Any node-negatives decide against chemo?

Katie,

this post is wonderful.  I am currently in the to chemo or not to chemo stage.  My cancer was only 2mm but I am 35 yrs old.  my oncologist recommends chemo because of my age.  The bc specialist however is telling me he doesnt think its necessary because the cancer was so small.  I had a left mastectomy, clear margins, nodes negative.  We dont know positively that I am triple neg because there wasnt enough invasive tissue to stain for the Her2 test.  The specialist says 10% or less chance of recurrence with a 2-3 % benefit of reduction from chemo.  Do I do everything in my power and do the chemo (4 treatments of taxotere & cytoxan) or play the odds and see what happens?  I dont know yet.  I am being tested for the BRCA1/2 but havent had the test done yet.

Hi Colleen

Colleen,

Those numbers in the parentheses usually are statistics referring to the study group.

Central fibrosis is a necrotic (dead) region that sometimes appears in the center of tumors. From what I understand, this dead zone develops because the tumor is growing so fast it cannot "feed" itself sufficiently. This can be seen as an indication of an unresponsive immune system.

The presence of the lymphocytic infiltrate they talk about is indicative of an immune system response. I believe that's why the study showed that people with moderate to extensive lymphocytic infiltrate had a lesser re-occurrence rate -- because their immune system was attempting to respond.

Here is a quote from the study that quantifies what "moderate to extensive" lymphocytic infiltrate is, as well as a clinical definition of a central necrotic zone. I literally copied this and gave it to my pathologist.

"The amount of lymphocytic infiltrate was scored as follows: none = no lymphocytes present; minimal = scattered lymphocytes, <10 lymphocytes per high power field (40x); moderate = lymphocytes easily identified, but no large aggregates; extensive = large aggregates of lymphocytes in >50% of the tumor. Central fibrosis was deemed to be present when the center of the tumor showed collagen, with a variable amount of fibroblasts, without tumor cells."

Now, remember, there were only 71 cases used in this study. There are so few studies on Triple Negative, I was grateful to find this one, but it's not much to go on. My pathology came back with moderate lymphocytic infiltrate and no central fibrosis. That, in combination with my overall good health and negative test for BRCA1/2, led me to my decision to forgo chemo.

Again -- DISCLAIMER -- I am not a doctor! I am not qualified to give medical advice in any way!

Good luck,
Winkie