[Jean]

Hi Lin,
Lani did a detailed job with her explanation of DCIS/and/IDC.
I am sorry that your friend has been dx. with breast cancer, but you have found this site and it will offer to you great support and information.

As Lani mentioned it is unusual for Her2 to be Grade 1 and well differentiated. But it does happen, my tumor was small - 6mm, was
Grade 1, and well differentiated. I had a lumpectomy and sentinal node biopsey. The node was negative, which is favorable, but please do know there are millions of cells in a small tumor and can pass through or enter the blood system. While this is not the route of choice, the ususal is via the lymph system. I did read many research articles about recurrence
in node negative patients.

All of the dr. recommended lumpectomy to be followed with radiation treatment, then anti hormonal (Arimidex). I had to fight to get a Oncotype DX test performed, since the dr. in NY did not feel it was gold
standard of treatment. My insurance was great and paid for the test, it came back with a very high risk recurrence score. The dr. were now changing their recommendation. I decided to see Dr. Slamon out in Calif.
He believed that the Dr. in NY had missed the call, since my KI 67 level
was at 40% which is high. He tested me for TOPO 11 which I was negative, therefore A/C would not be the chemo of choice for me.
He recommended TCH and herceptin for one year. He told me at that time TCH was just as good as A/C without the risk of heart
issues. The 2nd year data was just released and the TCH tretment is a slight difference with no heart damage when compared to
A/C. I did have PT/CT and bone scans done prior to chemo/herceptin treatment. I completed my treatment and I am now on anithormonal therapy (Femara).

I will share with you that there is controversy when it comes to treatment with small tumors. Many onc. are still making treatment decsions based on size of tumor. I attended a session in SABCS on this topic. Dr. Hudis
from Sloan in NY has a very conservative approach. Some dr. will do an Oncoypte test and if it has a score of 30 and better will then consider chemo. Some dr. are starting at a score of 25 it depends on the patient.

I do think that since you are not that far from Miami (about 550 miles) it might be in your friends best interest to see Dr. Pegram. He worked with Dr. Slamon at UCLA and they are cutting edge. He can review and check the pathology of your friend. Please know that Her2 likes to travel and it is very possible to have a very small invasive tumor be grade 1, node negative, well differentiated and be a very aggresive tumor. If you have any questions
please feel comfortable to reach out to me. This is a special site and you will have support along iwth up to date information.
Your friend is fortunate that you are by her side.

Sending all good wishes,
jean