[Lani]

The dogma that there is no need to scan when asymptomatic was developed when they thought breast cancer was ONE disease and that everyone died within TWO years of diagnosis of Stage IV anyway, whether they gave monotherapy, combined therapy, sequential therapy or dose-dense therapy.

That wasn't so long ago (remember going to a state-of-the-art conference in 2005 where that tune was hummed repetitively)

Noone knows whether finding oligometastatic disease earlier in nonher2+ bc allows cures. Dr. Hortobagyi wrote articles suggesting they try to find out around the same time.

Now that treatment has changed noone has come out with a subtype specific study. As long as new treatments keep coming available for her2+ bc it will be hard to do these, but a we get closer and closer to making this a treatable chronic disease it MAY turn out that finding disease when it has not yet outgrown its blood supply so radically and started expressing HIF-1 (in response to hypoxia) may make a substantial distance in terms of OS and perhaps even cure.

That is why I continue to advocate they add bone marrows to clinical trials to see if they can determine who is more likely to turn to Stage IV, if they can intervene to prevent that and whether treatment given so far has been effective (and if the mets have "changed their colors" ie are now of a different ER pR or her2 status. Susan Love onced Poo-pooed the idea, but now that she herself has had leukemia is now willing to add it to her recommendations of
samples gathered for trials.

If they don't look, they can't find.

Off the soapbox for me now.

Bottom line of getting scans---from my reading and conference attending it seems they really don't know whether or not they should, because they really haven't relooked at the issue of whether getting routine scans would make a difference in OS now that they are dividing bc into subtypes.