Do I need the fish test?

[Melissa]

Hi,
I'm asking for opinions. When I was dx both the biopsy and surgery results came back as her2 + with a reading of 80% or more. My onc said with a reading this high there's no need for the fish test and I would have herceptin. I recently read about someone who has a 3+++ after biopsy but after surgery her onc said she would still need the fish test. Sure enough it did not come back as positive for her2 and she will not have herceptin. My question is should I have my tumor retested with the fish test or just forget it since I had herceptin. I guess I'm just hoping that herceptin worked for me and It seems to work better if your a strong her2 positive. At times I still get anxious and I am just wondering? I'm selfish and want to be around for my three girls.
Thanks,
Melissa

[Becky]

Dear Melissa

My vote is no. What is the point as you have completed Herceptin? Secondly, there are studies that Herceptin does help some women who are Her2 neg. So, Herceptin helped you regardless. Bet on it and never look back.

I toyed some similar questions myself at one point - should I get Top 2A tested (if positive, AC chemo is a better choice than TCH) - well chemo was over so what's the point even if Top 2A neg, AC works but is more toxic so one could choose the less toxic TCH safely. Oh well. Same with the Fish or Pten test. Finished Herceptin so there was nothing to do about it if I was fish negative. Even thought of getting EGFR (aka Her1) tested. There was nothing to do about that and treatment was well over anyway.

I did everything I could and so have you. All you might find out is you did more than necessary and oh well about that. I do think your thinking is natural because I was that way too probably right around the time (2 yrs out) as you.

Peace

[Joan M]

Melissa,

I would try to get the FISH test because results can vary.

When I was first diagnosed, the immunohistochemistry test showed 3+ and I was given Herceptin based on that. However, two months after my mastecomy and immediate DIEP flap reconstruction (and after two round of AC) I had a small pea-sized nodule appear in my reconstructed breast. It was taken out but not tested for HER2 until a year later when I requested the test (it had been tested for the bc cancer in general). The test came back HER2 +2 for IHC and HER2- for FISH (when IHC is +2, the FISH test is automatically used as a tie-breaker).

Because of the inconsistent results my onc suggested I have my original bc slides and the slides for the little nodule tested in a major lab. They both came back IHC 2+ and HER2 borderline (2.0), and the onc there considered that borderline positive (rather than negative, since 2.0 is right in the middle) and felt it was good that I had taken the Herceptin.

(As an aside, it's unclear what the little nodule resulted from. It could have been leftover from the skin-sparing mastectomy which is what I had to facilitate the reconstruction (there's a tiny chance of that) or perhaps it was from the core biopsy because it occurred just directly under the scar from the biopsy. In any case, it was removed -- so I now have a lumpectomy in my reconstructed breast -- and I've never had a problem there since.)

Joan

[BonnieR]

Melissa, I was told the same thing you were. That my reading was so high the fish test was not required.
Perhaps you could look at this situation differently. What if you DID have additional tests that resulted in NOT receiving the Herceptin? Might you not have worried about that scenario more? In that case, I would be always be wondering which test was the one to bank on.
Keep the faith.

[BreezeGirl]

Melissa,

I was originally diagnosed 2.7 Her2u +. In my course of treatment I went for a second opinion that that DR. suggested the FISH test. It was actually quite stressful because I had already accepted that I was HER2U+ and if it came back negative I would need to rethink my treatment and potential go back for more chemo. The FISH test came back 3.1. I would discuss with your Onc how the original test was performed and what the risk of false positives would be. Also, discuss what would happen if it did come back negative.

[harrie]

Melissa, check out the thread Jean started "Want your 2 cents worth on this".

[juanita]

Never had the fish test and my onc didn't think we needed to go back and do it since we knew I was her2+. I did my year of herceptin based on that.