[AlaskaAngel]

The intensity of trying to understand just the basics at first leaves out much chance to have the confidence to ask common sense questions.

Those who are younger have a harder time getting and staying genuinely postmenopausal, and are at some degree of higher risk because of that. More of them tend to be HR negative. They tend to be able to lose any weight that was gained during chemo, and keep it off because they have more testosterone and proportionally more muscle and less fat.

Most of those who are older and tend to become more genuinely postmenopausal with chemo are at higher risk for weight management issues, and tend to be more HR+. Maybe that is why they tend to recur later on, as weight continues to become more and more difficult to manage with slower and slower metabolism. In addition, by then whatever protective effect there is from doing chemo is far less.

What especially seems obvious is that there needs to be some calculation that estimates risk that includes BMI (or something similar) at time of diagnosis. Why would anyone fail to take into account the starting excess weight when calculating risk and benefit, especially for those whose likelihood of complete postmenopausal status with chemo is high to begin with based on age?

My older sister is in her 60's and obese, and the recommendation for chemo for her under the standard guidelines is the same as the recommendation is for someone who is age 25. What good is all the heavy-duty analysis of tumor, if they don't get the common sense picture to begin with in making recommendations for treatment?

A.A.