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Jean · 04-17-2012, 09:11 PM

JJames,
Sorry that you were dx and you are experiencing what many of us have had to go through. First of all you are in the group that early detection is a favorable marker. Now on the other hand we just don't have the concrete answers as to who will benefit the most. Here is what we do know. Her2 is aggressive, likes to travel and once out is a difficult enemy. I had a 6MM tumor like you. I had asked Dr. Salmon how many tumor cells in a 6MM tumor. Millions was the answer. therefore my thoughts were what are the odds of one getting away?
Also we now know saying a small 6MM tumor is not a threat is not a truth - it has to be taken as seriously as a 2CM tumor...since size is not the issue. While we have a greater chance of the smaller tumor not shedding as soon or as much...it still can happen. Remember there are millions of cancer cells even in a small tumor. It is like saying I am a tiny bit pregnant. Cancer is cancer...catching it early is a good advantage but there are many gals on our site who were dx. stage 1 and progressed onto stage 4...don't think you get stage 2, 3, once the cell is out and about and sets up shop in another part of the body you are stage 4.

Oncotype DX is a test to have the tumor tissue analyzed for recurrence but you are weakly ER positive and one must be ER positive for that test.
I had the test and my tumor came back with an extremely high recurrence.
There is no cut and dry answer on this decision. What we have learned is that a great majority of women who are DX Her2 have benefited from herceptin. We do not know who or why some women who are treated continue to progress. But the landscape of Her2 has changed (for the better) in the last decade. Prior to herceptin most dx. women were given a poor prognosis.

Read the recent trials and the benefits. Yes there is a dark side to treatment all meds have side effects. You will have to make a medical decision that answers your concerns. A few years ago you would not even have had the choice of treatment as early stage women were not offered treatment.
I had to fight to get treatment off label back in 2005. Do you know what your KI 67 level was from your pathology report.

Your tumor may have been tested for Ki-67, your pathology report will show a Ki-67 score. High scores—greater than 20%—mean that the cancer cells are growing and dividing at a rapid pace.

Higher-grade tumors typically have a higher Ki-67 score. However, there is no conclusive evidence that Ki-67 is associated with survival. Some studies have found that it is; others have found that it is not.

Some studies have suggested that there are certain estrogen receptor (ER)-positive tumors with a high Ki-67 score that may not respond as well to tamoxifen or an aromatase inhibitor. However, they do respond well to chemotherapy. Since you are boarder line ER receptor positive
portion of your cancer you may not fall into either group.

What most who are dx. (early stage 1) are most concerned about is recurrence - none of us know if we will recur. I was speaking with a wonderful lady the other day who was dx. 15 yrs. ago - of course she does not know if she was her2..back then they were not checking. But she had lumpectomy, rads, and done. She has no evidence of disease since.

Weigh the positive and negative - do so with knowledge and not fear -

Read different studies and then make a decision.

http://www.youtube.com/watch?v=AbUbdOnsfao

http://www.asco.org/ascov2/Press+Center/Latest+New
s+Releases/Women+with+Small+HER2-Positive+Breast+Cancers+Have+Significantly+Greater +Risk+of+Recurrence,+Metastasis+and+May+Benefit+fr om+Adjuvant+Trastuzumab+Therapy

http://www.cancer.org/Cancer/BreastC...ating-by-stage

Warmest Regards,
Jean

04-17-2012, 09:11 PM	#3
Jean Senior Member Join Date: Oct 2005 Location: New Jersey Posts: 3,154	Re: NCCN Guidelines and adjuvant therapy JJames, Sorry that you were dx and you are experiencing what many of us have had to go through. First of all you are in the group that early detection is a favorable marker. Now on the other hand we just don't have the concrete answers as to who will benefit the most. Here is what we do know. Her2 is aggressive, likes to travel and once out is a difficult enemy. I had a 6MM tumor like you. I had asked Dr. Salmon how many tumor cells in a 6MM tumor. Millions was the answer. therefore my thoughts were what are the odds of one getting away? Also we now know saying a small 6MM tumor is not a threat is not a truth - it has to be taken as seriously as a 2CM tumor...since size is not the issue. While we have a greater chance of the smaller tumor not shedding as soon or as much...it still can happen. Remember there are millions of cancer cells even in a small tumor. It is like saying I am a tiny bit pregnant. Cancer is cancer...catching it early is a good advantage but there are many gals on our site who were dx. stage 1 and progressed onto stage 4...don't think you get stage 2, 3, once the cell is out and about and sets up shop in another part of the body you are stage 4. Oncotype DX is a test to have the tumor tissue analyzed for recurrence but you are weakly ER positive and one must be ER positive for that test. I had the test and my tumor came back with an extremely high recurrence. There is no cut and dry answer on this decision. What we have learned is that a great majority of women who are DX Her2 have benefited from herceptin. We do not know who or why some women who are treated continue to progress. But the landscape of Her2 has changed (for the better) in the last decade. Prior to herceptin most dx. women were given a poor prognosis. Read the recent trials and the benefits. Yes there is a dark side to treatment all meds have side effects. You will have to make a medical decision that answers your concerns. A few years ago you would not even have had the choice of treatment as early stage women were not offered treatment. I had to fight to get treatment off label back in 2005. Do you know what your KI 67 level was from your pathology report. Your tumor may have been tested for Ki-67, your pathology report will show a Ki-67 score. High scores—greater than 20%—mean that the cancer cells are growing and dividing at a rapid pace. Higher-grade tumors typically have a higher Ki-67 score. However, there is no conclusive evidence that Ki-67 is associated with survival. Some studies have found that it is; others have found that it is not. Some studies have suggested that there are certain estrogen receptor (ER)-positive tumors with a high Ki-67 score that may not respond as well to tamoxifen or an aromatase inhibitor. However, they do respond well to chemotherapy. Since you are boarder line ER receptor positive portion of your cancer you may not fall into either group. What most who are dx. (early stage 1) are most concerned about is recurrence - none of us know if we will recur. I was speaking with a wonderful lady the other day who was dx. 15 yrs. ago - of course she does not know if she was her2..back then they were not checking. But she had lumpectomy, rads, and done. She has no evidence of disease since. Weigh the positive and negative - do so with knowledge and not fear - Read different studies and then make a decision. http://www.youtube.com/watch?v=AbUbdOnsfao http://www.asco.org/ascov2/Press+Center/Latest+New s+Releases/Women+with+Small+HER2-Positive+Breast+Cancers+Have+Significantly+Greater +Risk+of+Recurrence,+Metastasis+and+May+Benefit+fr om+Adjuvant+Trastuzumab+Therapy http://www.cancer.org/Cancer/BreastC...ating-by-stage Warmest Regards, Jean __________________ Stage 1, Grade 1, 3/30/05 Lumpectomy 4/15/05 - 6MM IDC Node Neg. (Sentinel node) ER+ 90% / PR-, Her2+++ by FISH Ki-67 40% Arimidex 5/05 Radiation 32 trt, 5/30/05 Oncotype DX test 4/17/06, 31% high risk TOPO 11 neg. 4/06 Stopped Arimidex 5/06 TCH 5/06, 6 treatments Herceptin 5/06 - for 1 yr. 9/06 Completed chemo Started Femara Sept. 2006 Last edited by Jean; 04-17-2012 at 10:43 PM..