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Sounds like your friend has been run from pillar to post with diagnoses, tests and treatments. However, the good news is that this sounds as though it has been caught very early, which is good.
I'm sure the breast cancer treatment centre will take the time to explain the situation to your friend but if you want a layman's 'unqualified' translation, I believe what this says is:
What was originally diagnosed as DCIS (a kind of pre-cancer made up of pinhead sized nodules which do not always develop into invasive cancer) had by the time it was examined post-surgery progressed to three very small invasive tumours.
The DCIS and the invasive microtumour was found to be hormone receptor negative (so it can't be treated with Tamoxifen and other related drugs). But one sample from the lymphatic channel showed it to be Eostrogen Receptor positive. So there is a question mark here, but the Dr is erring towards a view that he is primarilly dealing with an Hormone Receptor negative, but HER2 positive cancer risk.
HER2+ cancers tend to be more aggressive. The account for about 25 to 30% of breast cancers and are more common in younger women. They are also the type of cancer which often respond well to herceptin, a drug you have no doubt been reading about.
What seems to be occupying his mind is what - if anything - to do next. The cancer has been caught very, very early. The patient has had a mastectomy and the tumours are threfore removed. There is no node involvement (so no sign of local spread beyond the small tumours). Hence the chances of recurrence should already be very, very low.
In many centres the view could be that with a good surgical result the inconvenience and risk from chemo etc probably outweighs the small relative benefit of chemo. So no further action.
However, he's conscious of DCIS being found in a surgical margin (but doesn't know which margin, which means he's uncertain where to localise any radiotherapy), and that although tiny the cancer was high grade and HER2+. Also, the patient is very young.
Taking a belt and braces view, he's wondering about Herceptin. It sounds like this is not his main area of expertise (he's been looking up literature) so he's asking for a steer but signalling in his referral letter that he feels that a prudent approach would be to do either some adjuvant chemo or radiotherapy.
Adjuvant treatment is used to mop up any remaining cancer cells and minimise the risk of it returning. The relative reduction is risk offered by adjuvant chemotherapy is often quoted as between 30% and 50%.
In other words, if they were to tell your friend that they judged her chances of recurrence at about 10%, then further chemo etc might reduce that to 5% to 7%.
Showing above average medical sense he has pointed your friend towards a specialist breast treatment centre - where her situation will not be unusual and a wider range of options will be available.
They may recommend radiation therapy. They may recommend AC chemo. They may recommend Herceptin + Taxol. Or another combination. If they judge the risk of recurrence to be very low indeed they might even say that regular monitoring and tests may be preferable to undergoing treatment that in itself is not risk free.
Though your friend has been unlucky, she is very lucky in that it has been caught so early. I suggest she listens carefully, takes plenty of notes, pre-prepares a few questions and gives due regard to the advice of the specialists.
Good luck, I'm sure everyone reading your note will have their fingers crossed.
John L
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