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Hey Alaska Angel,
I'm not sure I have much to add to this thread other than that I'm completely sympathetic. I don't want to bash oncologists here--there are many good ones, I'm sure!--but there are also loads of them who should really be called, as Neil Ruzic does in his book Racing to the Cure, "chemotherapists." They admninister the same treatment to people who appear ot have the same disease, without asking many questions. I'm sure this is largely due to the pressures of seeing too many patients.
In my partner Rachel's case she had an oncologist originally who wouldn't give her herceptin off-protocol but WOULD give her the name of another oncologist who would. She made it clear that her own reasons for not giving it had a lot more to do with professional issues and community standards rather than what might be best for Rachel.
As for her2 and hormonal treatment, it's been clear for awhile, I think, that women with her2 positive breast cancer were at best getting not much benefit from tamoxifen, at worst, possibly, being harmed by it. But that is mostly based on in vitro evidence and oncologists (and drug companies) won't do a thing until they have lots of data from a million different Phase III clinical trials. And there will never be enough women who are her2+ and er/pr+ to launch those kinds of trials.
Aargh.
Jeff
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