[AlaskaAngel]

Hi,

To add to the decision-making process in regard to the real world...

What about the HR-positive premeno HER2 patients who:

1) missed out on trastuzumab (by virtue of being diagnosed and treated before it was available as adjuvant therapy)

2) might be able to access a pill form of treatment, but are economically or logistically unable to access an IV form

They may not be commonly accessing the internet or this forum, but they also are part of the picture. Due to the concern about not taking tamoxifen without Herceptin, they are are particularly at risk, aren't they?

My "feeling" (not scientific) is that docs are groomed to offer a pill as a solution for diseases, and the patients pressure them for something to use as a reassurance, and psychologically it makes docs feel like they are doing something and allows them to play the all-knowing role of a hero who has "done all he can", and so they avoid dealing with specific splinter groups like HER2's any differently for the most part than general bc as much as possible partly out of convenience. Habits formed are hard to break. Thus the continuing physician endorsement of tamoxifen for HER2's continues.

At the same time, these wise men give zero emphasis at patient visits to the importance of balancing fats, or to promoting exercise, or to encouraging weight loss, or to avoiding the foods that are created through the use of supplemental hormones and pesticides. I feel their net credibility is rather limited.

AlaskaAngel