Advice needed urgently, please

Diagnosed with breast cancer Recently diagnosed with breast cancer
1

Hello, my sister who is younger than I am was recently diagnosed with stage 2 breast cancer.
I live in the USA, but my Sister lives on a small Caribbean Island. She wants to get a mastectomy done ASAP, however her Oncologist wants her to go through 8 rounds of Chemotherapy, one every three weeks, so she will be finishing Chemo at the end of February 2025, then the Oncologist wants to do bloodwork and scans again, and then have my sister schedule with the breast surgeon for the surgery.
Our concern is that my Sister just wants the breast removed already since the cancer has not spread to Lymph nodes or other organs. We do not understand why the Oncologist wants her to wait for all this time with a proliferative tumor. Why does she have to Shrink or attempt to shrink the tumor first? My Sister is upset and scared that the cancer will spread in the meantime. We are very worried about this approach. Are we wrong in wanting the surgery first, and do the Chemo after? Please advise. We are desperate to take care of this as soon as possible. I would appreciate all the answers, ideas, and suggestions we can get. Thank you, and sorry for the long post.

This is her report. Sorry for bombarding you with all this information, but we need help.

SPECIMEN:

720/24, left breast mass core Bx

CLINICAL DIAG:

GROSS DESC:

See Note

r/o malignancy

3 tan tissue fragments measuring up to 8x1 mm (AE,3c)

BIOPSY OPINION

See Note

INVASIVE BREAST CARCINOMA, NOT OTHERWISE SPECIFIED (DUCTAL)

Nottingham score

  • tubule score 3
  • nuclear score 3
  • mitotic score 2

total score 8

overall Grade 3

no DCIS seen no lymphovascular invasion seen tumour infiltrating lymphocytes present

IHC 56-24 (ER, PR, HER-2, Ki67 on block 3)

Estrogen Receptor (ER) Status: Positive (greater than 10% of cells demonstrate nuclear positivity)

Percentage of Cells with Nuclear Positivity: 61-70%

Average Intensity of Staining: Strong

Scoring System: No separate scoring system used

Progesterone Receptor (PgR) Status: Positive

Percentage of Cells with Nuclear Positivity

Blockquote

: 11-20%

Average Intensity of Staining: Strong

Scoring System: No separate scoring system used

2

Hello,
This time for your sister & the rest of the family is really stressful. I cant offer much advice. The only thing I can say is, please take the advise of what the team are saying to you/your sister. They are the experts, they know what they are doing, they do this day in, day out.
I had chemotherapy first and then surgery. I was diagnosed on 7th March and didnt start chemotherapy until 3rd May. Ive just had my results back and i had no node involvement and i am completely cancer free.
Trust the team x

1 Like
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Glitteryrainbow, thank you so much for responding. We are besides ourselves with worry. Your answer has helped me tremendously. I am very happy to hear that you are Cancer free. We will do our best to trust the doctor and the team.
I’m hoping that I can report back that my sister is cancer free as well.
Wishing you all the best,
XOXO

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This is similar to what I had so I’ll chime in. If they think the tumor is smaller, no spread apparent, yeah surgery is what they normally do first with a hormone positive tumor. Then they do an oncotype test to see if chemo is needed. Since her progesterone is on the lower side and she’s a grade 3, she’ll probably score high enough for chemo to be useful. So in saying that, a lot of times when they have a high suspicion chemo is needed they do perform chemo first. But usually not a long time. Like if nothing is in her lymph nodes, it should be at most four sessions of T/C three weeks apart. I’m not one to questions doctors and usually I’d say to go along with what the doctors say but in her case I can see the conundrum. Since hormone positive tumors have a lower response to chemo I would want the tumor out first, too, and then do chemo. I’d suggest your sister bring is some research about what is common treatment in the UK and the US for breast cancer and see if they’ll change the treatment plan accordingly. The only caveat I would say though is that all of that depends on how her surgery goes. If she doesn’t heal well, chemo can be delayed and that also isn’t good. After surgery you need to start chemo if needed within a month. So I’d consider that, too, if you want to fight for surgery to be the first step.

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Kay0987, thank you so much for your detailed response. Your answer is so so helpful. I truly appreciate the feedback from the wonderful people in this group. Every response means so much. I will pass all of this information on to my sister. She is too overwhelmed to join this group herself.
I hope and wish that your health is improving and you are in a good place with this disease. Best wishes, and I cannot tell you enough how grateful I am to you.
XOXO

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6

In the UK, chemo would be given first in higher risk situations. The main advantage being the ability to see how well the tumour responds to the chemo. If they find it has responded well, that also offers additional reassurance that the chemo will have worked on cells that may have already leaked elsewhere. If it doesn’t, they can move onto other things. A secondary benefit is that she may have more surgery choices when the time comes if it has shrunk her breast tumour. This approach is evidence based to give better results in anything but small early stage tumours.