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To chemo or not chemo....

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TerriD View Drop Down
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    Posted: Nov 09 2018 at 7:03pm
I am struggling with the decision whether to have chemo or not. Stage 1, 1cm, lumpectomy, not in lymphnodes and negative pathology report. I have met with both radiology and medical oncology and they feel I should have both but not sure. Had a friend that had radiation only after lumpectomy and she's 10 years clean and free. Having TNBC, I'm not sure what to do.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Meadow Quote  Post ReplyReply Direct Link To This Post Posted: Nov 10 2018 at 12:36am
I don't know what kind of breast cancer your friend had, but TNBC is different from other types of breast cancer. You really have to think of the different types as totally different diseases. TNBC is more aggressive than most other types, and I've heard it can spread through blood vessels as well as lymph nodes. Also, for others types of breast cancer there are targeted treatments like Herceptin and Tamoxifen. There is no targeted treatment for TNBC. Chemo regimens are based on years of study and resulting survival statistics and type of cancer is taken into account. Ask your doc to show you survival statistics for those with your profile w ho do and don't do the chemo regimen that is recommended for you. For my profile (TNBC, age 44, Stage I, no lymph node involvement, negative pathology report, in good health otherwise), the chance of metastasis without chemo was something like 22% and with chemo it was something like 12%. I wanted that extra 10% chance of a cure. I'm 9 years out now. I'll never know if chemo made the difference, but I have no regrets.

I can't speak to radiation. I had mastectomy (due to having a BRCA mutation), and there were clean margins between the tumor and my chest wall, so radiation would not have increased my chances of survival. So it was not recommended.

Take care and keep posting if you have questions or need support.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rstar Quote  Post ReplyReply Direct Link To This Post Posted: Nov 10 2018 at 4:21am
Hi Terri,

There are chemo regimens like CMF and TC that do not include Adriamycin and its (small) potential heart damage. Keep in mind that these regimens are considered lighter than the standard AC-T and most likely are less effective, but better than having no chemo at all if that's the route u decide to take. I personally would go with the standard regimen because Triple Negative is not a disease to mess with.

Edited by rstar - Nov 10 2018 at 12:22pm
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gordon15 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Nov 10 2018 at 7:25pm
Get a second opinion before you do anything. It takes 7 years for breast cancer to show up, not to minimize that it is TNBC. You have a month to decide, based on a second or even third opinion.

Edited by gordon15 - Nov 10 2018 at 7:42pm
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017
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TerriD View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote TerriD Quote  Post ReplyReply Direct Link To This Post Posted: Dec 01 2018 at 3:30pm
Iwent for a second opinion and it was confirmed that I definately need to do chemo.  Now I have a week to decide on whether I want "dd-ACT" for 4 months (8 doses) or TC for 3 months (4 doses).  The doctor recommends dd ACT saying there is a 2% advantange over the TC statistically.  I would like to only have to do half the amount of doses however with the TC.  Anyone have any feedback, it would be appreciated.  
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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Dec 02 2018 at 11:38pm
Hi Terri,

I don't have the answer to help you out.  What do you want to do?  Do you want the extra 2% advantage or go with the shorter dose cycle?  I can tell you my story.  My tumor was 1.5 cm, stage 1 and after my bilateral mastectomy I had TC chemo.  What we didn't know at the time was that some cells had escaped the tumor prior to surgery and ended up in some regional nodes.  They were too few to be detected at the time by the MRI.  About 13 months after finishing chemo, a PET scan showed the recurrence to the internal mammary nodes.  I've always wondered if I had the AC/T chemo, if it would have wiped out the cancer in the regional nodes.  I do have some regrets, but at the time, all the nodes appeared to be clear, including the sentinel nodes. 

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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Post Options Post Options   Thanks (0) Thanks(0)   Quote Meadow Quote  Post ReplyReply Direct Link To This Post Posted: Dec 03 2018 at 6:35pm
TerriD, I was given exactly the options you were given. I was Stage I with a 1 cm tumor and clear lymph nodes. I chose to go with dd-ACT because I wanted that extra 2% chance of a cure.
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ron View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ron Quote  Post ReplyReply Direct Link To This Post Posted: Jan 21 2019 at 1:36pm
My wife has tn grade 3, 4 mm size.  Had lumpectomy and will do radiation.  Some oncologists say to do chemo, others as under .5 say don't (including Sloan).  An original MRI/Mammo stated tumor may be .6 but Sloan states go by tumor size at biopsy.  Anyone's Doctors mention similar about forgoing chemo.  My wife wants best survival rate but not crazy about chemo risks unless measurable difference.  Some told her 5% but Sloan basically said under 1%better odds with chemo but study cited did not have a huge # of participants and a bit older.  Thoughts?  
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rstar Quote  Post ReplyReply Direct Link To This Post Posted: Jan 21 2019 at 11:28pm
Hi Ron,

If your wife is boarder line as to whether she needs to receive chemo or not, discuss the option of maybe having a light chemo regimen such as CMF. It does not have the major side effects and still considered effective for women with node negative. Also, she'll get to keep her hair ;)


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Post Options Post Options   Thanks (0) Thanks(0)   Quote ron Quote  Post ReplyReply Direct Link To This Post Posted: Jan 22 2019 at 8:22am
Thanks for the reply.  We actually had some Doctor's say that CMF does have a drug in it at a higher dose than TC.  Believe drug that may be at risk for a future Leukemia but not 100% sure.  I guess our concern is if there is a measurable difference in preventing a reoccurrence she would have chemo but if not, then why do so.  Unfortunately, seems that still a "grey" area with TNBC and tumor size as to whether or not chemo necessary.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote lavi Quote  Post ReplyReply Direct Link To This Post Posted: Jan 28 2019 at 3:54pm
Hi Donna,
First i want to thank you for your always logical and helpful posts.
I've always  wonder. You had BMX  no radiation. You say that sometimes you wonder if you had ACT the reccurence could have been avoided. What about radiation?
My name is Lavinia,. Was dx Feb, 2017 TN 1.2 cm no nodes or invasion. I had LX right away followed by chemo FEC-D (equivalent of ACT- I'm in Canada). Right after chemo was done I insisted for BMX (just could cope mentally for leaving my breasts in place). The path report after BMX was clean, nothing was found. I insisted hard fro radiation but the doctors didn't want to give it to me.
Physically I'm doing well, I changed my lifestyle completely, but recurrence is on my mind every single day, every single minute. I'm 57 yo.


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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: Jan 28 2019 at 6:45pm
lavi,

Another good question and one I thought about when I had my recurrence.  Radiation after a lumpectomy or mastectomy would usually not include the regional lymph nodes.  Usually radiation is to the breast area, incision area and axilla.  We thought I was stage 1, 1.5 cm tumor, clear margins, all sentinel nodes clear.  My recurrence was to the internal mammary nodes and that is not an area they normally radiate without evidence of cancer spread to those nodes.  So even if they gave me radiation after bi-mx, it would not have hit those nodes.

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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Post Options Post Options   Thanks (0) Thanks(0)   Quote HopefulToday Quote  Post ReplyReply Direct Link To This Post Posted: Apr 27 2019 at 11:34pm
I didn't do chemo after the first lumpectomy and the cancer was back within 3 months. I did the chemo with Dr Ben Chue in Seattle and had a double mastectomy after. So far so good. 1 /1/2 years out. Learned the hard way... but look into your options in chemo. The type of chemo is really important. Read these boards and do your homework. There are no shortcuts to the homework unfortunately. You really need to be informed and you don't want to be looking back and saying, "wish I had known." 
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