HER2 serum test...

[DonnaD]

I to am confused about the Her2 serum test. Joe posted a spot for a very good article. It is http//breast-cancer-research.com. Once on the site go under articles. The title is Her-2/neu diagnostics in breast cancer. It was published 4 June 2007.

I just saw my onc last wk for my first mammograms since being diagnosed last year. Thankfully all came back fine. At that point I ask about the Her2 serum test. Onc said they don't do them. I would feel better having scans to be sure all is well. Nothing else is schedule now unless symptoms appear.

Could someone who gets the Her2 serum test regularly explain it to us. Is it just a blood test? How often do you get it? What does the test results show? Is the expense a problem for some insurance companies? Perhaps the test is not done when there is no reoccurence. But the article says it can indicate reoccurance 2 to 9 months before it is detected by clinical diagnoses.

Thanks in advance for you knowledge!
Donna

[dlaxague]

There are actually two discussions going on here.

1. After primary diagnosis and treatment, what surveilance for recurrence is needed, and why?

The answer to that is that NCCN and other guidelines do not recommend any kind of scans or tumor marker monitoring after primary diagnosis. The reason for this is that studies have shown that women who have their recurrence detected this way (as opposed to waiting for symptoms to occur) do not have a better outcome. The do not live longer nor do they have a better quality of life. In addition there is the problem of false positive results which raises everyone's anxiety for no reason. When recurrence happens, the cancer either does or does not respond to any given treatment, regardless of whether it's detected by scans, markers, or symptoms. There is no such thing as finding a distant recurrence "early" (except brain mets which are rarely the first site of recurrence). The HER2 serum test is a marker, thus not recommended, has no benefit to women after primary treatment, and is a waste of health care dollars when used to monitor women after primary diagnosis.

For those with advanced (metastatic) disease, it's a whole different story. Markers, including the HER2 serum test, may be useful to monitor response to treatment and perhaps to track status during periods of NED.

2. Second question - is the HER2 serum test itself a good (reliable) test to use when doing tumor markers? 'Sounds to me like it's one more piece of information to add to the mix but perhaps not a stand-alone one. Although some women, over time, may find that it's an accurate indicator for them, just as the other tumor markers are for some women. (some women have widespread disease and no elevation of the currently-used tumor markers - each cancer is different). Plus it may have some use in making decisions about the use of Herceptin, in advanced disease.

This information about not doing scans and markers after primary disease is so hard for some to accept. "But it makes me feel better to have a negative marker or scan", women will say. I say that a negative scan or marker today does not carry a warranty. You may have a negative scan today and a recurrence begins tomorrow. After breast cancer, there is some risk of recurrence, varying for each of us, but always there. That is a fact. Our best option is to accept that fact and learn to live with it. It's perfectly possible to do that, and it may enrich our lives to do so.

I don't say this to alarm anyone but to emphasize how useless these surveilances are. And to be blunt, imho - it is selfish and wasteful to demand an expensive test that is of no value, just because you think it gives you peace of mind. We (the global "we") don't have enough money to keep up with the incredible cost of advancing medical technology. We cannot provide the most basic of health care to many humans on this planet. And if we continue to mis-use what is available to us, we drain precious health care dollars, for no purpose. Dollars that could be used to save lives.

I know that this post is blunt and critical, and I know that the people on this list are wonderfully polite and supportive. I do admire this list for its civility. But I feel strongly about this issue of responsible stewardship of our health care resources. And let me emphasize again that I am talking only about surveilance after diagnosis and treatment of PRIMARY breast cancer.

Debbie Laxague

[KellyA]

Dear Debbie,

I did not find your post critical or blunt. It was actually very informative, and I appreciate the matter-of-factness in it. I have had my markers checked, three times, and had 3 bone scans (to moniter a spot on my ribs). I have had a few scares now, and after aging about 10 years with each one, and obsessing for hours (heck, DAYS!!) with did I have a reoccurance, or didn't I- I think I am finally reaching a "new era" in my treatment. I am SICK,SICK,SICK, of this absolutely controlling my life. It has become who I am, has engulfed me at times, and I am wasting very precious time worrying over it. In addition, I think that I have allowed my worrying to skew the facts in my head and I have forgotten that I do have a very good chance of beating this. Of course there is the chance that I won't- but how sad I would be if that time came and I had not lived my life to the fullest. I have always said that getting breast cancer can be a blessing- people die every day in automobile accidents and never have the chance to say the things they want to, do the things they love, etc. etc. What a wake up call we've gotten.

I agree that much of the testing is not helpful, that it certainly can increase anxiety and fears, and that it can take away from life a bit. I do think that one has to listen to their body, take very good care, and genuinely put forth the effort to do whats humanly possible to be vigilant and fight. The rest is in God's hands. For me letting go of the control THAT I DON'T HAVE has been the hardest part.

Anyways, just wanted to let you know that I appreciate the time you took to write and explain. I don't know why, but the docs seem to have a very hard time explaining what you just did. :-)

Love, Kelly

P.S.- Don't take this the wrong way, but you have even more "credibility" with me just because you've been there yourself, just like us, and had real reason to worry, and dealt with many of the same issues. So I know you understand. Its harder to listen to from a person who has never actually dealt with cancer.

[suzan w]

I just asked my oncologist (again!) about the serum Her2 test and she said (again!) that it is not a useful tool in monitoring post-treatment 'stuff' for early stage breast cancers. It is a whole different story for those with mets. And, to back up what you said, Debbie, she also believes that most scans done to rule out recurrences are unnecessary...for the patient-exposing them to unnecessary radiation etc., and they are not cost effective. I know that it seems contradictory for a doctor to say...'there is really no effective method of picking up an early recurrence...and to wait for symptoms to appear..." when everything I believe tells me that 'early detection is the key'!!!
These discussions are one of the reasons that this board is so important to me. We are all researching, reading, ASKING, these important questions and sharing our knowledge and the wisdom of our respective medical teams. It is this sharing of information and experiences that is so valuable!!!

[Gerri]

Thanks Debbie for your comments. My onc follows the national guidelines and for the most part I am comfortable with no tests, no scans, no markers being run. Every once in a while I find myself wondering "what if" (after all, I felt perfectly healthy when I was diagnosed), but then I read a post of an anxiety ridden member waiting for results and realize that this is the best course of action for me. I have total confidence in my onc and feel that sometimes we get carried away with thinking that we know better than the trained professionals. While I think it is crucial to remain informed of our choices and options, I think it is equally important that we put our trust in our health care proffesionals and follow the guidelines put out by respected organizations.

[DonnaD]

Debbie,
Thank you for responding and explaining things so well (better than my onc ever did). That is what this board is all about, getting others opinions, learning and making responsible choices.

I applaud your stand for responsible stewardship of health care resources.

Hitting the year mark is a big step. I am still trying to put all this into prespective. The treatment is over now except for Herceptin. Like Kelley said it is hard to let go and understand we are not in control. Learning to live with the possiblity of a reoccurence is not easy, we all must deal with that. I have much to be thankful for and I thank God daily.

Can't wait for the day I don't think about cancer once! Its coming.

Donna

Donna,

One more bit to add to the rest. Today was my next-to-last herceptin and the last draw I would have for tumor markers--I've had three this year and this would be the last. I have primary breast cancer with generally higher than average tumor markers: 27-29 is 37; started at 41, went to 45 (then had PET, nine months ago), and then down to 37. Don't know where it is today.

I've had two HER2 serum markers done. First was 16, next was 11.5 (couldn't get enough blood for today's, so I'm taking it as a sign not to do it again).

My oncologist told me he only does the HER2 for two patients, me and another, and prefers not. The other patient's HER2 went up quite a while ago (more than nine months he told me) and they can't find anything, and she's living in constant fear.

He uses the other markers routinely, but emphasized that they're not recommended by oncologists in general, for reasons quoted by Debbie earlier.

I will say, just for myself, that starting down the path of tumor markers was the worse mistake I've made since getting cancer. Now I'm in the position of knowing I have high markers and a good prognosis (4% mortality in ten years by Adjuvant). And the fear of the markers has upper hand.

I agree with Debbie, but just don't have her courage to say 'don't think about this and get on with your life.' I'm trying though. But my recommendation is if you're feeling good with no symptoms, let the markers and scans go. This is one woman's opinion and, admittedly, she's a coward!

When I tell my doctor of stories from here regarding markers and scans, he reminds me, but very politely, that we're a self-selecting group

[juanita]

i see my onc tomorrow and have this on my list of questions for him.