[Lani]

There is always a gap between guidelines, the most recent literature and practice

Guidelines do not yet cover the quandary as to how small a her2 + tumor should receive herceptin. If you go to the search function on the burgundy bar above and type in small tumors and Lani I am sure I have posted on this (or search pubmed and SABCS and ASCO meeting indexes) Neil Love's audio series often questions leading on oncologists on how they treat "small"her2+ tumors.

That said, I just wanted you to know that if your wife is premenopausal the magnitude of her Ki67 varies with what phase of the menstrual cycle she was in when the biopsy/surgery was done.

Lots of things go into the "cost/risk/benefit" analysis of adjuvant herceptin--including your risk aversion and how you weigh each risk ie, cardiac dysfunction from herceptin(usuallly reversible) vs doing everything possible to guard against recurrence.

Hope this helps