Does Her2 + status nearly guarantee chemo?

mom22girlz · 03-07-2006, 12:21 PM

I have been diagnosed with Stage 1 breast cancer. At first thought I would just have radiation, but now the Dr. indicates a possible need for more. will find out on March 14. I got the impression it was because of my her+ status. I am 47 and premenopausal. does this perhaps mean chemo? I was also a bit confused by my pathology report. Any one who can decipher?

The breast tissue aggregates to 4 cm in greatest dimension. Multiple sections of breast biopsy show extensive ductal carcinoma in situ (cribform, micropapillary and solid type) with high grade cytology. Blocks (7 and 9) show foci of microinvasive carcinoma with surrounding stromal reaction. Sections of the surgical resection margin show no evidence of malignancy.

ER 2+
PR 2+
Her2 2+
FISH results 25 cells examined her-2/neu signals to chromosomes 17 signals calculated. Ratio was 6.41, indicating amplification of this gene.

Thanks. S

Sherryg683 · 03-07-2006, 12:28 PM

I'm not a doctor, but I would guess because of your her2 status and the fact that the cancer is agressive they would also want to treat you more agressively, with chemo. Hang in there, you'll be fine....sherryg683

03-07-2006, 02:31 PM

well the good news is you are er/pr+ which means that you can use hormonal treatments and you had "microinvasive" disease. That is really good. Was it in your lymphnodes?

Maggie · 03-07-2006, 08:17 PM

I'm also thinking, it's because of the size of the tumor.Maggie

AlaskaAngel · 03-07-2006, 11:49 PM

I wondered the same thing. I haven't heard yet of anyone who tested strongly positive HER2 that wasn't recommended to get chemo.

AlaskaAngel

03-08-2006, 05:44 AM

I was her2 (2+) positive fish and chemo was not recommended but I was stage 1 breast cancer infiltrating ductal cacinoma
had lumpectomy radiation and now on arimdex
should I have insisted on chemo due to her 2

Sheila · 03-08-2006, 06:56 AM

I was also Her2 3+, but because of the tumor size 7mm or 0.7cm, I was not recommended to get chemo. I was ER- PR -, no nodal involvement. I reoccurred 1 1/2 years later in the nodes. I think tumor size has alot to do with chemo recommendation in node neg Her2+ women. If you are unsure, get more than 1 opinion...
Hope this helps

mts · 03-08-2006, 07:08 AM

I agree with Sheila- get another opinion. I think that reviewing previous posts can also help. Before I received the FISH test, the thought was to not do chemo -and I am ER/PR negative! Once FISH came back positive, chemo was a no-brainer.

Obviously there is no guarantee either way, but follow your instinct...

Maria

Lisa1962 · 03-08-2006, 08:47 AM

My initial diagnosis was Stage IV - ER/PR/HER2 positive - mets to liver and spine

I have not had chemo... just Herceptin and hormonals and I am NED I was after 2 herceptin treatments (two lupron shots and daily femara)

lucky - very lucky

but I do anticipate being on chemo one day

I just have a reprieve - and I do appreciate that it is most likely only a reprieve

I don't reccommend this treatment - just saying that HER2 doesn't ALWAYS mean chemo right away

Michelle · 03-08-2006, 12:30 PM

I'am also stage 1, but chemo was reccomended as my tumor was 1.9cm.
Michelle

CLTann · 03-08-2006, 06:22 PM

I am also stage 1, the tumor size is 0.8 cm. Her2 +++, Er/Pr both positive. The Onc left it to me whether I need chemo or not. I had mastectomy. I opted to do no chemo, and no radiation. I am on arimidex. No tests were suggested on my last six month visit. So not everyone with HER2 positive is destined for chemo.

Wish you the best and luck.

Ann

Petesmom · 03-09-2006, 03:40 PM

Last year I had a recurrence. The tumor was 7mm, ER/PR+ and Her+++ (IHC test done, but no FISH). I had a mastectomy and the oncologist said no to chemo. He put me on Tamoxifen because I was still having periods (I am almost 53). After much research on these boards and elsewhere, I decided to have my ovaries removed so that I could take Arimidex because I have been reading more and more that this drug is possibly better than Tamoxifen for Her2+++ ladies. Who knows if this is the right decision. I just had my annual mammogram on my other breast and it was fine and the check up with the surgeon today was fine. We tend to just second guess ourselves all the time and it comes down to having good info, an oncologist who is thoughtful and listens and doing what we think with the info we have at the moment. I think you ladies are wonderful and once again I send blessings to you all.

Petesmom

Jean · 03-09-2006, 05:53 PM

I was dx with 6MM tumor size - Her2/nu-3+ estrogen positive - node neg.

Chemo WAS NOT recommended by three top oncs. Dr. Michaelson at St. Barnabas was and is one of my Onc. Being Her2/nu does not mean that chemo is a given. There are many other factors that must be considered. This was a painful jounrey for me - since I pushed very hard thinking that I should have chemo since I was Her2 etc . Tumor size has very much to do with the decision and grade of the tumor plus the nodes. But I stand on the soap box and shout get two three or more opinions from the top oncs in the field.

Jean

Jean · 03-09-2006, 05:55 PM

Oops! Forget to mention - had 26 x rad, plus 6 boosters - and I am taking

Arimidex. Will be one year out April 15th...Gold Bless Us All!

Jean · 03-09-2006, 06:01 PM

Oops once again, I am her2/nu postive...typo on earlier post.

I want to say once again that we are so very fortunate to have this site. I have learned so much from all the wonderful ladies. A big thank you!

Jean

03-09-2006, 06:30 PM

7mm er/pr- her2 + and three oncs recommended chemo ACx4 for me although they did not recommend herceptin. I did push for it and am now on it every 3 weeks for 1 year. I was told that if I was er= that I would not be given chemo.

03-09-2006, 07:08 PM

Unregistered.
Did you have a node biopsey done also? If so was it negative or positive?
Node results is a major component in the treatment decision. I am sorry but I did not understand your post regarding er= are you stating that if er positive
than chemo is always given? Please explain.....Thanks.
Jean

Maggie · 03-09-2006, 08:35 PM

Unregistered said.. "I was told that if I was er= that I would not be given chemo." I think it was a typo error and she meant + not =.

I think if she was er/pr neg, she might have gotten chemo.

AlaskaAngel · 03-09-2006, 09:04 PM

I should have been more specific in my answer earlier. There are guidelines used for whether or not chemo is recommended and they don't specify HER2 status, but rather they suggest that if the cancer looks more aggressive, then tumors between 0.5 and 1.0 cm probably would be recommended to have chemo (and like CLTann they could still turn it down of course).

What I was wondering was whether a tumor under 1 cm would ever actually be HER2+++ or not. And there seem to be some.

Here's the guidelines (hope this works):

http://www.nccn.org/patients/patient...t/4_stages.asp#

03-10-2006, 03:29 PM

Sorry I was the "unregistered" that had a confusing post. Yes I did have a sentinnel node biopsy which was negative. Since I was er-, it was suggested that I have chemo. If I had been er+, they would have given me hormonal treatment only. I had to fight for the herceptin as I was told that because I was under 1cm that insurance would not pay for it.

I actually looked up the guide lines from the national comprehensive cancer network for er/pr- her2+++ BC, and found out that anything 5mm or under- chemo would not be recomended, anything 6-10mm- you should consider chemo and anything over 1cm (10mm) chemo was advised and given in combined with herceptin. This recommendation was revised in Decmber 2005 so really recent.
Hope this helps. Sorry for the confusion.