[Val Pfeiffer]

hi Debbie and everyone--
When a recurrence happens, the pathology isn't necessarily the same as the pathology we receive at the initial diagnosis. My onc and I had quite an interesting discussion about this a couple months ago when we were discussing my decision to go off Herceptin.

For example, I was Her2+++ and ER-/PR- (I don't recall the percentages negative, but that doesn't matter for purposes of this discussion). But suppose that I was 80% negative for each. That means that there were around 20% non-negative ER and PR cells in that primary tumor. So if I ever have mets down the road, the pathology may not necessarily be ER/PR negative. It depends on what cells migrated and then eventually turned into mets--if some of the minority ER/PR+ cells "got away," then the mets could display that pathology. It's also possible that the Her2 status of the mets could be different than the primary tumor.

What I find even more interesting is that the new primary case I had this year was ER+/PR- and since it was stage zero they didn't test for Her2. So I have now had cells with two distinct pathologies.

Not sure if this helps the discussion...probably clouds the issue a bit. The odds are that if someone is really strong ER/PR either way, that it will be that much more likely that the mets will match the primary. And the time to mets varies quite a bit. But the bottom line is that we can guess at the odds all day long, but each case will be different because we can't predict on what side of the odds a specific individual will end up.

That's enough of the geeky stats chat tonight :-) I'll be interested to hear what y'all have to say about this concept...I haven't seen this discussed on this board before (although I will admit my absence has been obvious the past year or so--sorry about that!!)

Val