Hi all, wondering if anyone can share perspectives on why hormone therapy may not be recommended for bc that is highly hormone receptive. I recently had a lumpectomy for a 16mm IDC with no lymph node involvement. ER6 / PR8 /HER2 negative at biopsy with ER 100% / PR 95% post surgery. No lymph node involvement. Was told about margins and Prosigna score etc in post surgery follow up and that radiotherapy is indicated but not hormone therapy. Initially was told grade 2 from core needle biopsies but grade 1 from post surgery histology (difference was overall score going from 6 to 5)
I was expecting radiotherapy but given hormone receptivity scores was also all set for hormone therapy too. Will get to discuss with oncologist in coming fortnight but would be keen to better understand how recommendations on hormone therapy are made before that. Might it be due to M1Bi (5%) and low Prosigna (24) score weighing in to overall risk benefit calculation.?
Sorry this is so long!
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It’s not long really ! Maybe it’s due to Prosigna and the other thing you mentioned . I had a 10 mm grade 1 stage 1 node negative with clear margins ER8/8 PR7/8 - I never had Prosigna etc. My Surgeon said that my predicted benefit from hormone therapy was very low though worth trying but it would be reasonable for me to stop if I didn’t get on with it. My tumour was also a type that rarely spreads outside the breast. When I told my Oncologist that I was wavering she ran through Predict 2 and hormone therapy only improved my chances of survival by 0.8% at 5 years to 1.3% at 15 years . When Predict 3 came out I ran my stats myself and it came out with something like 0.1% improvement over 5 years . I wasn’t able to take Tamoxifen due to my medical history but tried Anastrozole which I stopped after about 5 months over 3 years ago . I did have radiotherapy. Your Oncologist may feel differently- either way try to get them to explain it and if you’re not sure you could speak to your BCN or for someone impartial ring the helpline here .
It’s hard when you’re geared up for something to give yourself the best chance of avoiding recurrence but its a fine balance between preventing that and over treatment and for those of us who are low grade the risk / benefit ratio isn’t that clear especially if there are underlying medical conditions to consider . There are a lot of people out there managing on hormone therapy perfectly well but there’s also quite a few of us with significant side effects and some like me have stopped taking it . Of everything taking / not taking hormone therapy provokes very strong feelings - many threads on here about hormone therapy and quite a few arguments .
Try to get as much information about your particular case as you can . I hope that that your Medical team are in agreement as it just causes more stress for the patient when they’re not. Take care xx
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Thanks for the reply. On predict 3 I get less than 1% 15 year benefit from hormone blockers so that makes sense. I get even less from radiotherapy but it seems to be protocol if having lumpectomy rather than mastectomy.
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Having stopped the AI I’m glad I did have the radiotherapy . Unlike Predict which is all about survival radiotherapy can help prevent local recurrence I was told that it cuts the chance of local recurrence by 50% . Having said that as there’s no reliable way of predicting recurrence you’re left thinking 50% of how much ? However it keeps on working for up to 6 years apparently. Xx