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Jun 9, 2019 11:14AM
Jun 9, 2019 11:16AM
Kellyruss, with a BMX, the odds are that all the cancer was removed from your breast. But even after a BMX, a small amount of breast tissue always remains - it's impossible for the surgeon to remove every cell of breast tissue - so you do still have a small risk, probably about 1% - 2%, that you could develop a local (in the breast area) recurrence.
More significantly, however, is that the BMX does nothing to address cancer cells that might have escaped from your breast prior to surgery, and moved somewhere else in your body. Clear nodes is a good indicator that no cells moved into the body through the lymphatic system, but it's not a guarantee - if it was just a few cells, they could move through undetected. The same thing can happen through the bloodstream. When women develop a distant recurrence, i.e. metastatic breast cancer, it's usually because those cells moved out into the body before the cancer was even detected. Breast cancer has usually been in our breasts for years before it becomes large enough to be detected, so there is plenty of time for a few cells to break away. Therefore a BMX, while reducing your risk of a local recurrence and reducing your chance to develop a new primary breast cancer at some time in the future, does nothing to reduce the risk of a metastatic recurrence. This is why study after study have shown that the survival rate is the same whether a patient has a MX or a lumpectomy + rads.
There is unfortunately no way to know with certainty if any cancer cells escaped before you discovered your breast cancer and before your surgery. This is because in most cases, it's just a few cells, too small to be detected by screening or tests. This is where systemic (i.e. whole body) treatments such as chemo and endocrine (anti-hormone) therapy come in (i.e. Tamoxifen and the AIs). Those treatments are given to track down and kill off rogue breast cancer cells that might be sitting somewhere in the body.
The Oncotype test is used to analyze the genetic make up of the cancer, to determine if it's a cancer that's likely to have shed off some cells as it was developing and growing. A low Oncotype score will suggest that the risk is low that your cancer would have shed cells, which would mean your risk of mets is low. With a low Oncotype score, chemo won't be recommended but in all likelihood hormone therapy will still be recommended as a precaution, because it's still possible that some cells could be sitting somewhere in your body. With invasive breast cancer, no matter how indolent, there will always be a least a small risk of mets. A high Oncotype score means that your cancer has an aggressive genetic profile, increasing the risk that some cancer cells might have moved out from your breast into your body prior to surgery. With a high score, both chemo and endocrine therapy will be recommended.
If I may ask, what was your diagnosis? Specifically, size of tumor, grade of tumor, ER/PR status? Since an Oncotype test has been suggested, it means that your tumor is ER+, but the % ER+ is an important factor that influences the Oncotype score. I'm assuming you are HER2- because if you were HER2+, chemo would likely be recommended without need for an Oncotype score.
“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke