Paul C.
08-13-2003, 05:31 AM
Dear Cassandra
The general issue of "prognosis" is as you know quite complicated and involves many factors. An experienced board certified breast cancer oncologist is the best person to assist you with this issue. Every woman's case is different and a "prognosis" is nothing more than a "prediction" or "estimate." In cases similar to those of Ginger Empey (8 yr Herceptin bc survivor) and Barbara Bradfield (10 yr Herceptin bc survivor) the so-called "medical prognosis" was proven wrong -- big time wrong!
Juliet's post (and my earlier post entitled "HER-2 and Cell Proliferation Relevant to Node Negative Cases")refers to a small study in which Italian researchers found that combining thymidine labeling with HER-2 analysis can assist in assigning risk of relapse to patients with node-negative breast cancer receiving local-regional treatment only. The study findings appeared in the July 15 2003 issue of the Journal of Clinical Oncology.
In this study 529 women with node-negative localized breast cancer not treated with systemic therapy were evaluated. The researchers tested for HER-2 expression and cell proliferation (or growth rate) as measured by the thymidine labeling index. They found that HER-2 expression alone was not predictive of recurrence in the node negative woman. However in women who had both a rapidly proliferating tumor and overexpression of HER-2 there was an increase in recurrence rate from 26% to 40% compared to women with only rapidly proliferative tumors. These researchers concluded that “HER-2 expression in association with proliferative activity identifies a subgroup of node-negative breast cancer patients with the worst prognosis who are candidates for specific intensive adjuvant therapy.�
The study does not address what the outcome would be for node-negative HER-2 positive patients with a high thymidine labeling index after receiving aggressive clinical trial neoadjuvant therapy or aggressive clinical trial/standard adjuvant therapy. The study also does not address how one would factor in other known risk factors for recurrence such as tumor size histologic grade other measures of cancer cell proliferation hormone status lymphovascular invasion age etc. (i.e. many of the items that typically appear on a breast cancer pathology report(s)).
The study seems to suggest that one of the more aggressive treatment regimens be used for "node negative" women whose cancer is HER-2 positive with a high cell proliferation rate.
In sum Cassandra we can not place all "HER-2 positive node positive" women in one prognostic catergory. Any prognosis of HER-2 positive node positive/or node negative cases should be made by an experienced oncologist(s) who carefully examines ALL of the facts relating to that particular case. Even when this is done the Ginger Empeys the Barbara Bradfields and the Christine Druthers often prove the experts wrong!
For those who are interested I have posted several cross-links (beneath this post) to select websites that discuss the significance of various breast cancer pathology report items. Each woman should speak directly to her doctor regarding the significance of these items.
I hope this information is helpful.
Warmest regards
Paul C.
The general issue of "prognosis" is as you know quite complicated and involves many factors. An experienced board certified breast cancer oncologist is the best person to assist you with this issue. Every woman's case is different and a "prognosis" is nothing more than a "prediction" or "estimate." In cases similar to those of Ginger Empey (8 yr Herceptin bc survivor) and Barbara Bradfield (10 yr Herceptin bc survivor) the so-called "medical prognosis" was proven wrong -- big time wrong!
Juliet's post (and my earlier post entitled "HER-2 and Cell Proliferation Relevant to Node Negative Cases")refers to a small study in which Italian researchers found that combining thymidine labeling with HER-2 analysis can assist in assigning risk of relapse to patients with node-negative breast cancer receiving local-regional treatment only. The study findings appeared in the July 15 2003 issue of the Journal of Clinical Oncology.
In this study 529 women with node-negative localized breast cancer not treated with systemic therapy were evaluated. The researchers tested for HER-2 expression and cell proliferation (or growth rate) as measured by the thymidine labeling index. They found that HER-2 expression alone was not predictive of recurrence in the node negative woman. However in women who had both a rapidly proliferating tumor and overexpression of HER-2 there was an increase in recurrence rate from 26% to 40% compared to women with only rapidly proliferative tumors. These researchers concluded that “HER-2 expression in association with proliferative activity identifies a subgroup of node-negative breast cancer patients with the worst prognosis who are candidates for specific intensive adjuvant therapy.�
The study does not address what the outcome would be for node-negative HER-2 positive patients with a high thymidine labeling index after receiving aggressive clinical trial neoadjuvant therapy or aggressive clinical trial/standard adjuvant therapy. The study also does not address how one would factor in other known risk factors for recurrence such as tumor size histologic grade other measures of cancer cell proliferation hormone status lymphovascular invasion age etc. (i.e. many of the items that typically appear on a breast cancer pathology report(s)).
The study seems to suggest that one of the more aggressive treatment regimens be used for "node negative" women whose cancer is HER-2 positive with a high cell proliferation rate.
In sum Cassandra we can not place all "HER-2 positive node positive" women in one prognostic catergory. Any prognosis of HER-2 positive node positive/or node negative cases should be made by an experienced oncologist(s) who carefully examines ALL of the facts relating to that particular case. Even when this is done the Ginger Empeys the Barbara Bradfields and the Christine Druthers often prove the experts wrong!
For those who are interested I have posted several cross-links (beneath this post) to select websites that discuss the significance of various breast cancer pathology report items. Each woman should speak directly to her doctor regarding the significance of these items.
I hope this information is helpful.
Warmest regards
Paul C.