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All TopicsForum: IDC (Invasive Ductal Carcinoma) → Topic: IDC Stage 1, grade 3, ER+, PR+, HER2/neu -, lymph node neg

Topic: IDC Stage 1, grade 3, ER+, PR+, HER2/neu -, lymph node neg

Forum: IDC (Invasive Ductal Carcinoma) — Just diagnosed, in treatment, or finished treatment for IDC.

Posted on: Jun 11, 2008 05:13AM

monandeclan wrote:

Hello all, and thanks in advance for any input/help you can provide.  This board seems so supportive and helpful.  I am a newbie here.  I am a 45 (almost 46) yr old wife and mom of 7 yr old DS.  I was diagnosed on 4/25, lympectomy with SNB on 5/9.  Oncologist is recommending AC chemo 4X, in addition to radiation and tamoxifen.  I am reconciled to the radiation and tamoxifen, but am having trouble with the chemo decision.  Just got my Oncotype score yesterday, 24.  Much higher than I had hoped.  I am sad and scared.  HELP!

Thanks.

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Jun 11, 2008 06:01AM hopefor30 wrote:

Well, I'm sure we can all relate to being sad and scared.  I know that I was and although I did not end up doing chemo, I too dreaded the thought.

In my case, my Oncotype score was 16 and I had a very small tubular breast cancer (3mm) with negative nodes -- grade 1 --

In your case, with an Oncotype of 24 and stage 3, I think I would take the chemo -- at least you are not getting the full 8 treatments, only 4 -- I am sure someone will come along who has done chemo and can offer more encouragement.

Good luck and you can always get a second opinion to help with your decision.   I got two and because they were the same, I was comfortable with my decision.

M.

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Jun 11, 2008 07:32AM monandeclan wrote:

Mamhop,

Thanks so much for your input.  I think deep down, I know what  I need to do, but am just so overwhelmed and somewhat in shock.  My tumor was even smaller at .9 cm.  And I am grade 3 and stage 1, not stage 3.  Does that change your opinion at all?

Thanks again.

Mona IDC, Dx 4/25/08, .9 cm, Stage I, grade 3, 0/2 nodes, ER/PR+, HER2 -
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Jun 11, 2008 11:15AM hopefor30 wrote:

My tumor was .3cm -- so it is smaller and I meant to say grade 3 -- sorry -- but no, that doesn't change my opinion.   I would do the chemo -- I would have done chemo if my doctor suggested it, but they didn't -- and I really pushed for an opinion.   I told my doctors I didn't want them to say that I had to decide.   I wanted a recommendation first and then I would decide.

M.

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Jun 11, 2008 11:47AM amberyba wrote:

I didn't want chemo either, I had stage 1 grade 2 (almost grade 3, just one more point would have pushed me to grade 3, (I was 7 on the grade (8-9 is a grade 3) my tumor was over 1 cm (1.5cm), and even without the oncotype results, usually chemo was recommended for that size. My oncologist was very matter of fact and just showed me the recurrence percentages with my BC, and that he would just do 4 rounds of chemo if I decided to do the chemo...but he left it up to me...

as i was waiting for my oncotype results, I did a lot of thinking and researching, I found a lot of BC comes back even with chemo and other treatment...the med onc. wanted me to be in a trial...and the study was using the oncotype...the real truth is that it is not known if chemo is beneficial for those who fall in the mid range (that is you) and the trial would throw some women in the mid range to do chemo and tamoxifen, and then some of these women to just do the tamoxifen..I opted out of the study because I didn't want anyone making the chemo decision for me.

but I struggled with the decision and told myself if the oncotype came in the mid range middle 24-25 I would do the Chemo...but the more I thought about it, I decided I would only get the chemo if I was in the high range over 30.

Mind you I really thought my oncotype score would fall at the end of the mid range (25-29) or over 30. ultimately I prayed and felt that I would only get chemo if I fell in the high range....over 30. this is the only group that they are sure of that chemo is beneficial to.

 the mid range 19-29 they aren't sure the best way to treat. that is why the trial study is being done.

Years from now, we will have the results from this study.

In the end the medical oncologist called me personally and told me chemo would not benefit me at all, I had scored a 7....and that he didn't think he had seen any score that low...

It is a hard decision, especially if your breast care team recommends strongly one way or the other...

Talk to others, pray a lot and look for answers...I will pray for you as well.

I have just finished radiation therapy and the next recommendation is tamoxifen, that is a decision I'm working on and I'm leaning more to at least give a try.

Good Luck and

God Bless!

Amber

Amber Almond Dx 2/2008, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Jun 11, 2008 01:48PM dalycity wrote:

Dear Mona: I was diagnosed 1.5 years ago at age 56 and post-menopausal; and my surgeon at that time said that if I were pre-menopausal, he would consider chemo.  I believe younger women usually have a more aggressive type of tumor as opposed to ones of the same characteristics in older women. Seems the doctors always give us choices because there are very few definitive answers in medical; we have only percentages to work from.  Good luck to you in your decision.

dalycity Dx 11/30/2006, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Jun 11, 2008 01:53PM levogs wrote:

I also had IDC stage1, grade 3, ER+, PR+, HER2/neu-, lymph node neg.  I was diagnosed in Aug. 2004.  My onc. recommended chemo because of the grade 3.  I had a mastectomy so I did not need radiation.  They were not using the oncotype test at that time so I could only go by what the onc. thought would be most beneficial.  I had 8 treatments of dose dense CMF chemo.  I did not lose my hair, it just thinned.  I am now on Arimidex.  Given the grade 3 and the oncotype score I would do the chemo.  Ask about the CMF.  Hope this helps and good luck with your decision.

Lenore

Dx 8/26/2004, IDC, Stage I, Grade 3, 0/3 nodes, ER+/PR+, HER2-
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Jun 11, 2008 06:28PM gramadeb wrote:

Hi - I also had IDC, stage 1, grade 3, ER and PR+, node negative, HER2 -. My oncotype came back at 28 and my onco recommended chemo. I just finished 4 rounds of TC. Chemo was very doable for me. Had minimal se. I am now moving on to radiation then Arimidex.

I hated the thought of chemo and cried for days when i was told I needed it. However, I always felt in my heart that it was the best thing and I knew I was doing everything to beat bc.

Good luck with your decision.

Deb

Dx 2/7/2008, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2-
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Jun 11, 2008 07:09PM monandeclan wrote:

Deb. just curious how old you are.  Your case sounds very similiar to mine, except the arimidex.  They are suggesting tamoxien for me as I am pre-menopausal.   I wonder if that makes a difference in the chemo recommendation too.

Mona IDC, Dx 4/25/08, .9 cm, Stage I, grade 3, 0/2 nodes, ER/PR+, HER2 -
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Jun 12, 2008 07:45AM gramadeb wrote:

Hi monandeclan - I am 54 years old - surgical menopause 5 years ago. I know menopause determines Tamoxifen or an AI. Not sure what role it plays in type of chemo. I was given Taxotere and Cytoxin because clinical studies show this regimen is as effective as AC with less cardiac risk. My onco told me I was too young and chemo would benefit - didn't make me happy about chemo - but did make me smile to be told I was young at 54!

Deb

Dx 2/7/2008, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2-
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Jun 12, 2008 11:31AM otter wrote:

monandeclan, my situation was kind of like yours and gramadeb's, with just a few exceptions.  My IDC was just a Grade 2, but it was bigger (1.8 cm) and was PR- (although ER+ HER2-).  My Oncotype score was 26, which was above my comfort level.

Both of the oncos I consulted recommended chemo because of the size of my IDC, the fact that it was Grade 2 (not Grade 1), the lack of PR receptors on the tumor cells, and my "young" age (56 ha ha!)..oh, and my Oncotype score.

I just received my last chemo treatment last week--4 tx's of Taxotere/Cytoxan, at 3-wk intervals.  Chemo is rough but it is very do-able.  My Oncotype score translated to a distant recurrence risk of 17% without chemo, even with Tamoxifen or an aromatase inhibitor.  Chemo supposedly reduces that percentage by 1/3, so my risk of a distant recurrence will be around 12%.  For me, that was enough to justify chemo.

otter 

Dx 2008, IDC, Stage Ia, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Jun 12, 2008 08:07PM SueYA wrote:

Hi monandeclan, I am in a quite similar situation as you - 46, mother of a young child (10), premenopausal, dx 4/17/08, IDC <1cm, stage 1, grade II/III, lymph neg, ER+/PR+/Her2-.  Lumpectomy on 5/13. OncoType DX score 8.   My onc recommends: rad, tamox, no chemo.  

Dx 4/17/2008, IDC, <1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Jun 12, 2008 08:49PM wishiwere wrote:

monandeclan, with your dx and the onco RS, personally I'd be doing the chemo, but in the end it is your opinion and life that has to make that decision.

ONE thing I do want to say is that A/C is what I had.  I would recommend getting a second opinion if for NO other reason than that A/C I don't believe is the the gold standard for ER/PR + anymore.  I believe they are doing more TC as a result of the SE's that can occur with Adriamycin.  Most specifically heart myopathy.  There is a life time limit of how much they can give and they give much less than they used to, but still.  It's a powerful drug, they all are.

Consider other options if you can before committing to A/C.  Do the research of what's recommended and ask a lot of questions of your docs. 

wishiwere~ Path read stage 1C- 1st Primary was IDC w/DCIS 1.4 cm, ER/PR+ & HER2- Dx 9/21/2007, ILC, 1cm, Stage Ib, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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Jun 13, 2008 04:56AM GramE wrote:

Hi:

I am 62, obvioulsy Post menopausal, er/pr -, Her +, 2 cm IDC, and have opted for chemo, surgery with (hopefully) modified mastectomy versus total mastectomy, then chemo and radiation. I had a team of 5 experts reviewing all my tests and they ALL agreed on this course of tx for me.

You are entitled to as many consulations as you want, in my humble opinion. If you are confident in your doctors suggestions, go with your gut feeling then. I decided to pull out the BIG guns and will be doing dose dense AC every 2 weeks for 4 rounds, then weekly of Taxol for 12 sessions. 2 weeks to 2 months after the last Taxol, I will have surgery, depending on my white blood count and other factors.

BTW, by the way, I was given a full round of pre oncology doctor visit tests: CAT scan of pelvis, abdomen, and chest, with dye contrast. MRI of breasts, Bone scan with dye, and a MUGA (for heart) with dye. I think I may glow in the dark from all the radioactive dye, but a very good doctor friend once told me: test, test, test, test, and then double check the tests before cutting.

I understand that some insurance will not cover all of any of these tests, but your doctor or hospital should have an insurance specialist person who can advocate on your behalf. I ended up with cauliflower ear from phone calls, but I wanted the best and most complete information before I made my final decision.

It is VERY scary and to add to all my shock and anxiety, my one and only son was married May 24, just 3 weeks after I got my cancer diagnosis. My doctor agreed to postpone the tests till after the wedding, so now I am on track for an aggressive attack on my cancer. I will start AC on June 19.

Good luck and use this site for your research. The doctors can give you the technical/medical information, but these fine ladies can give you their experience - as only those who have been there can.

HUGS, lefty/Nancy

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Jun 13, 2008 05:59AM chloekat wrote:

Monandeclan, I'm going thru the same decisions. I was diagnosed on 4/25 too via ultrasound. Then I had my 1st surgery on 5/5. My path came back as IDC Stage 1, grade 2, ER+, PR+, HER2-, lymph node neg. All margins were clear except the inferior which had some 'non-invasive' cells. I opted to have reexcison on 5/19. Surprisingly, that path revealed a 4mm invasive tumor. I just had another reexcision on 6/9. Thank God, that came back completely clear. In the meantime, I was anxiously awaiting that Oncotype score. After the Monday's surgery, my surgeon went over the results. My score is 21. (I was kind of shocked as I was hoping for <17). She went on to say that I still am in the range of just surgery, rads and tamoxifen. When she called to gleefully report my clean margin resection, I asked if I should go ahead and schedule radiation. She hesitated and then said she wanted me to talk to the oncologist first since my Oncotype score is 21. (What? What happened to the convo after surgery?) I spoke to the oncologist yesterday and she strongly advised chemo. I don't want to do the chemo. She thought I was fighting it because I'd lose my hair. It's not at all about losing my hair. I just feel that since I'm on the border that chemo would be 'overkill'. I also am a little jaded since I've been dealing with family members going thru different cancers/chemo for the last 12 years. I don't like what I've seen. My mom wound up having chemo after chemo after chemo. Her situation wasn't the same as mine, but still, I feel that chemo is strong medicine to kill the cancer, but it also kills 'good' cells in your body. My friends and family that went thru it say they were never the same afterward. Again, I'm not against doing it - it saves lives. I am just not sold that it would really help me now. I want to ask the docs to just watch me extra closely, maybe do a broader spectrum of radiation and of course the tamoxifen. I am also considering ovarian shutdown. I again just feel like I need to 'save' the chemo for when/if I really need to do it. Maybe I'm totally wrong. I'm really confused right now.

49 yr old, IDC, Dx 4/25/08, lumpectomy 5/5/08; 5/19 & 6/9, .1.2 cm tumor; 4mm tumor, stage 1, grade 2, 0/2 nodes SNB, ER/PR+, HER2 -
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Jun 13, 2008 06:39AM deborye wrote:

Hello Ladies,

I'm 56, post men, I was dx 3/27/07, IDC 6mm DCIS 7mm, Stage 1, but what puzzles me is the Grade, on my path report it reads Grade II/III, what does that mean?  Grade 2 out of 3 or borderline 3?  er/pr+ 90% her2 negative, BRCA negative, biopsy w/wide excise 2x to get clearer margins because of the DCIS which did not show up on mam or US. Node neg.  A oncotype test was not done, why I don't know, maybe they did not think it was necessary.  All three of my doctors said no chemo is needed, just surgery, rads and arimidex.  I am stilll nervous on their decission, I think I just have to get over it.  The reason for that is my mom lost her battle from bc 12 yrs ago and it is still fresh in my mind.  I will never get over that. I would have done chemo just for the small % of survival rate.  My onc told me there is only a 12% chance it would come back.  I wish is was 0%.

 Whatever 







~~~Deb~~~NEVER GIVE UP/NEVER SURRENDER**IDC 6mm & DCIS 7mm
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Jun 13, 2008 08:49AM gramadeb wrote:

Hi deborye - my biopsy path report came back as grade 2 - then changed to grade 3 after surgery. I am guessing you may be a grade 2- borderline grade 3.

Chloekat - I watched my sister battle cancer - not breast - but she had multiple chemos and I too was scared to death to go through chemo. But it was doable and they have changed the process so much from when my sister went through it. A lot of side effects she had are now alleviated with meds.

Deb

Dx 2/7/2008, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER+/PR+, HER2-
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Jun 13, 2008 12:41PM , edited Jun 13, 2008 12:42PM by otter

deborye, I'm pretty sure the "grade II/III" means it was a grade II (2) on a III (3)-point scale...but I could be wrong.

The grading is based on 3 different histologic features of the tumor; each of those features is given its own score from 1 to 3.  Then the 3 scores are added up and put into a little chart that says, "if the total score is 3, 4, or 5, the grade is 1; if the total is 6 or 7, the grade is 2", etc.

Here is a website with a really good explanation of the grading used here in the U.S.:  http://www.imaginis.com/breasthealth/histologic_grades.asp

I think one reason why the pathologists write "II/III" is because there are other grading systems that might be used.  With the system that's usually used in the U.S., the highest grade is a "III".  That's just my interpretation, though.  The grade of my IDC was recorded in the path report as "II/III" and my onco told me it was a "grade 2".  I know some people have interpreted the "II/III" as meaning it is in between II and III, but I don't see how that's possible with the grading system that's used.  There are no fractions in the scoring--it's all integers.

BTW, I've been looking on-line for the past half hour for an explanation of the "grade II/III" notation, and I can't find anything.  Maybe someone else knows this?

otter 

Dx 2008, IDC, Stage Ia, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Jun 13, 2008 06:26PM deborye wrote:

Thank you otter, I think your right, it must be Grade 2. The DCIS I mentioned was staged as T1b, N0, MX.  I thought DCIS was stage 0.  I see my onc again in Oct.  I will write this down so I can remember to ask upon my next appnt.

I am also going to check out that website.

 Big Hug 

~~~Deb~~~NEVER GIVE UP/NEVER SURRENDER**IDC 6mm & DCIS 7mm
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Jun 22, 2008 09:23AM , edited Jun 22, 2008 09:24AM by amberyba

Deborye,

I don't think they usually recommend chemo with dcis,

 read on this website it states that it is stage "0":

http://www.breastcancer.org/symptoms/dcis/

 because it is not invasive...

and about the oncotype, I'm thinking that if they don't ususally do chemo on dcis that it is stage "0" why they wouldn't recommend the test for dcis, because the Oncotype is done to help decide if chemo is beneficial:

http://www.genomichealth.com/oncotype/about/hcp.aspx

good luck

Amber

Amber Almond Dx 2/2008, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Jun 22, 2008 03:42PM otter wrote:

Amber, deborye's tumor contains IDC (invasive ductal carcinoma) as well as DCIS.  She said it was "IDC 6mm DCIS 7mm, Stage 1."  Her tumor was classified as "Stage I" because of the 6 mm IDC.  If it had been only DCIS, it would have been Stage 0.

Chemo was not recommended for her because even the invasive component of the tumor (the IDC) was very small.  The other characteristics of the tumor that argued against chemo were the grade (2), the fact that it had hormone receptors (ER+ PR+) so it can be treated with an estrogen blocker, and it did not over-express HER2 (HER2-).

otter 

Dx 2008, IDC, Stage Ia, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Jun 23, 2008 06:27PM amberyba wrote:

Thanks Otter, It took me a while to figure out what you were saying...I suppose I was responding to Deborye's second post about DCIS being stage 0, I looked above and saw the earlier post about the IDC 6mm. You are good.

Otter how are you doing? I see that our dx are similar, I was dx a month later, Are you doing any hormonal chemo...how is it going?

Amber Almond Dx 2/2008, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Jun 24, 2008 11:55AM otter wrote:

Amber, you're right--our sig lines are nearly identical!   I had a mast/SNB in February, so I don't have to go to "rads camp" next.

I read back aways and saw that your Oncotype score was 7. That's fantastic!  I was hoping for a low score, but mine was way too high at 26.  So, while you've been finishing your rads, I've been doing chemo.  I guess we're both getting done about the same time.  Are you on Tamoxifen now?

I just finished 4 cycles of Taxotere & Cytoxan, and the more reading I've done about that, the better I feel that I did decide to do chemo and that my onco agreed to TC.  (The original plan was to give me AC.)  Today or tomorrow I'm going to take my first tablet of my 5-year course of an aromatase inhibitor.  My onco wanted me to try Arimidex first, so that's what it will be.  For me, post-meno for 5 years already and with an ER+ PR- tumor, Arimidex was a good choice because of its ability to reduce the risk of recurrence pretty dramatically.  My onco says there really isn't a significant difference among the 3 aromatase inhibitors (Arimidex, Femara, Aromasin), at least from what they know right now.  What she said is in agreement with what I just read in the 2008 guidelines from the National Comprehensive Cancer Network (www.nccn.org).

How are you doing?

otter 

Dx 2008, IDC, Stage Ia, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Jun 24, 2008 05:38PM amberyba wrote:

thanks for sharing about your oncotype, BC is a funny thing, so many varying degrees, my onc said the same thing for me if i would have had to do chemo, it would have been
TC and 4 rounds...I know you were glad of just the 4 rounds, I've read AC is much tougher....

I have heard good things about the AI's, seems like they are more effective than tamoxifen. I will see my med onc July 3rd, and I know I will get the tamoxifen prescription. I am nervous about it though...my sister had difficulties with both tam and AI, and I have met one BC survivor who did well on Tamoxifen....others have had relapses or severe SE...

but I am 2 weeks out of radiation, and have had 2 -3 good days, fatigue set in when I stopped walking, my rad techs scared me about the boost markings and not letting them disappear, I sweat when I walk and always had problems keeping the whole breast markings intact...they fussed at me all the time...so when they stressed the boost markings I stopped walking my usual 2-5 miles 2-5 times weekly. the last week of the boost I just didn't really care about the markings, because I had a nice red shaded area that was clearly marked the area they were zapping.

I am so glad you don't have to have radiation, the first week of rads I wished i had gotten a mastectomy and even told everyone even the rad Dr. that maybe I should get a mast and quit rads...but I made it....and I seem to be healing and resting helps the swelling and pain go away.

I am off to a big trip tomorrow and hope I don't fatigue. I will be on a golf course 5-7 hours a day, and I suspect on my feet...but it will be a happy time and I bought several loose "shirts" that are stylish yet what me and my friend call "pregnant" shirts. But really I don't care if someone asks me when I'm due (just kidding), but I can't stand something hugging my BC boob. I modeled one of the shirts for my husband and he was encouraging about it.

do you have any problems wearing tops now?

let me know how the Arimidex goes.

God Bless!

Amber

Amber Almond Dx 2/2008, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Jun 25, 2008 06:35PM otter wrote:

Amber, I have a terrible time wearing tops.  Well, it's not the tops that are the problem--the problem is the bras under the tops.  I still had a bit of swelling under my arm 8 wks after surgery, so I didn't go for a prosthesis "fitting" before I started chemo.  None of my bras fit very well then, because of the puffy tissue under my arm.

Once I started chemo, the Taxotere caused even more swelling and fluid retention.  At certain times and on certain days my mast incision and under-arm area would be tender and slightly puffy.  Wearing a bra just didn't work--it would fit OK when I first put it on, but after a few hours the band left an impression in the skin on my mast/SNB side. That's not good--it can lead to lymphedema.  So after trying ELEVEN different bras, I finally gave up and quit wearing one.  I still need to work on that issue.

I took my first tablet of Arimidex today and had ... no SE's at all.  Ha ha.  It's a bit early for SE's, I know.  I'm just trying to be optimistic about it, since it's the best strategy I have left to prevent a recurrence.

Glad to see you've finished rads.  Have a great time on your trip!

otter 

Dx 2008, IDC, Stage Ia, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Jul 11, 2008 02:33PM tbi110 wrote:

think about CMF. WORKS JUST AS WELL AND MUCH LESS TOXIC. MY WIFE TRIP NEG. WISH SHE WAS ER+ she couldnt do the AC CHEMO. WE DID THE SELENIUM, VITAMIN D

FLAX SEED..TRY IT.

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Jul 14, 2008 05:55AM plonyalmony wrote:

I hope someone can give me some insight-I am very confused and anxious. I have Stage 1, grade 3, ER +, PR+, HER2/nue -, lymph node neg BUT there is lymphatic vessel invasion. Much to everyone's surprise my oncotype is only 11 and showed that I will be very receptive to hormone therapy. I am also having radiation therapy. My dilemma is that I am getting mixed advice on whether to also have chemo. Using the histology (grade 3, vessel invasion) I would definitely have it-in fact one doc said he wouldn't have even done the oncotype, but the oncotype score is so low that the other said I wouldn't benefit from it. Am really struggling with this. Very unusual to have low oncotype w these factors. Anyone similar? Any advice or suggestions. Thanks.

Dx 5/6/2008, IDC, 2cm, Stage I, Grade 3, 0/1 nodes, ER+/PR+, HER2-
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Jul 17, 2008 05:36PM echogirl wrote:

hello! i am new to this board. i was dx'd 3-07 with IDC,er+pr-,0nodes,HER2-. i had a bilat for my 3.4cm tumor.no rads, 6 cycles of FAC, and i strongly urge all of you to ask about Emend for nausea. it stops nausea at the brain. i took it the day of and before chemo, and for 2 days after, i never was nauseated-at all. they also ran Zofran during, and i could take ativan under my tongue if needed. taking it SL helps with nausea. lost my hair in 2 weeks-my only good feaure left at age 55! i shaved my head myself. ok, it was weird, and i got tired of it, but now i am a total short curly haired person. it is easy. chemo was no day at the beach, but it wasn't as bad as it could have been. don't be scared, God is with you. i have refused the Arimidex. the more i read about crippling side effects, and my job is physically demanding(gotta have the insurance)welp, i said no. did anyone have chemo brain? any advice? thanks, women.

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Jul 24, 2008 07:02PM MarciaW wrote:

plonyalmony, you have exactly the dilemma I had but worse!  My situation was very similar to yours, minus the vascular invasion but with a slightly higher oncotype (17).  I nearly went crazy trying to believe the oncologist who said I should skip the chemo -- but without being able to get my arms around how a grade 3 tumor came out to a 17, I just couldn't get there.  I even called Genomic Health to see if they could look at my details and tell me what was driving such a low score..   super estrogen receptivity?  a different take on the mitotic rate?  What??  But they weren't able to disclose anything but the final number and their numeric rating of degree of ER/PR receptivity, which seemed to be pretty much in the mid-range. 

What finally convinced me to go for the chemo was this study: 

Histopathologic variables predict Oncotype DXTM Recurrence Score
Presented in part at the International Academy of Pathology meeting in Montreal, QC, Canada; September 16-21, 2006.
Melina B Flanagan1, David J Dabbs1, Adam M Brufsky2, Sushil Beriwal3 and Rohit Bhargava1

I found the abstract online but I think you'll need a medical library to get the whole thing.  It summarizes all of the traditional risk factors (pathology, histology, etc) of 42 patients at the authors' hospital, grouped by their oncotype results (Low/Med/High).  So it was possible to assess the extent to which I was similar to or different from the rest of the "Low" population that AS A WHOLE has low recurrence risk and supposedly doesn't benefit from chemo.  The telling thing for me was that I looked almost nothing like the Lows presented in this study (in fact I looked quite a lot like the Highs!).  Not one was grade 3 (I don't think any were even grade 2); their average age was 58 so they were generally post-menopausal (I'm 50 and still swimming in estrogen); etc.  My oncotype 17 translated to an 11% recurrence risk, but when I looked at this group it seemed pretty obvious to me that if somebody had to be in the 11%, it was a lot more likely to be me than them!    So that answered the question for me of whether I was comfortable with my risk (not) -- but still left open whether the chemo would help if I did do it.   The oncotype validation study says no, but why is that?  One reason is that oncotype Lows usually have a low mitotic rate, and chemo is not as effective in those cases because of the very nature of how chemo works (interfering with cell division).  But my Grade 3 (9/9) meant I had a high mitotic rate -- so it seemed to me that I might also be different from the typical Low in terms of how much chemo would help.  And in my case, at 50, there's a good chance it will push me into menopause, which I take to be another benefit -- the less estrogen the better.  So I laid this all out with a second oncologist and he agreed -- it was worth it to go for it in spite of the 17.  I'm through three rounds of TC now, just one more left and doing very well.  It's not pleasant, but it's certainly bearable, and at least I can sleep.  My three favorite pieces of advice were "Don't waste a bullet," "Your first shot is your best shot," and "You need to find the Path of Least Regret."    

Dx 3/21/2008, IDC, 1cm, Stage I, Grade 3, 0/1 nodes, ER+/PR+, HER2-
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Aug 1, 2008 06:43AM mb2226 wrote:

plonyaliimony: my diagnosis was almost identical to yours, except slightly larger tumor (1.2 cm) and a much higher onco score (20).... i also had grade 3 and vascular invasion (no lymph nodes) and was 50, pre-menopausal.  i did not do chemo - i looked into all the probabilities, etc., and decided against it.  my onc also thought it was not going to buy me a lot, and he is an active researcher at a major university.  many folks in this situation, however, would do it to maximize prevention .  that said, i am almost 2.7 years out and so far so good... good luck, embee

Dx 10/10/2005, IDC, Stage I, ER+/PR+, HER2-
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Nov 21, 2008 07:59AM paras wrote:

hello i also have a similar dx. i am stage 1 but my tumor boarders stage two 1.9 cent.but the grade is 2/3 which is similar. i am taking tc . chemo i had my first tx. on november 17th.2008 i guess by now you have had your tx. as i see you posted this back in august. i am wondering if this tx plan is the gold standard in chemo tx. i was reluctant to have this also but i have 3 more to go.new technology in the medical field are popping up every month. my chemo tx is different from yours it is tc only 4 times. let me know what you decided and how it went for you. i wish you well

paras Dx 8/4/2008, IDC, 1cm, Stage I, Grade 2, 0/7 nodes, ER+/PR-, HER2-

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