Tamoxifen Resistance in Her2+ - what to do?

[wtfsanjo]

when cancer presents in young women it is not just generally later stage, but more aggressive in general. there are more grade 3, high proliferative, hormone negative, and Her2+ cancers in younger women. and even controlling for all of these variables, many studies show that the risk of death is higher for younger women even when they are matched against older women with the same diagnosis and stage.

there was actually an incredibly depressing study that came out last year showing that the risk of death of dying from your cancer increases by 5% for every year under 40 you are.

as for why this is, there really is no consensus in medical science. it sucks and is extra scary, but there are also lots of women who have breast cancer in their 20s and 30s - even some with many lymph nodes - who make it long enough to get breast cancer again when they're 80. and if i make it long enough to get cancer at 80, i'll be pretty freaking happy.

krista - are you on YSC?

katie

[Lani]

her2 breast cancer recurs earlier, spreads more extensively and has a shorter survival time (in the days before herceptin) and is more often resistant to various chemos and hormonal therapies than breast cancer as a whole.

At a lecture I attended yesterday by Joel Gray, who got this year's Brinker award at SABCS he highlighted what he called luminal/amplified (50% of which are her2+ER+) and basal which included ER-s as the two worst subtypes which skew all the rest of the breast cancer statistics when you examine breast cancer as a whole.

Another thing to think about is whether these subtypes appear more often at earlier ages, skewing the statistics similarly. Just as blacks have a poorer prognosis--partly because of poorer access to early detection and care and partly because they are more likely to have triple negative breast cancer.

These old statistics based on all breast cancer thrown together need to be thrown out with the bathwater to allow in new meaningful statistics based on subtypes of breast cancer so that we may learn the best way to treat each individually instead of giving anthracyclines to 92% of breast cancer patients who, according to Dr. Slamon's talk at SABCS, will gain no benefit from them and only expose themselves to possible health probles from them in order to gain some benefit in the 8% of patients who will benefit. And only by separating out those 8% have they found that their benefit with anthracyclines is no greater than if they were given TCH alone. They 92% and 8% figures and the equivalency of treatment of those 8% were all from Dr. Slamon's talk at SABCS and couldn't have been generated without learning from biomarkers how to differentiate subtypes of breast cancer.

[kcherub]

Katie,

Hey! I do read over at YSC, and have posted there a few times, but I tend to get quicker, more researched answers over here. Plus, HER2+ is what (I believe) is my worry stone with BC, so I need to get all the info about it I can.

Thanks for replying. I get that younger women are more likely to "have" those variables, but aren't those variables just cruddy in general, no matter your age? Wouldn't that also make the variables the bad part, not just the age? Sorry--I do have a real thought here, but I swear I still have some chemo lurking in (my usually very intelligent) brain!

Like for me, I do have the HER2 bugger, but was grade 2, node negative, and ER+. With Herceptin around now, HER2+ is not the "done deal" people used to think of it as. The woman who owns the shop next to mine said that when she first went to a support group and told them she was HER2+, several women went, "Oh. I am sooo sorry." That had to make her feel good, eh?

As for the "matched against older women", and the 5% for every year you are under 40, the "why" is what I want to know. Are we talking 70-year old women whose life span is around 80, and therefore 10 years DFS might not happen due to just age? Sorry again--I am rambling.

I am basically to the point where I think there are two ways it could go--it is either going to come back or it isn't. People keep telling me that I have "such a positive attitude". Well, what else am I going to do?!? I refuse to "live like I am dying" in a negative sense.

Oh--love the picture! Cute do!

Talk to you soon!