Review of early stage bc and adjuvant therapy

[AlaskaAngel]

Currently, UpToDate indicates that presently well over 50% of patients diagnosed with bc are over the age of 65. Most patients deal with menopausal changes starting around age 45, which makes the group of bc patients who are menopausal or postmenopausal at time of diagnosis even much larger.

Younger patients are a fairly small group among breast cancer patients, and premenopausal.

In addition, the majority of breast cancer patients are being diagnosed much earlier than in the past, with early stage breast cancer.

Consider the question of the value of application of chemotherapy for the vast majority of breast cancer patients, given the characteristics noted above, with the information in this May, 2011 article:

http://www.nature.com/nrclinonc/journal/v8/n5/full/nrclinonc.2011.19.html

[tricia keegan]

Thanks AA, I've been offline a few days so only just seeing this now!

[AlaskaAngel]

Thanks, Tricia!

I think the rough information obtained from the recent polls in regard to how initial detection of real HER2 positive breast cancer patients has generally been occurring, and the stages at which it has generally been detected, are rather interesting.

Currently those polls indicate that about half of those who responded were detected early (stages 0-2), and half were detected at later stages (stages 3-4). The other poll indicates that about 75% were not detected by mammogram. Younger patients have denser breasts, and older patients have more fatty tissue and less dense breasts. Younger patients are not generally recommended to have mammograms. What can we learn from all of this?

Maybe there should be a clinical trial comparing the use of markers vs mammograms for early detection (with fewer of us having to be exposed to radiation annually)? It is apparent that the majority of HER2 positive who are being diagnosed are either not being given/getting mammograms, or else the mammograms aren't helping the majority to find HER2 positive cancer early on.

And how might all of this correlate with the menopausal status of HER2 positive patients vs general bc patients?

A.A.

[tricia keegan]

I agree AA, Mammo's are not done here in Ireland until fifty so I found the lump myself while showering which was already almost 2cm with three nodes affected! I often think if a Mammo had been offered to me ten years earlier at forty I would have taken it and maybe could have saved myself some chemo treatment!!
In saying that I hear what you say about exposure to radiation but from a personal point of view I'd have preferred that in the hope of finding my her2 bc earlier so think all things considered it's worth having a mammo earlier in life but of course there's always cost to consider:(

[AlaskaAngel]

Hi Tricia,

I had one mammo around I think age 38 that was clear, and didn't have any more until age 49 (by choice), and that one was where the originally 0.6 mm lump was picked up (although diagnosed late at 1.01 cm and then 1.06 cm). So, a mammogram did actually pick up mine too. (The problem I had was that the radiologists picked it up and they repeatedly recommended biopsy, but the idiot surgeon failed to do so until it was well over 1 cm.)

But the poll indicates that most HER2 positive bc's aren't being found by mammogram. I don't know if that is because those whose cancers started when they were younger weren't getting any mammos, or whether most had such dense breasts when they were young that they weren't seen by mammos.

My thinking is that if over 70% of HER2 positives aren't being found by mammos but instead by other means, we need to nail down a better strategy. Mammos might work fairly well for most of those with other breast cancers, but it doesn't seem like they are working well for HER2 positives. We don't know which ones are going to BE HER2 positive..... So I'm wondering if maybe they should try doing a clinical trial using both mammos and markers, to see if markers do a better job of finding the HER2 positives sooner. I know I avoided mammos for years myself because of the radiation issue, and that issue is one reason why they aren't generally recommended earlier -- whereas markers only require a blood draw, so more people might actually be seen (and cancer detected) sooner if they could have the blood draw instead.

I'm just speculating.... trying to figure out a better way to catch more of the HER2 positives sooner.

AlaskaAngel