Hi Ladies!
I am hoping someone might be able to lend their personal experience of Letrozole (and shrinking of the cancer) as I am seriously thinking of deferring my surgery to see what effect the Letrozole has on my cancer. I’m making this decision not because I would opt for lumpectomy if it were an option (I might still opt for mastectomy) but because I don’t feel ready for such a huge operation and for personal reasons, the timing is not ideal.
Some of you may know my situation but for those who don’t…
Briefly: I was diagnosed in August with Grade 2 Invasive Ductal Carcinoma with Lobular features (left breast only). I was recommended a mastectomy with immediate reconstuction. No in depth discussions were had re-treatment options. It all felt a bit rushed and hurried.
So far, and from the scans, MRI, physical exams, my team are satisfied that my cancer has not spread to the axilla-but they will obviously only know that at the time of surgery when they do the sentinel node biopsy. I have been taking Letrozole for 3 weeks and any side effects are very tolerable.
My surgery has been planned for 14th Nov *however* I am not feeling confident that surgery is the right option for me at this time. a) it feels very extreme and b) I need to be fit and well and able to fly in January (my mother will be having surgery in Jan or Feb and I want to be there for her-in Canada).
At my initial consultation with my breast surgeon she said that if I wanted to defer surgery for 9 months to a year, she would be happy for me do that provided I take Letrozole (which can shrink the cancer)-I realise it may not shrink it enough for me to have a lumpectomy (my breasts are not big) *but* it can allow me to have some more time before such a huge operation. For personal reasons, the timing at the moment isn’t ideal and I want to feel more certain that surgery is the best option for me. The message was: there is no urgency for the surgery.
My Oncotype Dx test score is 1 (the second opinion breast surgeon and my oncologist have both said they’ve never seen a score this low). This score means I am very low risk of the cancer recurring. What isn’t clear to me is this: is this based on the assumption that the cancer has been removed? Presumably yes.
And so if I decide to defer my surgery for 6 months-year am I putting myself at risk of it growing?
I’ve emailed my breast surgeon as well as my second opinion breast surgeon; the latter replied with:
"The grade of the tumour does not progress so no it will not turn into a grade 3. That said sometimes the original grade changes after surgery due to having more material to examine (if that makes sense). Lobular cancers are mostly grade 2.
If you defer surgery and go on Letrozole you will be monitored to check the tumour is not enlarging but I would expect the Letrozole to be effective in controlling the tumour. I do not think you will be taking any risks. There is lots of evidence and scientific publications to support using Letrozole to facilitate breast conserving surgery. The success rate is higher with ductal type tumours.
Kind regards…"
With that-have any of you experienced a significant shrinkage in your cancer such that it opened up your treatment options? What is the worst possible scenario if I delay surgery? I’m thinking “that it doesn’t shrink”-I understand that it should not *grow* while I’m on Letrozole. Are there any cases of growth while on Letrozole??? And are there other ways to check whether the cancer is in my lymph nodes other than sentinel node biopsy (SNB) at the time of surgery? Do people have sentinel node biopsies as stand-alone procedures? I’ve read that these come with their own consequences and risks. Is it worth me having this done just to be sure it hasn’t spread? My team are satisfied it hasn’t spread but obviously can’t give me 100% guarantee until they do the SNB.
I’m just wondering what the possibilities are, what the risks are, and whether there are any cases of Letrozole shrinking the cancer down to nothing? (remission).
I look forward to hearing from you…
xx