[bwAK]

Hello ladies,

I’m your classic forum lurker, but lately my wife and I find ourselves in the midst of making a big decision and I was seeing if anyone has had any relatable experiences or decisions to make. We’re triple positive and most likely stage IIish IDC (T2N1M0 -- hard to know what our final stage would have been because we got a pCR). She started neoadjuvant chemotherapy (TCHP) in December and had her BMX a week and a half ago. As I said, we received a pCR -- no sign of residual disease, the one lymph node we knew was positive before chemo had scarring (they call it the therapy effect). They were able to take out a total of six sentinel lymph nodes with only the one showing scarring – so we can be confident it didn’t spread much further. Furthermore, my wife’s reaction to her chemo cocktail was superb, with the tumor melting before our touch within days of the first infusion and being undetectable by the second.

So, everything has been textbook to this point, but now the question of radiation has us reeling. We fall into a gray area of knowing whether or not it is needed in our case. Being Her2+ with aggressive cancer and one positive node, we know we would be getting it had there been any residual disease after surgery. But with a pCR and such a good reaction to chemotherapy, is it necessary now? This choice is made much harder because we are quite young (by BC standards). My wife and I are 26, thus we have a longer time to develop a secondary carcinoma. In addition, younger survivors' risk is just generally higher after radiation (did you know child cancers survivors have a 25% increase in developing a cancer like BC throughout their lives?). Our chance of getting a secondary cancer is not that high (maybe 2-4%), but it’s stupid to think about -- would a future recurrence of BC be easier to treat than a secondary cancer like lymphoma, myeloma, or lung cancer?

So there it is. We had early but aggressive breast cancer and now a pCR – so what to do about radiation? Our breast surgeon and RO are both leaning towards no – but our RO called the head RO at MD Anderson (a colleague from med school) for a second opinion and he was adamant on radiation based on our age and that we should throw everything we can at it. Blaaagggh.

I’m definitely not looking to the community for a definitive answer, but has anyone had to make or think about this decision? How and why did you come up with your answer? I always appreciated the ladies on this forum and the information and comfort you’ve provided me even though I haven’t been a member. Thanks for your consideration.