[Becky]

Dear Kriss


One thing you can do is to make an appointment with at least 2 medical oncologists. It will take a week or two until they can see you anyway and you will have your own copy of your pathology then (as you will need it for them). There will probably be more than one way to go but you are young and everyone wants you to die an old lady in bed. Because you are young, chemo is in your future.

Many oncologists will want to give you 4 dense doses of AC (Adriamycin and Cytoxan) followed by 12 weekly taxol treatments with Herceptin. After that, you will get either another 40 weekly doses of Herceptin or 14 every three week (triple) doses of Herceptin. New data clearly shows that another chemo regime also works just as well as the AC followed by Taxol/Herceptin. That regime is 6 doses of Taxol/Carboplatin/Herceptin (continuing Herceptin out to a year). This regime has been shown to work just as well (you can site this year's San Antonio breast cancer symposium that took place just 2 weeks ago). This regime is easy on the heart and does not have as much long term side effects as the AC regime. Ask about it during your medical oncology opinion visits.

During the Herceptin only, you will have radiation if you did not get a masectomy. Some women get radiation even if they did have a masectomy if they had alot of positive nodes (you did not and that's really good) or if their tumor was very close to the chest wall (which yours was not). After chemo and radiation is done, you continue the Herceptin and add an (anti) hormonal (since your cancer is ER+ - make sure to ask if your tumor is also PR(progesterone) positive and how much you are positive strong or weak). There are many schools of thought on how to pick what kind of anti hormonal to go on. You should probably wait to look into those options as it will be 6 months from now (at least) before you have to decide on what to do. There are differences on how strongly positive you are, if you are both ER and PR positive etc. If you are still premenopausal or not. You can have a discussion with us on that later. It is best to tackle one thing at a time and the first thing is to find yourself a medical oncologist (and in a couple of months, a radiation oncologist).

We are here for you and can answer all your questions.

PS - I did have my ovaries removed last year (at age 46) but I was weakly ER+ and I was PR negative therefore, the common premenstrual antihormonal is known not to work well (if at all) in someone with that kind of pathology. I wanted to be postmenopausal to take an aromatase inhibitor which works better in general and best for someone with my pathology (namely - if only one of the hormone receptors is positive and not strong positive).

I know it is very overwhelming at first but you can do it.