right Radiation Therapy Lymph nodes, Chest wall Hormonal Therapy Arimidex (anastrozole), Zoladex (goserelin)
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Jun 14, 2016 06:32PM cookiegal wrote:

Fair enough question, the test is what it is. It measures your benefit from chemo and your risk of developing mets. I feel like the past few years the idea that the test is less of a guide for young people has been falling out of favor. There was someone on the board recently with a similar issue, and got a 2nd opinion not to do chemo. So it's a tough call. I would really really get a second and even third opinion. I skipped chemo at 22, it was a tough call. I would have a difficult time accepting it at 14 but I am not an oncologist.

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Jun 14, 2016 11:43PM Cowgirl13 wrote:

If I were in your shoes I would do chemo due to tumor size of 3.5 and your age. I chose to throw everything at it because if I had a recurrence and hadn't thrown everything at it I would have felt so bad about my decision.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER+/PR+, HER2+ Surgery 6/17/2009 Chemotherapy 8/2/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/22/2010 Arimidex (anastrozole)
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Jun 16, 2016 04:24PM - edited Jun 16, 2016 04:25PM by cookiegal

It's true that younger women tend to get more aggressive cancers, but this woman now has specific information about her cancer. I am not saying there is no case for chemo here, I really don't know the latest guidelines on tumor sizes. However since she had an oncotype test I would not say that the tumor is more aggressive simply because of her age.

I hope this link is helpful. It is an organization for young women with BC.

https://www.youngsurvival.org

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Jun 16, 2016 04:51PM - edited Jun 16, 2016 05:00PM by ChiSandy

An OncoDX score of 14, negative nodes, clean margins, hormone+/HER2- status, and a tumor grade of 1, regardless of age, would indicate that despite the OP's youth and tumor size chemo would not be sufficiently effective to warrant the risks (albeit smaller than in older women with more vulnerable hearts, bones & immune systems). Grade 1 is the least aggressive cancer, sometimes described as “indolent." Its slow-growing cells are not very vulnerable to cytotoxic chemo. The OP called her invasive cancer “mammary" but didn't specify whether ductal or lobular. ILC is sneakier than IDC, so sometimes chemo does get prescribed for it. Also, some MOs will prescribe neoadjuvant chemo to shrink tumors that large, to facilitate breast-conserving surgery--but the OP already has had the tumor removed, via mastectomy.

I would definitely seek a second or even third opinion--giving chemo to node-negative grade 1 IDC tumors (Luminal A) scoring 17 or lower definitely goes against the current grain. Size is less relevant, given that both the tumor and breast have been removed. Endocrine therapy, however, is definitely indicated--whether a SERM (tamoxifen or raloxifene) vs. ovarian suppression or removal followed by AI is a personal decision for someone so young; considerations include decisions about future fertility and the likelier rougher SE's of being thrown into premature menopause--the estrogen withdrawal would be far more abrupt and precipitous than in women past menopause. But chemo also can induce at least a temporary menopause (“chemopause") as well.

Where in WV is Hinton and how close is it to a topnotch cancer center at a major university teaching hospital? Perhaps a trip to NC’s Research Triangle area--Raleigh’Durham/Chapel Hill (Duke), Phila. (Penn), NYC (Memorial Sloan-Kettering), Baltimore (Johns Hopkins), Boston (MGH or Dana Farber) or even Chicago (U of C, Rush, Loyola, Lynn Sage/NWM) or Houston (M.D. Anderson) for a second MO consult might be worth it--the treatment agreed-upon could then be administered closer to home. Dr. Kathy Albain at Loyola (near w. suburbs of Chi.) was a pioneer in developing OncoDX and its predictive value.

Diagnosed at 64 on routine annual mammo, no lump. OncotypeDX 16. I cried because I had no shoes...but then again, I won’t get blisters.... Dx 9/9/2015, IDC, Right, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 9/23/2015 Lumpectomy: Right Radiation Therapy 11/2/2015 3DCRT: Breast Hormonal Therapy 12/31/2015 Femara (letrozole)
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Jun 21, 2016 11:42AM cookiegal wrote:

ChiSandy, good post, I hope the OP sees it.

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Jun 21, 2016 04:42PM sschreier wrote:

I am going through that pressure of choosing or not choosing.I am choosing.Mine was 17 and tubular 2 nuclear grate 2 and mitoic (?) 1.My tumor wAs 8 mm.My oncologist had said he first thought it would be lower.It was my choice but I too feel I have to give it all I got right now

Stage one IDC, right lumpectomy 5/16, octotype 17, chemotherapy to start July 18, ER+, PR +, HER -
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Jun 21, 2016 05:00PM debiann wrote:

An important question may be "what chemo is being recommended?"

No chemo is fun, but some regimes are better tolerated with less risk of long term effects. If it's a matter of 4 months of TX with little long term effects, maybe go for it.

"I live knowing it will be ok when I'm not." Dx 3/2014, IDC, 2cm, Stage IA, Grade 3, 0/2 nodes, ER+/PR+, HER2+ Surgery 4/2/2014 Lumpectomy: Left; Lymph node removal: Left, Sentinel Targeted Therapy 5/7/2014 Herceptin (trastuzumab) Chemotherapy 5/7/2014 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 9/28/2014 Mastectomy: Left, Right; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 11/4/2014 Arimidex (anastrozole)
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Jun 21, 2016 05:35PM - edited Jun 21, 2016 05:35PM by debiann

This Post was deleted by debiann.
"I live knowing it will be ok when I'm not." Dx 3/2014, IDC, 2cm, Stage IA, Grade 3, 0/2 nodes, ER+/PR+, HER2+ Surgery 4/2/2014 Lumpectomy: Left; Lymph node removal: Left, Sentinel Targeted Therapy 5/7/2014 Herceptin (trastuzumab) Chemotherapy 5/7/2014 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 9/28/2014 Mastectomy: Left, Right; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 11/4/2014 Arimidex (anastrozole)
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Jul 7, 2016 03:39PM christina0001 wrote:

I agree with getting a second opinion. It's a very common thing to do and I've done it myself. You can just call where ever and ask how you can get an appointment for a second opinion consultation.

Surgery 1/10/2012 Lumpectomy: Right Dx 1/16/2012, IDC, 2cm, Stage IIA, Grade 3, 0/7 nodes, ER+/PR+, HER2+ Surgery 2/9/2012 Lymph node removal: Right, Sentinel Targeted Therapy 2/12/2012 Herceptin (trastuzumab) Chemotherapy 2/12/2012 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 8/9/2012 Mastectomy: Right Hormonal Therapy 8/23/2012 Radiation Therapy 9/30/2012 Breast Surgery 7/29/2013 Reconstruction (right): DIEP flap

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