Need help with treatment choices

[Louise O'Brien]

I'm a newcomer here and I have a week to make a decision. I was diagnosed with invasive breast cancer in August; had a left breast mastectomy four weeks ago.

The pathology report indicated Stage two; Cell grade two; ER/PR negative; HER2 positive. Sentinel lympth node negative. No spread. Tumour 1.5 cm. Very clear margins.

Had appointment with oncologist last week and I was convinced I would just be put on Herceptin. But I'm told that OHIP (Ontario Health Plan) will only pay for Herceptin if it is combined with chemo. The oncologist agrees that chemo will make very little difference in my case - about 4 per cent. They're recommending a medium dose of Adriamycin/Cyclophosphamide for the first four doses; switching to Taxol & Herceptin at the fifth dose. Herceptin to continue for one year.

He says if I'm experiencing any severe side effects - particularly neuropathy (sp?) from Taxol they will pull me off chemo and continue with just the Herceptin. He says while it appears they "got it all", there's no guarantee there isn't a dormant, renegade cell lurking around somewhere.

I should add that I am 67 but in extremely good health and very fit - although just before my mastectomy when they ran me through an echo-cardiogram - they discovered a faulty heart valve that I was probably born with. It wasn't considered serious - just a "trace" problem.

So here I am. I have a decision to make within a week. This is also a quality of life issue with me. My husband is about to retire and we want to do some travelling and I figure I probably have ten good years in front of me before we're less able to get around.

Having said that, I am inclined to do whatever it takes since I know HER 2 is extremely aggressive but I worry about the side effects considering my age, especially "chemo brain", since I was hoping to go back to school next year.

I feel a bit like a guinea pig because there aren't that many studies around on women with Early Stage Breast Cancer/No Nodes being treated with Chemo and Herceptin. It's like the Lady and The Tiger. Damned if I do - and damned if I don't.

I'd really appreciate some of your insights.