How do they decide if you need chemotherapy? I assume if the bc is triple negative, they have no other option, but if it isn’t, is it dependent on Grade/Stage? What about age? I keep reading about ladies being borderline. What age is that? I am 55. I know I shall find out eventually, but there are so many questions that keep popping into my head, and it really helps to get your opinions.
Ann
They use an online calculator, called Adjuvant Online. You have to register as a doc to use it, but there is a similar one here:
cancer.lifemath.net/breastcancer/therapy/index.php
You can input the details of your condition (age, grade, stage etc) and it works out your prognosis with and without treatment. They will make their recommendations based on this - I’m not sure what percentage they consider ‘borderline’ - this may vary from oncologist to oncologist… if anyone knows, please tell me!
But ultimately it’s your decision and depends on what those percentages mean to you in your personal situation.
That sounds scary!
Hello Ann!
Well, in my case it has ultimately been my decision with strong hints from Oncologist that I should and originally feelings from my surgeon that it wasn’t neccessary!! I am the exception though as I was so borderline!!
Basically it depends on the tumour size, node involvement, grade of tumour, whether there is vascular invasion, the hormone positive status of the tumour and your age. This is all inputted into adjuvant online where the % benefit to you of chemo is calculated
Then, it seems, it also depends on where you live! Some health care trusts will only offer chemo if there is more than a certain percentage of benefit!
Anyhow, I am seeing my oncologist tomorrow to set up dates to start FECx6. I’m 37, had a 13mm grade 2, no vascular invasion, no nodes involved, ER+ and PR+.
I have felt so at ease now I know what my treatment plan is. I hope you get your answers soon and that this may have helped a bit.
Positive vibes,
Al
x
Hi Al,
Again, so sorry to hear about the burglary, but glad you are feeling better having made your decisions and having a plan.
Can you remind me what your ‘borderline’ percentage was? What was their reasoning behind it do you know?
Mine is not borderline, so both surgeon and onc. are recommending chemo, however due to issues in the past (I watched my dad go through lung cancer when i was a kid) I need more time to think about it and they are supporting me on this as there are emotional issues as well as physical.
x
I had almost identical results to Al above, but I was 44 at the time and had a friend who had same results ,she was 52 and chemo wasn’t even mentioned to her and we have the same onc.
I already had good prognosis with my 10 year survival stats being over 92%, the chemo only gave me an extra 3% and I had a 2% chance of kicking the bucket through an accident or non cancer illness. I was told I was borderline,they weren’t advising me to have chemo but I could have it if I wanted. Bit like when I was told could have a WLE or could have mastectomy if I wanted. I took the view that if they really thought something was necessary they wouldn’t have given me the choice but advised me accordingly. Im happy with my decision but it is something that is totaly down to you and you have got lots to get your head around. Good luck with your treatment.
Sandra x
Hi Ann
they make decisions, with you, based on what the pathology of the lump is, as Al was saying. first time out I was an easy ‘no’ with grade 1(not aggressive), stage 1 (no sign of anything elsewhere, including lymph nodes, 9.9 mm lump ER+ (responds to oestrogen).
Sorry if it sounds patronising putting all the definitions in, but sadly, cancerspeak becomes a second language and if you are new to it, thought that might be helpful. Definitely NOT patronising you!
anyway, this time I’m an easy ‘yes’ with recurrent cancer, grade 3 (most aggressive grade) 19.9mm lump - still no sign of spread and still ER+. both times had DCIS.
I have never heard of it being age related, but if it were, 55 is far too young to be anywhere near that. We are just babes! (I am 50)
anyway, hope it goes well for you - be thinking of you
take care, love, Monica xx
Hi again,
Gardenbeetle, I have a 3.2% better survival rate with chemo over just tamoxifen and rads. My hospital recommend chemo at 4%. However as I am under 40 it kind of weighted my 3.2% if you see what I mean.
I also took the view that if there was even the remotest chance of a rogue cell floating around my body that chemo could zap where tamoxifen couldn’t that I would take the chemo, side effects and all.
Hope that helps.
Al
xx
Hi all again,
the age thing is just me repeating what my oncologist said. It is a factor when caluclating the benefits of chemo. The younger you are the greater the benefit, so my hospital offer chemo to all under 40. Hope that clears that bit up!.
Al
x
Hello
I am such a nugget sometimes - I forgot about the age thing from that perspective - I thought of it from an ageist perspective!!! not sure if thats chemo brain or a premature chip on my shoulder LOL
forgive silliness…
love monica xx
Thanks for all your help.
Sandra - So did you choose not to have a mastectomy or chemo? Couldn’t quite tell from your reply.
Reading various posts, I get the impression that if you are post-menopause, you are less likely to have chemo. Hence my question about what age they may decide is post-menopausal, since it varies so.
Any post-menopausal ladies out there who have, or not had chemo, and the reasoning behind it?
Thanks, again.
Ann
Hi Ann, I opted for WLE , my lump was only 15mm and I have big 40e boobs so having a WLE hasnt changed them much in appearance at all I’m happy to say. The surgeon said that rate of reoccurence is same whether you have mastectomy or WLE plus rads. Didn’t see the point in losing the whole lot if I didn’t have to,and think pyschologically that is a lot easier to deal with.He also said that when given the choice it’s 50:50 what women decide,some feel that everything must be taken away to give them peace of mind,whereas others want to keep as much as possible. It is good in a way to be given the choice but like with chemo I would much rather they just told me what to do ! As I didn’t get advised to have chemo but given the choice ,looking at all the pros and cons I didn’t feel that 3% benefit outweighed the associated risks,different if it was over 5% but then it is a personal thing,some people will take it even if it only gave 1% increase in stats. Whatever decisions are made it’s still a hell of a thing to get your head around,but onwards and upwards,I’m out the other end and looking forward to puting the madness of 2009 behind me.
Sandra x
Sandra
So glad you are able to move on now. I had started to get my head round WLE, until they told me they had found more. Each time I go for an appointment, it gets worse. I thought that as the original lump was fairly small, it would be fairly straightforward - but no. I am not well endowed like you are and so whatever they do will notice, but I am one of the 50% who wants to hang on to what I have, if possible. One gets rather attached to them!
Sorry, did you say when you were diagnosed? How long has it all taken?
Ann xx
Monica
No, I don’t think you are patronising. The terminology does take some working out sometimes. I have tried to find out as much as I can, and I shall be able to ask, and sort of understand, about my actual results, with help from this site. Everyone is so kind.
Ann xx
Ann, I was diagnosed January,op February,started tamoxifen April,finished rads May,diagnosed with lymphodema August…phew !Am back up and running with most things now,but still have occasional twinges . Looking forward to potting up my tubs with spring bulbs.
Sandra x
i’m a 34 B (always thought I was a 36A) and I had a quarter or so removed but I still have both by breasts or 1 and 3/4 anyway. I also didn’t have chemo although premenopausal when diagnosed aged 48. I had low grade cancer and a smallish tumour with DCIS.
I am still here without a recurrence 5 years later, I’m glad I didn’t have chemo as it has risks of later cancers and it is unpleasant and I didn’t want to have prolonged treatment over another six months not to mention hair falling out(although it soon grows back). I wouldn’t have liked all the idiots saying my head was a great shape - it isn’t I’d just have looked bald
Mole
Mole
Thanks for that. Do you pad out your bra to make them match? I am a similar size but not yet sure what they are going to do. I wondered if I put on weight whether it would help. I am on the thin side at present.
Ann
Hi Anne
I am post menopausal - 52 and have been advised by my onc to have chemo (3 x FEC & 3 x TAX) this is because I had three lymph nodes positive for cancer. Having chemo improves my stats by 9% so well worth it - with AI and Tamoxifen increases to 16%. Hate the thought of all the side effects and other risks but want to see my future grandchildren so going for the lot. Rads too as only had WLE - tumour was 5cm - large and vascuar involvement. Best wishes and hugs to you all - Lyn xxx
Hi there
I’m 57 and post-menopausal and had chemo last year. I was dx with IDC, 3cms, ER+, PR+, HER-, 3/24 nodes affected. I was just told I needed chemo, rads and femara. It’s automatic if nodes are involved.
Mal
I was 60 when diagnosed and had a 12mm tumour, and 2 positive nodes. ER+ PR + HER2 +++. Because of the positive nodes I was offered chemo but the onc pointed out that it is less effective in older women - they said it would add 4% improvement.
I decided to have the chemo as I wanted to feel that I had done everything possible to get rid of the cancer. So I had WLE & ANC, 3 x FEC, 3 x Taxotere, 18 rads, a year of Herceptin and am now on Aromasin.
Best wishes
Anthi x