[Becky]

There will always be controversy over the type of treatment one receives for any disease - not just breast cancer. Most diligent people, when diagnosed with a life threatening disease explore and investigate all options of treatment. This is much, much easier to do now with the internet versus the old days. And, because of the internet, it is easy to reach out and find sites, such as this, for any ailment and find out what others did and how it worked out for them.

During my bc journey I got numerous medical opinions during each stage of treatment and also relied on my friends here. Being curious and investigative by nature, I read everything about breast cancer, even the subgroups that do not pertain to me as it brings insight on the whole picture. This is beneficial to me and differing opinions are beneficial to all.

I have always seen both sides to the early stage dilemma - aggressive to the max treatment or minimal treatment (or in between). I think Her2 changes the picture a bit though. For example, women who are diagnosed with very, very small dcis are told that they need lumpectomy and radiation. Many are also told that 80% of dcis are harmless forever. They could stay untouched and nothing would ever happen. It would never learn to grow and become invasive. It might even go away at some point. However, 20% do learn to grow and become invasive (all of us here obviously had a dcis at one point that learned this trick!). The problem is that all dcis are removed and (if a lumpectomy versus mastecomy is performed) radiated. Why? Because science hasn't been able to determine which ones will be a future problem.

That's why I feel that care must be taken when women are diagnosed with early stage Her2+ or triple negative breast cancer. Both types are notorious for future trouble but the use of chemo and/or biologics (like Herceptin and/or Tykerb) really reduces the future risk. Like the dcis situation, scientists just don't know which will be problematic and which ones won't be. Period! Therefore, women need to know that in order to make informed decisions, period. We all know Stage 1 women who do poorly and Stage 4 women who do well. Its a fact of life. Every cancer, even every Her2+ cancer is unique to the individual. Its our own cell that went awry and our cells are unique to us.

As the years pass, not one of us with earlier stage (or later stage) cancer who is doing well will ever be able to tell you why they are doing well. Was it just the surgery? Did I only need surgery and radiation? Was it the chemo (and which chemo, the adriamycin, the taxol, the carbo what?). Was it the herceptin? Was it because I took fish oil, vitamin d, walked what? We don't know. We will never know anything except that we are still here. We are alive and many are because we were empowered with knowledge to make decisions for ourselves - whether it be minimal or aggressive treatment decisions.

Until more is learned and understood about the biology of breast cancer subtypes, no one will argue that any new patient must be informed about all options. And until more is learned, I don't believe any patient, any Her2+ (or triple negative) patient will forgo a path that doesn't have some aggressive treatment component.