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Lani · 12-30-2007, 09:18 PM

As I said, if it the DCIS was her2 positive and not the invasive foci (which were well differentiated and GradeI) the treatment would could be much different than if the invasive foci were her2+ as well.

In light of the strong family history your friend has, the medical literature supports an MRI is indicated (guidelines wise,this is helpful in trying to get Medicare to pay for it--since your friend is over 65, I am making an assumption (perhaps I shouldn't)

Has anyone in her family been BRCA1/2 tested? I believe Medicare pays for BRCA1/2 testing as well--it may be important for the sake of other family members (whose insurance may not pay for it)

her2+ breast cancer does not tend to be BRCA1/2 positive, but it has been known (I believe one person at least on this board is +)

The picture you paint with several infiltrating foci (which are not just microinvasions by your description), but Grade I well-differentiated and her2 status + but unclear if in DCIS only, infiltrating ductal component only or both, is confusing--

.

If the infiltrating portions of the biopsy turn out to be the her2+ areas, then your friend is lucky to live in Florida. Two of the country's (if not the world's) experts on her2+ breast cancer are there--these are among those who have published the most, been involved in the development and trials of herceptin and continue to write papers and educate others on the topic at conferences. Dr. Mark Pegram moved to Miami this summer from UCLA and Dr. Edith Perez, who was head of the North American herceptin trials as I recall is in the Mayo Clinics Branch there in Jacksonville. I am not speaking from any knowledge of them as treating doctors, just on the basis of having read their papers and heard them talk at conferences.

(also, Not being much on Florida geography, I don't know how far these are from Pensacola.)

Perhaps the Mayo Clinic branch could do a second pathologic opinion, with your arranging for a second opinion based on their findings ie, whether or not you are dealing with her2+ breast cancer.

To explain: DCIS is felt to be a precursor of invasive ductal breast cancer, but a much higher percent of DCIS is her2+ than IDC is her2 + ie not all DCIS that invades remains her2+. If the IDC is not her2+, it is believed that it behaves according to the other markers found ie, ER,PR, Ki67 in the infiltrative tumor itself.

Hope some of this helps...

12-30-2007, 09:18 PM	#7
Lani Senior Member Join Date: Mar 2006 Posts: 4,783	Perhaps the surgeon could provide your friend with the pathology report As I said, if it the DCIS was her2 positive and not the invasive foci (which were well differentiated and GradeI) the treatment would could be much different than if the invasive foci were her2+ as well. In light of the strong family history your friend has, the medical literature supports an MRI is indicated (guidelines wise,this is helpful in trying to get Medicare to pay for it--since your friend is over 65, I am making an assumption (perhaps I shouldn't) Has anyone in her family been BRCA1/2 tested? I believe Medicare pays for BRCA1/2 testing as well--it may be important for the sake of other family members (whose insurance may not pay for it) her2+ breast cancer does not tend to be BRCA1/2 positive, but it has been known (I believe one person at least on this board is +) The picture you paint with several infiltrating foci (which are not just microinvasions by your description), but Grade I well-differentiated and her2 status + but unclear if in DCIS only, infiltrating ductal component only or both, is confusing-- . If the infiltrating portions of the biopsy turn out to be the her2+ areas, then your friend is lucky to live in Florida. Two of the country's (if not the world's) experts on her2+ breast cancer are there--these are among those who have published the most, been involved in the development and trials of herceptin and continue to write papers and educate others on the topic at conferences. Dr. Mark Pegram moved to Miami this summer from UCLA and Dr. Edith Perez, who was head of the North American herceptin trials as I recall is in the Mayo Clinics Branch there in Jacksonville. I am not speaking from any knowledge of them as treating doctors, just on the basis of having read their papers and heard them talk at conferences. (also, Not being much on Florida geography, I don't know how far these are from Pensacola.) Perhaps the Mayo Clinic branch could do a second pathologic opinion, with your arranging for a second opinion based on their findings ie, whether or not you are dealing with her2+ breast cancer. To explain: DCIS is felt to be a precursor of invasive ductal breast cancer, but a much higher percent of DCIS is her2+ than IDC is her2 + ie not all DCIS that invades remains her2+. If the IDC is not her2+, it is believed that it behaves according to the other markers found ie, ER,PR, Ki67 in the infiltrative tumor itself. Hope some of this helps...