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Jun 16, 2016 04:51PM
Jun 16, 2016 05:00PM
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....
9/9/2015, IDC, Right, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC)
9/23/2015 Lumpectomy: Right
11/2/2015 3DCRT: Breast
12/31/2015 Femara (letrozole)