Suggestion of breast cancer after surgery - 1268352

Tue, 02/03/2015 - 00:57

My wife is 38 y/o breast cancer patient, stage 1A — invasive ductal carcinoma (T1/N0/M0) — tumor size 1.6 cm, ER+++, PR+++, and Her2-, ki67 <3%. we are waiting the report of Mammaprint to decide whether the chemotherapy is needed.

Based on above symptoms, May I have suggestion here?

Because we went to three hospitals for the best answer, but looks different opinions from each one..

It's very difficult moment to well know the way of further treatment, except the one of Tamoxifen which was followed up already.

The given answer from those hospital were,
- chemo (4-6 rounds) + radiation + Tamoxifen (for 5 years, up to 10 years)
- Zoladax (for 3 years) + radiation + Tamoxifen (for 5 years, up to 10 years)
- radiation + Tamoxifen (for 5 years, up to 10 years)

Million thanks for your reply.

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catdander

Hi Roy, I'm so sorry about your young wife's diagnosis.
It's not unusual to find different ideas about how best to aggressively treat for a cure in cancer. I'll make sure one of our faculty comments.
I hope for the very best for you wife and you,
Janine

dr cianfrocca

Dear Roy,
If she had a lumpectomy (not a mastectomy), she would need radiation therapy. Standard therapy would also include hormonal therapy to reduce her risk of the breast cancer coming back. There are currently multiple options for hormonal therapy for premenopausal women including tamoxifen, tamoxifen plus zoladex and exemestane (a different type of hormonal drug than tamoxifen) plus zoladex. As your wife is not my patient, it is not for me to say which option is best for her. She would need to discuss the advantages/disadvantages of each with her treating oncologist to be able to make that decision. The decision whether to recommend chemotherapy will likely be determined by her mammaprint results.
All the best,
Dr. Cianfrocca

royjason

Hi Cianfrocca,

Thanks for such detail, in fact, that we knew the therapy of radiation + tamoxifen is necessary, and optional one "zoladex" could be considered, and I spent all my time to try seeking out all references from worldwide on combination differences between "zoladex + radiation + tamoxifen" and "chemo + radiation + tamoxifen", which both of them are indicating the outcome not obvious difference as same 7-8% recurrence.

It may be personal genes related to different result, but I wonder if chemo is really necessary based on my wife's situation, because it may give more affecting than zoladex therapy instead, if it's same therapy for my wife.

Because of there's one government national insurance to people here in Taiwan, so the SOP is chemo first, whatever which stage it's, even if just carcinoma in situ. most of doctors are suggested to have chemo at the beginning. then I am confusing and just concerning if chemo is basically required for my wife's case. Here they are not recommended to use zoladex, I don't know why?

Although, now we can wait for mammaprint results which is more standard to convince me, but I don't want to give up any possibilities from you all suggestion to my decision.

Or was any result to show the lowest recurrence after all treatments by chemo + radiation + tamoxifen + zoladex?

Thank you very much.

dr cianfrocca

The magnitude of benefit from chemotherapy is very variable in breast cancer. The use of testing such as Mammaprint attempts to better define who benefits the most from chemotherapy and who could reasonably not take it. I encourage you to wait until the Mammaprint results are available and then discuss with her oncologist how likely she is to benefit from chemotherapy and whether she should take it or not.
Dr Cianfrocca

royjason

I understood all of your suggestion, I will wait and discuss further with my wife's oncologist.

Thank you.