BRCA 2/Her-2 Positive

[vinnie]

We just found out that Bhuvana is now BRCA2 positive as well. They said she has a 70% chance of breast cancer in her right breast(left breast mastectomy on May 8) and 30 % chance of ovarian cancer so we are now seriously considering mastectomy of her right breast and also an oophrectomy.

The little reading I have done on BRCA2 shows that tamoxifen may be better for BRCA2 positive women. Do you all know what is better arimidex or tamoxifen for BRCA2 and Her2 positive women?
I have read arimidex may be better for Her2+/ER+ women, so we now to decide what is better for HER2+/ER+/BRCA2+.

She will receive has last cycle of dose-dense AC on Friday, and then move onto weekly taxotere/herceptin.


1) Stage IIB IDC
2) 1.5 cm Tumor ( poorly differentiated, lymphovascular invasion )
3) ER/PR +
4) HER-2 + ( FISH positive )
5) Node positive ( 3/17 )
6) 36 Years Old
7) No Mets
8) Left breast mastectomy on May 8th, 2004
9) BRAC2 positive
10) Currently premenopausal

Thanks

[lauren]

If you don't know me already from this board, you will soon realize that my advice will be a constant chorus of: double mastectomy, double mastectomy, double mastectomy. I see no point in saving a breast once it has developed a cancer. It is only a ticking time bomb, in my opinion. As for the other, my opinion is, it too is a ticking time bomb, brca or no brca, and why would anyone really want to be a one-boob woman? I like my matching set of reconstructed breasts.

I was 36 at diagnosis and never for one second considered anything but double mastectomy and immediate recon.

As for the ovaries, two things come to mind: 1) er/pr positive and 2) ticking timb bomb. So, of course, I had my ovaries removed. Easy choice: I was done having kids, my doctor supported my decision and I had no interest in having periods so that every month I could worry that the hormones were feeding the cancer cells floating around in my body (I accept that there will ALWAYS be some, even if I never have a recurrence...breast cancer is systemic no matter what stage it is caught at, and if you read this board for any length of time you will realize that).

So, you know what my vote is for...

[christine-Australia]

Intersted to hear your opinion as I am currently agonising when/if to do my left breast. I am having the expander in my RHS changed over on Aug 4. I can't stand the thought of not being able to lie on either side if i had the other one off at the same time. Did you have both mastectomies at once?
Christine

[jeff]

Hi all,

I wanted to reply to Vinnie's and lauren's posts. First off, lauren, I want to say I really admire your forthright and strong voice in your posts. You speak your mind and don't hold back and that's amazing. As a North Jersey boy originally, I find that your powerful New York sound even makes me a little homesick!

That said, I think it's important to separate out our own opinions, from what's medically reasonable. As you said bc is always a systemic disease. There's a surgeon named Blake Cady at Brown U., who in an interview I once saw said something like "No woman ever lost her life for saving her breast." And most researchers and oncologists seem to back that up. So, as Vinnie's wife makes her decision, it's important to remember that what she's weighing is how she feels about the risk of developing a recurrence or second primary as opposed to how much she wants to keep her breast. LOTS of women want to keep both their breasts, within medical reason (I know one of these women very intimately). LOTS of women want to keep one breast if at all possible--for all kinds of reasons, including that it's an important site of their sexuality, it's an important part of their body image, etc. You've seen that amazing picture (in Our Bodies, Ourselves and elsewhere) of the strong woman with the mastectomy scar turned into a tattoo flower?

Anyway, I know a few women who did not have bc but did test for the mutation who, upon finding out that they had it, went on raloxifene and had an oophrectomy. That too is a reasonable choice...

Good luck, Vinnie, as you and your family negotiate this painful decision.

Best,
Jeff

[Paul]

Hey Jeff,

Your position is beautifully stated. Nice touch!

Paul