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neoadjuvant versus adjuvant

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Judy15ws View Drop Down
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    Posted: Mar 01 2018 at 1:32pm
I am a very new member, and only learned of my diagnosis two days ago. I have been reading studies about neoadjuvant and adjuvant therapy for TNBC, but I am not learning anything very satisfactory about the one versus the other. Since I have been preparing for some weeks now to move from where I have lived for over 40 years to another city to be closer to my grown children (and grandchildren!Big smile ) , but still haven't found a suitable apartment for rent, it seems pretty basic that I would prefer to first have surgery, which I would do where I have lived for so long, and then start chemotherapy after I have moved to my new location. The closest relative to me at my present home is my brother, who lives 45 minutes away, and is very busy with his own very young grandbabies. So I would not have the support I need to get through chemo, I think. But I do not want to blow the small advantage that I have for good prognosis: the cancer was discovered early, the lump is only 1.5 mm and the surgeon did not feel anything in the nearby node.
I would like to ask the forum members about their experiences with having chemo before or after surgery. 
I also am having trouble finding studies or information about the timing of treatment. Like, how long is it acceptable to wait until having surgery? How long is it safe to wait until starting neoadjuvant therapy? How long is it acceptable to wait between surgery and starting adjuvant chemo? 
I would really appreciate hearing from you, since my first meeting with an oncologist is on Monday, March 5th. Nothing too technical please, since I still have a long way to go. Many thanks in advance! 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote mainsailset Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2018 at 5:10pm
Hello there and welcome.
   There were studies some years back from MD Anderson that indicated that for Tneg it would be a better choice to have chemo first, followed by surgery and then radiation.
   The best argument I've heard for having chemo first is that by keeping the tumor in place it is easier for the medical team to gauge how well the chemo is working. If the tumor does not soften up and then start to shrink a decision can be made quickly to make a course correction into a different chemo cocktail.
   After chemo, the optimum time to have surgery is about 6 weeks. Your body needs to recover, your immune system and white blood count need to stabilize and you need to have a breather. Individuals vary but that's a generic guideline.
   Over the years I've seen so many women here who have been dx'd with small tumors and have received less than the full on treatment only to return down the road with a recurrence which is then much more difficult to treat. So, when you are meeting with your team and then making your decisions please consider not backing off on treatments but hitting your tumors hard with the chemo, surgery & radiation.
   It's so hard in the beginning because the doctors are all speaking medical eese and it's just difficult to process what's all going on.
   I found getting a 3 ring binder and getting copies of my medical reports helped me greatly. I could pencil in questions, verify that things were on track and just get my head on straight. Also, medical mistakes happen, every team does their very best and all of them care deeply about their patients but mistakes happen so it's all the more reason to become involved, check your scans and tests and know what you present medically. It's just part of being on the team.
   Lastly, 2nd opinions are a good option, they are a learning experience and can make a good difference. You may also want to ask about clinical trials, there are lots of them out there but not every oncologist has access to every trial, which is another reason for a 2nd opinion where there may be more choices that are a better fit for you.
Welcome aboard, and know that this is a wonderful & caring family here. We'll do all we can to help support you.
Mainy
dx 7/08 TN 14x6.5x5.5 cm tumor

3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Mar 01 2018 at 9:27pm
Hi Judy,

You are asking some excellent questions!  You say your lump is only 1.5 mm.  Is that correct, not 1.5 cm?  If it's 1.5 mm, that's really tiny.  If your tumor is 1.5 mm, that equals 0.15 cm.  If you look at the NCCN Guidelines for Stage 1, tumors 0.5 cm and smaller with clear nodes, chemotherapy is unlikely.  (See page 44 of the guidelines).


You may want to read through the NCCN Guidelines before your appointment.  It has so much good information and takes you through every step, explaining and showing you diagrams.  Jot down your questions and bring them to your appointment.

The following link discusses the finding about not delaying adjuvant chemo if you have surgery first.  The optimal timeframe is to start within the first 60 days.  This assumes you will need chemo.  With your small tumor, they may not recommend chemo.

http://forum.tnbcfoundation.org/dont-delay-chemo_topic11759.html


Are you considering a lumpectomy?  The recovery time will be less than a mastectomy.




DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Judy15ws Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2018 at 8:09am
Hi Mainy. I am very grateful for your quick and caring reply. I am so glad I found this forum early in the process! Following your recommendation, I found a divided multi-folder to keep track of things, and to bring with me to meetings. Since I do not yet have the path report from my biopsy, I am still pretty much in the dark. However, I think I made a mistake about the size of the tumor; it's probably 1.5 centimeters, not millimeters. Since the surgeon who typed the "meeting summary" misspelled ""triple" (he wrote tripple), I felt I could not be sure that he did not mistake cm for mm, just out of habit. This was my first meeting with the surgeon, with anyone actually. I tend toward medical paranoia out of habit (long story), and still find this whole thing very hard to believe..... 
As you can imagine, my thoughts are skittering around my brain nonstop. I realize that the cold medical and biological sense is to hit it hard in the beginning with chemo first, as you wrote. There is also the problem that I have a bad feeling about my presentation without me opening my mouth. I am 71 years old, and have serious issues with osteoarthritis throughout my spine, and had total hip replacement in 2015. I bring a wheelchair with me when I have to sit, since I cannot tolerate sitting on most chairs for more than 5 minutes without serious pain. Most people don't get that the wheelchair is for sitting, not mobility. It also disturbed me that the surgeon wrote in that meeting summary, without asking me, that I do no physical exercise or activity. Actually, I do 10 minutes of exercises recommended by my physiotherapist every morning, and have 45 minutes of physiotherapy every week. Doctors making assumptions is very disturbing, actually! I feel that I must correct this assumption before I am evaluated whether I am a good candidate for chemo, especially because of my age. Or, am I being petty?
However! While my sons love me, they have a problem with supporting me emotionally. I can't go into the probable reasons, and they have nothing to do with this brand-new diagnosis. So I am in a quandary about the timing of chemo. Since the tumor is small, most studies I have had time to read until now seem to conclude that long-term prognosis and risk for recurrence is the same whether surgery is before or after chemo.
I am trying to move to another city where my younger son lives with wife and 2 of my grandchildren aged 9 and 6. I am close with the 9 year old. I would like to hope that surgery in my present location, followed by chemo in my future location, where I would have family close-by to visit me, is a really good option for achieving cancer-free status. As a medical sociologist, I know how important the feeling of being supported is in achieving a good medical outcome.
I know you are not an oracle, and I promise not to put you on the spot. I would just like your thoughts in my case. Can I write you again when I have the path report in hand?
Again, I'm very grateful for your thoughtful and helpful remarks.
Have a great weekend!
Judy
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Judy15ws Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2018 at 8:47am
Hi Donna!
Thanks for your very quick answer. 
I might have jumped the gun with reporting the tumor size, since I only have the "meeting summary" of the surgeon who gave me the biopsy results, and not the pathology report itself. The surgeon wrote cm, not mm, but he also spelled "triple" "TRIPPLE", so my skittery, how-can-this-be-true? thoughts make me suspicious that he may have written cm purely out of habit. Anyway, tomorrow I will get the path report and will be sure (although one of my sons is even more unbelieving than I am and his first blurt when I told him of the diagnosis was "Are you sure that they didn't mix up your biopsy samples with someone else's?").
Many thanks for the links. I am going to the guidelines right now for questions to bring up. I see the surgeon again, together with the head of oncology, on Monday morning.
You ask good questions too!Tongue Yes, I have considered lumpectomy. It was my first reaction. Then, I started worrying about not hitting the tumor with the big gun of chemo first, and my thoughts went toward mastectomy. Then I started reading articles which seemed to be saying for a tumor as small as mine, lumpectomy versus mastectomy had pretty much the same prognosis. So altogether, I'm kind of confused right now and getting concerned about making the right decisions.
A big thanks for giving me the timeframe of chemo following surgery. I was having trouble finding information about timeframes. Is there a timeframe for having surgery, if surgery is before chemo? There was quite a long delay from the initial routine mammography (I am 71 years old with no family history, so had mammo every two years) catching something suspicious until I sat in front of a surgeon who gave me the results of my biopsy. The delay was 2 days short of 6 weeks! This horrifies and stresses me, so I am super-interested in those timelines! You see, for months I've been getting ready to move from my present location, where I have no closeby family living, to another city. I need to find a rental apartment, finish packing, and move. I have no problem with having surgery at my present location, but I really, really want to have chemo at my new location, where one of my sons lives with wife and two of my granddaughters, aged 9 and 6. I am close to the 9 year old. I know how important support is for cancer patients.
So many factors!
Again, many thanks for your excellent and thoughtful help. 
Have a great weekend!
Judy
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2018 at 12:56pm
Judy,

I found this study.  It's important to know that even 9 years ago, neoadjuvant therapy was recommended mostly for women with larger tumors and more likely to be Stage 2 or 3.  For Stage 1, it was typically surgery then adjuvant chemo.  You can ask your oncologist for statistics or studies to help make your decision.

Long-Term Outcomes With Neoadjuvant vs Adjuvant Chemotherapy in Early Breast Cancer

Key Points

  • Neoadjuvant chemotherapy was associated with a higher local recurrence rate in patients with early breast cancer.
  • No differences in distant recurrence or breast cancer–specific or overall mortality were observed.
The investigators concluded: “Tumours downsized by [neoadjuvant chemotherapy] might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received [neoadjuvant chemotherapy]. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by [neoadjuvant chemotherapy] should be considered—e.g., careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy.”

http://www.ascopost.com/News/58395


DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2018 at 12:57pm
One more study,

Adjuvant or neoadjuvant chemotherapy in early stage triple negative breast cancer (TNBC) comparison of outcomes in both BRCA positive and BRCA negative patients.

Background: NSABP Protocol B-18 was a randomized trial which found no statistically significant difference in overall survival (OS) in patients (pts) receiving neoadjuvant (NAC) or adjuvant chemotherapy (AC), however outcome was not analyzed by breast cancer subtypes. Subsequent retrospective studies in TNBC reported conflicting results with an initial study showing a significant OS benefit with AC and later studies showing a trend toward improved survival with NAC. Furthermore, studies have not included a significant number of pts with BRCA mutations. This study aims to analyze outcomes of AC versus NAC in pts with early stage TNBC with and without BRCA germline mutations. Methods: Pts with stage I or II TNBC who had BRCA testing were identified from a prospective cohort study of 4027 pts at MD Anderson Cancer Center. Clinical, demographic, genetic test results, chemotherapy, recurrence, survival data were collected. OS and disease free survival (DFS) were estimated using the Kaplan-Meier method, and log-rank tests were used to compare groups. Results: 305 pts with stage I and II TNBC who met eligibility criteria were included in the analysis. Pts who received both NAC and AC or no chemotherapy were excluded. 181 received AC (59.3%) and 124 received NAC (40.7%). The majority of the pts were less than 50 years old (236, 77.4%) and white (194, 63.8%). 134 were BRCA positive (44.1%) and 170 were BRCA negative (55.9%). The majority of the pts received an anthracycline and taxane regimen (223, 73.1%). There was no significant association between OS or DFS and treatment with NAC versus AC in the overall cohort. Furthermore, there were no significant differences between pt subgroups (NAC BRCA positive, NAC BRCA negative, AC BRCA positive, and AC BRCA negative) with respect to either OS or DFS. Conclusions: NAC versus AC with standard anthracycline and taxane containing regimens results in similar DFS and OS survival amongst pts with stage I and II TNBC regardless of BRCA status. Further studies are needed to evaluate whether similar results are observed with newer agents, such as platinums, PARP inhibitors and other targeted agents.
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2018 at 1:00pm
Judy,

One more research article.  

Current approaches in treatment of triple-negative breast cancer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493381/



DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kellyless Quote  Post ReplyReply Direct Link To This Post Posted: Mar 02 2018 at 2:01pm
Welcome Judy! Even though I live with my husband and my adult daughter moved in when I started chemo, a LOT was going on in our lives (building new offices and moving the family business) and I wanted to be as small a burden as possible. You may gain peace of mind lining some things up like I did, whichever location you are in.
I researched grocery delivery, found that Tom Thumb could be free if i was flexible about delivery times, and they didnt charge more than buying in the store. Theyd bring them right into my kitchen, it was awesome. Check with the stores in your area.
Amazon has damn near everything available for delivery from same day to 2 day, no delivery charges if youre a Prime member. Prime also has a great video service - movies and TV like Netflix does, as well as the most extensive E-book and E-magazine library for reading on your phone and tablet (great for whiling away the hours at a bazillion medical appointments).
Many pharmacies deliver now, Walgreens was $5 fee and usually same day delivery.
I found about 20 restaurant delivery services - They all did First Delivery Free deals, so I used them all at least once.
I did Freshly prepared meal delivery for a few weeks when I was at my worst, they had high protein meals which I needed for healing.
It gave me some satisfaction to be able to handle some things in my own, even on days when I could barely get off the couch to answer the door. My family really appreciated my efforts as well.
IDC, 2.2 cm, Stage IIb,lumpectomy 1/30/09 ACx4,Tx4 36 rads
6/1/17 Local recurrence same breast, same spot 1.8cm Carb.4x every 3 wks, Taxol 12x once wk. Dbl Mast. PCR!! Reconstruction fail, NED!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Judy15ws Quote  Post ReplyReply Direct Link To This Post Posted: Mar 03 2018 at 10:11am
Hi Donna.
You are awesome!
Quick question about this first article: All the women in the study had breast-conserving surgery, right? Or am I assuming, which I should not?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Judy15ws Quote  Post ReplyReply Direct Link To This Post Posted: Mar 03 2018 at 10:30am
About the second article, Current Approaches in Treatment..., you know what they say - that great minds run in the same channel? LOL I had already skimmed this article! 
I have this additional factor that somewhat worries me about what treatments will be offerred to me. I am 71 years old, and are concerns about those over 70 being too "frail" for chemotherapy or certain harsher regimes of chemo, and for other attributes common to older age, such as polypharmacology and comorbidities. For example, I saw by briefly skimming here and there that I would have to stop a medication I have been taking for years for acid reflux, and I might have a problem with one of my hypertension medications Unhappy. Don't worry, I am a fighter and have learned to be more questioning than I was when younger. I had to push pretty hard to be accepted, and then to get through the master's course for medical sociology at the advanced age of over 50. And I finally finished my degree, with thesis, at the age of 58. I greatly enjoy the Maxine comics! 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cheeks Quote  Post ReplyReply Direct Link To This Post Posted: Mar 03 2018 at 10:41am
Hi Judy, I don't think 71 is too old for chemo. Two years after my first diagnosis my mother age 76 then had to have chemo for ovarian cancer. She did really well and is still doing well. One of your premeds each time you have chemo should be iv tagament or something for your stomach.
Your oncologist will keep all of these things in mind. Make sure you let them know all of your concerns.
Take care
Lump found 11/08
DX: 2/09 @52 TNBC
L. Mast. 3/26/09, SN-, BRCA-,
4.5 cm (post surgical)T2NOMO
Chemo: 4/09-10/09 Taxol x 12,
A/C x 4, No rad.No recon. NED 1/17. New Primary right breast TN, 2/2018.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Judy15ws Quote  Post ReplyReply Direct Link To This Post Posted: Mar 03 2018 at 10:51am
Hi Kelly. Thanks for writing! I love your down-to-earth, practical advice. Really valuable and so reassuring to read about such "ordinary" things like groceries!Big smile
You wrote that you have a grown daughter. May I ask how old you are? I am 71, and one of my big concerns, aside from the whole rigamarole of moving, is that there will be a judgment call as to whether I will be able to physically cope with chemo, and which chemo drugs. There are also age-related chemo question marks about certain meds I take now.
I was surprised to see that you did not have a recur for 8 years. Isn't this unusual? I've been reading that triple neg, if it's going to recur, usually does at 3-5 years after first surgery.....
I was very sorry to read of your recurrence, double mastectomy, and reconstruction failure. But you sound like a fighter to me, and I wish you strength and health.
Must say that your post made me smile when you wrote "bazillion" because one of my favorite words is "gazillion".LOL
Best wishes,
Judy
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Mar 03 2018 at 12:47pm
Originally posted by Judy15ws Judy15ws wrote:

Hi Donna.
You are awesome!
Quick question about this first article: All the women in the study had breast-conserving surgery, right? Or am I assuming, which I should not?

Judy,

Yes that study says "breast conserving surgery", which is a lumpectomy.  I'm not a medical expert but the higher risk of local recurrence may be mitigated with radiation, making sure margins are good, etc.

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Mar 03 2018 at 12:52pm
Judy,

I wouldn't put too much weight into the discussion about chemo after age 70.  We've had members in this group who were 80 and handled chemo very well.  I think your oncologist will look at your overall health and make the best assessment.  It sounds like you are very active and should do well.

Regarding antacid medication, I know they put it into the premeds before chemo when I had it.  My onc had me take Pepcid AC during chemo.  I think your onc will work with you to get your medications adjusted accordingly.  There have been many women who take hypertension medication during treatment.


DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote mainsailset Quote  Post ReplyReply Direct Link To This Post Posted: Mar 03 2018 at 9:02pm
Hi again Judy. I'm very close to your age and both my sisters went through chemo at the same time as I did, they were in their mid 70's. I really think you're on the right track to make sure that your file reflects who you are rather than assumptions so I'm glad you're a fighter because every scrap of misinformation counts!

I'm a big believer that us older gals have an advantage that makes up for our added years in that we really know ourselves and what to look out for. In talking with your medical team in the first visits I'm really an advocate of making sure all the boxes are checked: get your Vitamin D level checked and start taking Vit D3, calcium & mag, get a bone density check to verify what's going on there, have the doc check your adrenal levels, go to the dentist before you start chemo if you can...all these kinds of things.

Strangely, I found that when I was on chemo I was very active in spurts, I think that was the meds they gave me so I wouldn't be nauseated. I really liked the xtra energy but still found naptime heavenly.

Keep in touch, you'll find that the search engine and archives here are treasure troves. We all seem to be internet warriors looking for good articles and research and bringing them home so to speak.
dx 7/08 TN 14x6.5x5.5 cm tumor

3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kellyless Quote  Post ReplyReply Direct Link To This Post Posted: Mar 04 2018 at 4:01pm
I'm 54 now, and Donnas right that we've seen many women here do chemo over 70 and do very well!
It is extremely rare to have a recurrence after 5 years like I did, unless you are BRCA + which I am not. There's no studies out there At All on what treatment to do because there's no patients to study! My reconstruction attempt failed because it turns out my chest muscle had extensive damage from radiation. I'd have never known if I'd not had cancer again, it caused no problems at all. I'm finally healed (after 8 1/2 months of wound care), but my chest is a sh!tshow, always uncomfortable at best and downright painful on bad days. The prosthetics work great, I wish I'd never attempted reconstruction. Oh well, other than that I'm feeling good so I normally don't complain.....it's a rainy day here tho, and that means I hurt, so pardon my whining.
IDC, 2.2 cm, Stage IIb,lumpectomy 1/30/09 ACx4,Tx4 36 rads
6/1/17 Local recurrence same breast, same spot 1.8cm Carb.4x every 3 wks, Taxol 12x once wk. Dbl Mast. PCR!! Reconstruction fail, NED!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Judy15ws Quote  Post ReplyReply Direct Link To This Post Posted: Mar 09 2018 at 6:08am
Many thanks for your addressing my concerns about my age and chemo. I am very thankful that my small mass, 1.5 cm, was discovered so early, on routine mammo. I have not yet had lumpectomy, but very soon, and my PET scan showed no nodes involved and no spread.
I am terribly sorry to read about your recurrence. My sincere hopes that you beat this!
My thoughts are with you.
Judy
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Judy15ws Quote  Post ReplyReply Direct Link To This Post Posted: Mar 09 2018 at 7:00am
I wonder if anyone else felt like I do at the beginning of the road. It's not even a month since my biopsy, and I did the PET/CT a whole 3 days ago! I feel like I'm walking through this heavy fog - I can't see a thing clearly, but I keep hearing these distressing noises (doctors, humf). 
The very good news is that the PET came out really good, no involvement of nodes, no sign of spread.
The really confusing part, though, is my diagnosis!Ermm There seems to be some disagreement as to whether I am triple neg or not. The immunohistology staining showed ER negative, HER2 negative, but PR "positive nuclear staining in 50% of tumor cells"!!! 
The ultra-conservative (according to my Family Physician) oncologist who saw me once the entire path report was in said that he would recommend only hormone therapy, and maybe radiation. After reading some research articles - a big thanks again to Donna for some! - I saw that I am considered not really triple negative by the authors of the studies, but some little known (2% of breast cancers) subtype called Luminal B/HER2-. Other studies found a poor prognosis for this subtype, not as poor as TNBC, but still not good. I just now spoke with a pathologist-friend (my age, so very experienced), and he just assumed that the oncologist recommended chemo. 
BUT! I am moving to be near my son and his family in just a month, and already have an appointment with the head of breast oncology at a major hospital near this city. So, I am hoping that I won't have to fight and get all stressed out in order to receive adequate treatment to avoid recurrence and let me enjoy my grandchildren in peace. 
Have you or anyone reading this heard of my subtype of IDC, and do you know how it was treated?
Ummm, one more thing driving me bonkers. Since it takes months to get an appointment for genetic testing for BRCA, that detail will have to wait until after I move. I should be tested, since Ashkenazi Jewish women are known to be at higher risk, and I belong to this group from both sides of my family, even though I am not aware of anyone in my entire family having had breast cancer.
I cannot tell you how much I appreciate this forum and want to hug each and every one of you beautiful, generous-souled ladies!
I hope that one of you seriously-smart gals can come up with answers about my unusual subtype.
And for the love of Pete, NEVER think you are "whining", kiddo!!!! 

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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Mar 09 2018 at 11:15am
Judy,

A couple of thoughts.  Since you are having surgery first, pursue getting another opinion on your biopsy results and surgery path report.  Maybe request the new oncologist to review the case prior to your appointment in the new city.  

Good idea about genetic testing.  To speed up the process, consider taking this test through Color Genomics.  You may get your results quicker.

https://www.color.com

https://www.color.com/learn/can-cancer-be-inherited

 Luminal B - you may have already read this study but posting just in case.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323135/

Good luck!  Yes, the not thinking clearly and feeling like a heavy fog is completely normal.  It's all the stress of dealing with the diagnosis and trying to make the best treatment decisions.  I felt like my mind was racing a million miles an hour and going in hundred different directions at the same time.  I sometimes think the time between diagnosis and the beginning of treatment is the hardest, most stressful part of this journey.

Donna

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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