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Hello,

I posted last week regarding my friends breast cancer situation.

I have more information that I would like to share with you. If anyone can understand her situation and help us figure out exactly what is going on.
Although she is going to a Breast Cancer Clinic tomorrow, I thought I would run it past you ladies first. She received a letter from her Oncologist today explaining her diagnosis to the Specialist she is seeing tomorrow. Any thoughts would be appreciated! I will attach a copy of her letter from her Oncologist to the Specialist.



Basically an abnormal mammogram was noted in August 2005. Then, in mid September she underwent a needle localization. Tumor was at the margin and was read as DCIS. Histologically, it was high grade ER negative, PR negative by our stains. At that point, the patient indicated that she wished to have a mastectomy because she did not want radiation therapy. In addition, she was small breasted. She had review of her slides by Dr. Smith who found three foci of frankly invasive carcinoma, two 1 mm (question microinvasion) and a 3mm focus. DCIS was present at one margin and a tumor embolus was seen in what was judged to be a lymphatic channel. By your stains, the DCIS was ER positive. The patient then underwent a mastectomy. No nodes were taken. Unfortunately, Dr. Smiths answer came back to me after the mastectomy was done. The patient was then returned to the OR a third time for axillary node dissection and 12 nodes were negative. A HER 2/neu done on the invasive cancer by Genzyme (we called to assure ourselves that the invasive cancer is what was tested) was positive with a ratio of 6.0. I told my patient that she has a stage I invasive carcinoma of the breast, T1aNO, with what your pathologist judged as a positive estrogen receptor and with Genzyme judged as a positive HER 2/neu. Our questions included the following: 1) What adjuvent therapy is indicated here? If her DCIS is truly ER/PR negative, then there is absolutely no role for a hormonal maneuver in my opinion. 2) As fas as I know, the invasive cancer was also receptor negative, but I am not certain that Dr. Smilth did any sort of receptors on that. 3) Is there a role for Herceptin here? 4) Is there any role for chemotherapy here? 5) This all started with the patients desire to avoid radiation therapy. Unfortunately, one margin on her lumpectomy was positive for DCIS. I do not feel stongly about radiation therapy here, but she is 40 and small breasted and we do not know which margin was positive for DCIS (invasive cancer was not at a margin). When I have looked at the role of post op radiation therapy in women with DCIS, who have DCIS at their deep margin, the literature is truly divided. I have gone both ways in my treatment of such women who are few and far between fortunately.

My take in the whole thing is a high grade invasive and probaly high risk cancer, despite its' small size. With her negative receptors, an OncoType DX will not be useful as I have no data in receptor negative node negative patients. I would be most interested in how you and your colleagues put this case together. It has been a particulalry difficult one for me. I have urged my patient to attent the Breast Cancer Clinic. I await your thoughts on this case.



Can anyone explain what all of this means? I told my friend that I would ask you ladies again for your thoughts!

Thanks,
Toni