[Lani]

Rolepaul

DOn't know where you got your stats, but the stats I consider most important (although from a tiny series) are those for her2+ breast cancer that is DTC positive with her2+ dtc (tumor cells in bone marrow)

50& of those without herceptin treatment died within 5 years
90% of those without herceptin treatment died within 10 years

The vast majority of her2+ breast cancer patients DO NOT HAVE her2+ dtc,, but discovering those that do to be certain the treatment they receive clears their bone marrow (early studies showed chemo alone usually did not, though those studies did not look for her2 on the dtcs just dtcs in those whose primary were her2+) would seem to be the way to "cure" this disease.

Lymph node status may not turn out to be the be all and end all Just like histologic appearance it may turn out to be of historical interest only. It was all they used to have to go by. Now we know the biochemical pathways activated/deactivated are what make the tumor act the way it does and determines its prognosis, not what it looks like under the microscope. Similarly, all they used to have to guess at what made some tumors spread distantly was whether it had spread locally to the lymph nodes. We found out the characteristics which made it tend to go there(the lymph nodes via the lymph channelsO were different than those which encouraged hematogenous spread (via the blood) and similarly those attributes which make them settle successfully there vs the bone marrow, lung, liver, bone etc are seeming to turn out to be different. Yes, those tumors which were lymph node positive tended to have worse prognosis, but as systemic therapy seems to becoming better, the difference between prognosis in N0s and Nxs has diminished.

Now that we know more about the natural history of the disease, bc stem cells and all, it may be that her2+ cells in the bone marrow are much better predictors

CTCs so far have not been as accurate regarding prognosis. They may someday get to be, but THEY MAY NOT. What is floating around in the blood may turn out not to be as important as what has set up housekeeping in the bone marrow. Just because it can float around doesn't mean it can "nest and thrive"

I remain unable to understand why bone marrow testing is not being done, even in clinical trials, even in I-Spy.

RolePaul--how about a letter-writing campaign to Joel Gray/Laura Esserman (I-Spy) and Susan Love to see if we can include bone marrow testing in more clinical trials/biomarker discovery trials.

An ex neighbor of mine, in her 80s had a bone marrow aspirate done (was paid $100 and knew the result might help someone someday) and had truly minimal complaints thereafter--and it was done by a nurse practitioner in a clinic minor procedure room.

This should not break the bank or cause undue suffering and may give us invaluable information.

Off the soapbox again. I need to stay off it for at least a month now!