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Jan 10, 2009 08:40PM
My Oncotype score was 23, with a 9 mm lesion, 0/3 nodes, ER+, low intermediate HER2+, grade 3. A PET scan showed no other cancer outside the breast. I had a bilateral mastectomy in September 2008.
It was the grade 3 that most moved me in the direction of getting chemo. All the oncologists I consulted said the decision was entirely up to me. I tend to believe the "character" of the tumor counts more than the size or node status, and based my decision on that, rather than that I found the nasty bugger so early, before it had grown large and metastasized to the nodes.
You may want to take into consideration what your other risk factors are as well. For example, I have kidney damage from another disease (endometriosis), which limits my chemotherapy choices and doses. Kidney failure would be as deadly as a cancer reoccurence for me, because with a malignancy you don't qualify for a kidney transplant, and dialysis is a dreadful, and foreshortened way to live. If you do not have additional risk factors in your way the decision may be clearer, if you have reason to believe you will tolerate chemotherapy pretty well.
Hormonal treatment is dicey for me as well. I cannot take tamoxifen because it is contraindicated for people with endometriosis. I developed my cancer while taking an aromatase inhibitor (Femara) for the endometriosis, so hormonal treatment has not worked for me. I cannot afford Faslodex, the only other hormonal treatment left to try. No insurance will pay for it in my case because it has not been approved for early, non-metastasized breast cancer, and it is over a thousand dollars a month, for an indefinite period of time.
Your tumor is HER2 negative, so it may well respond better to hormonal treatment than mine does, because HER2 positive tumors don't always respond that well to hormonal treatment. That would be an option you might want to talk about with your doctor. You likely have hormonal treatment options that I don't have, because you are ER+ and PR+, plus you are HER2-. Had that been my case it might have swayed me against doing chemo. Most oncologists believe that hormonal treatment of hormone receptor+ tumors is even more important and works better than chemo.
I decided to try the chemo even with my kidney damage, and will be starting it next week. I have talked with my oncologist about titrating the chemo carefully to avert any further damage to my kidneys, and we will try our best to make it work. He is a good egg, and we work well together, have a very comfortable rapport. I had to try several doctors to find one who pays attention to detail, like preserving kidney function, LOL.
Good luck with your decision, a second opinion may be very helpful. I wouldn't hesitate to go for a third, as well, if you need a tie breaker!
Please let us know how you are doing.