[AlaskaAngel]

Hi - It is an interesting discussion because it involves not only the numbers but the way we think of them and how we compare them in terms of benefit versus risk. The risk for AML has been considered low but that was when not as many patients were being given chemo (because it wasn't standard to give it so broadly before it was standard for adjuvant treatment). So the question is, does the risk rise once it comes a part of standard adjuvant care? And does it rise even further once it becomes part of treating those with micromets, etc. for whom it has not been standard treatment thus far?

Logic says the risk rises. But it takes time for that to happen because AML occurrence happens "down the road".

Personal perspective enters into the picture. To me, since oncologists have never done their homework for early stage breast cancer patients in terms of finding out whether trastuzumab ALONE (without any chemotherapy) works just fine for early stage bc, then why would oncologists wish to put these humans through chemotherapy that adds the already known risk for some degree of AML, as their way of "saving" more breast cancer patients?

How many patients with micromets go on to develop bc? Is that number greater or smaller than the number that go on to develop AML? How much does putting humans through the difficulties involved in chemotherapy and the longterm problems involved with that, and then for them to go through AML in addition "count" to these humans? How long on average does it take for micromets to result in additional breast cancer without chemotherapy, IF they do? Longer or shorter than it takes to develop AML?

I am 9 years out but because my treatment included doxorubicin and radiation I will always be at additional risk for AML. I do think that a healthy lifestyle makes a difference in the long run, but I don't know that for sure. I do know for certain that despite having no comorbidities and living a healthy lifestyle, my immune system response is much more minimal than it was prior to chemotherapy treatment. A tiny sore takes days if not weeks to heal, whereas prior to chemotherapy and radiation it would heal in a day or two.

Without knowing for sure who is right or wrong, some of us see more hope in treatment with toxic substances, and some of us see more hope in more limited application of the treatment. We can't find out until those who would do trastuzumab alone are given that opportunity with clinical trials using trastuzumab alone for early stage bc.

A.A.