I think this will be of interest to those querying the 6 FEC regimen v. 3 FEC 3 Tax regimen. It comes from the American website breastcancer.org but quotes a long term study published in 2009 in the Lancet which was conducted here in the UK in a Phase 3 trial involving 4,100 women.
breastcancer.org/treatment/chemotherapy/new_research/20090515b.jsp
It is worth looking at some of the other studies which suggest that the addition of TAX maybe beneficial, in ceratin circumstances. Look for the links on the right hand side. Near the bottom under research news.
Hi girls
This post is great for me - I’m seeing my Oncologist tomorrow with exactly this question! I was diagnosed with Grade 3 invasive, 5 out of 12 nodes involved. Had mastectomy and full node clearance. My Onc prescribed 6 X FEC, always wondered why no TAX as i’d heard this was prescribed with node involvement. Am coping well with the FEC so am in no hurry to try TAX but … even if it gives me a 1% better survival rate I would take it! It is all so confusing and scary! Lynne
Cherry Orchard
thanks for the link. Its very reassuring for me as finished FEC x 6 two weeks ago and because I am now entering a stage where I am questioning everything that has happened, ‘what -ifs’, have I done everything possible? (basically I am entering a ‘bonkers’ stage!)
I was node negative hence just the FEC but always had the thought ‘if only I could have tax then I would HAVE done everything’.
I am now reassured that my treatment was appropriate and that by simply having the chemo (along with mx and tamoxifen), that I HAVE done everything.
Karen xx
What an interesting thread.I was dx with tnbc when I was 62.It was 2cm,grade2 and had no node involvement and no vascular invasion.It just so happens that,at that time, I had health insurance[a cheap minimal policy with AXXA].Because I went private the oncologist said he was able to prescribe taxotere and also neulasta to help wbc.At the time neither would have been available on the NHS.
When I went for my first chemo the chem nurse said,‘I do wish all of our breast cancer ladies could have fec-t.’
Later the oncologist said that for tnbc tax had proved so good that NICE sanctioned it on the NHS,for primary tnbc, before all the trials were complete.
I am so very grateful that I was able to have it,hard though it was.
Now he [my onc] prescribes it for any tnbc with node/lva or over 2cm or Grade 3.I do fear that some PCT may use other excuses to withold tax when financial constraints are uppermost.
Vx
Lynne, You should still ask your Onc the questions you have on your treatment. The NICE guidelines which stated that Tax should be made available to women with node positve BC was published in Sep 2006. The study published in the Lancet is from May 2009.
Karen,
Glad you found the links helpful. I was much happier when I found these studies as I wanted reassurance that 6 FEC was the right way to go for me. Now I know it is plus I avoid the TAX SEs, I have enough dealing with FEC SEs. There are other studies that suggest that Tax may still benefit some small groups of node negative BC but from what I have read they have not been able to find a clear explanation for this. More studies needed I think.
hmmmm … just back from the Oncologist … still none the wiser really! Although I did find out that I am stage 2 (which sounds bad to my ears) but I am hormone positive (which she said is good as tamoxifen will work).
However, she said she couldnt tell me the answer to my question (which was basically, is this thing gonna kill me?!!) She said that research showed FEC was the best regime for me - she wouldn’t use TAX unless it was metastatic. As my tumour was less than 2cm and they did the surgery very quickly, removing the tumour and affected lymph nodes, FEC will be enough to ‘mop up’ any stray bad cells, and they are also going to zap the area with radio therapy after.
The best thing to come out of the appointment was that she agreed straight away to my request for a 2nd CT scan once treatment was finished. She said that it was not the normal thing to do but to put my mind at rest she would send me for another scan, which I am so happy about as I thought it would be a point-blank no due to cost 
Lynne,
I think you might mean you were grade 2 not stage 2. They don’t seem to go in for staging that much here, not like in the US. It really doesn’t tell you a lot more, IMHO. You can look up Grade 2 on this website. I would think, as she didn’t mention Herceptin, that you are HER2 negative, also.
All cancers are different and unique to that person, so there is no way that you oncologist could give you a definite reassurance about the eventual outcome of your disease, but being Grade 2 is definitely better than Grade 3 in terms of outcome.
I hope the second scan is neagtive and you can at least put all worries on that front out of your head while you are having chemo.
Hi cherryorchard
It’s definately stage 2, although im not sure if finding that out has helped me any (i just knew i didn’t want to hear stage 4!) My Onc told me that the stage and grade are totally different things. So it’s stage 2, grade 3 invasive ductal. She said herceptin wouldnt be helpful for me, but seemed to think that tamoxifen was a bonus for me, and gave me a better prognosis.
She was really positive but you’re right - she cant give me a definite reassurance that everything will be OK 
Hopefully once my chemo and rads are complete, I will get a lovely clear MRI scan, and get on with my life Lynne
Lynne… stage 2 is either larger than 2cm (which yours isnt) or has affected lymph nodes, which you have… its still very treatable and curable at this stage.
cherry orchard… i had genetic testing midway through chemo… so no reason why you cant have it… ask for a referral to genetics and leave it up to the genetic team to decide when is best for you to have tesing if you fit the criteria and indeed want to proceed… depending on the age of onset of the breast cancers will depend whether you get tested as although there are four breast cancers over 3 generations your paternal grandmother didnt have it… but it makes me mad when GPs get it so wrong… most referral guidelines state clearly that breast cancer can be inherited through the paternal family history… mine is through the paternal side too… mum had BC at 57 and no family history on dads side so after i was found to be BRCA2+ they tested mum but she was neg… then tested dad and he was pos.
everybody has 2 brca 1 and 2 brca 2 genes… but in people with a mutation they have a good copy and a bad copy of the affected gene… you inherit one copy of every gene from your mum and your day… giving you 2 genes… if dad has a faulty brca2 gene this means he has one good copy and one bad copy… so every child he has will either get the good copy or the bad copy… if they get the bad copy then this means they inherit the brca2 mutation and have a high risk of breast and ovarian cancer… dont mean to offend anybody if you already know that.
stella my family history is all strokes and cardiac disease so like you breast cancer just wasnt on the cards… infact in 5 generations of our family including all the cousins 20 times removed and i am the only one with breast cancer… it actually looks so odd that nobody else on my dads side of the family developed it even at age 80!
Lulu xxx
Lynne,
I’m similar to you - just finished 6 FEC, for a node positive (3/13) ER+ 18mm tumour. I wasn’t offered TAX (apart from when I had an allergic reaction to the FEC initially) and also didn’t get any scans at the beginning (apart from a heart scan). I have asked if I can have some once my rads are finished. I think it was probably down to the cost. Maybe they’re more tight with their money up here in Scotland?
Al x
I finished courses of FEC 5 weeks ago for secondary breast cancer and had a soft tissue ct last week. Get the results tomorrow.
Hi Al, aye us scots are grippit lol! Where are you being treated? I am at Ninewells in Dundee and Perth Royal Infirmary. The care has been fantastic :d
Good luck veggiebab for your results, the waiting is torture eh. I hope you get a good result
Thanks Lulu - that is exactly what i wanted to hear ‘very treatable and curable’ I like this!
Lynne - i got my surgery and chemo at St Johns in Livingston, and have just started rads at the Western in Edinburgh. I know Ninewells well though - was born there and lived just down the road from it for 18 years…
No herceptin for me either but I do have to start tamoxifen now. Going to leave it a couple of days until I feel better though…
Good luck with your treatment - are you still on FEC? I finished that 3 weeks ago. Phew.
Al x
Hey Al
Small world … i used to work just up the road fae the Western in Edinburgh, at a Shell garage, whilst i was at college at Telford ;D
Aye still on FEC, halfway through now - side effects have been minimal, actually worried it aint working as i feel so good!
Does tamoxifen have side effects? HOw are you getting on with yer rads?!
Lynne x
Lynne - I’ve sent you a PM.
Al x
Hiya Lynne
tamox can have side effects for some folk…the main ones are menopausal type symptoms like hot flushes and night sweats… they tend to be worst within the first few months and then settle down a bit but some people have very severe flushes.
other things can be changes in bleeding pattern… this usually needs investigated due to the very small increased risk of uterine cancer from women who have taken tamox.
there is an increased risk of getting a blood clot too… again its a tiny risk but its there.
btw i used to work at the western and i know the garage your talking about.
Lulu x
Lynne, I stand corrected on the stage/grade thing. I would be a stage 2 also as my tumour was 2.5cm. More specifically it would be a stage 2a, but I worked it out myself as my onc doesn’t do staging. There are so few references to stage of cancer on the forums (except sadly, stage4)that I think many oncs may not do it for early BC. Anyway, as Lulu said it is an early breast cancer for both of us so we still have a good chance of the thing never coming back again. BTW, I have some connections to Edinburgh, also. My grandfather was born just off Dairy Road, nr Haymarket. All that side of my family are from Edinburgh, Dalkeith, or Newbattle.
Lulu,
My sister, who had bilateral disease, developed her first tumour at 41 and a new primary at age 46. My father died from sarcoma at age 37. Given this history it may possibly be Li Fraumeni syndrome, or Li Fraumeni like syndrome. Even if they will not test for this I am determined that my daughters are acknowledged as high risk so they get regular screening at an earlier age. I have been looking at having the Brca testing done privately if they come back and say I don’t need it.
Hi Cherryorchard
you say your sis got BC at 41 and 46 and you got it 56… not sure what age your pat aunt was but if she was over 60 this would equate to 18 points and they usually would want you to have 20 based on 1st and 2nd degree relatives but you great aunt could possibly be taken into account.
there is also a research trial called the genetics of familial breast cancer study (called BRCA3 study) which also checks for the main changes in brca1 and brca2 so even if your family dont quite fit the criteria for laboratory testing they will fit the criteria for BRCA3 which is 3 invasive breast cancers.
i think based on the info you have said that your daughters would be considered high risk in most units and this would include annual screening from at least age 40 but possibly earlier.
btw Dalry is just round the corner from my work.
Lulu xxx
Hi Lulu,
Thanks for the info on where I am on the points scoring for at risk.
My aunt, my father’s sister, was younger than I was when she developed BC, either 50 or 51, perhaps earlier as I know she had finished her treatment when she came to visit in 1986 and she was born in 1935. I can’t ask her for the exact date as she cut herself off from the rest of the family soon after this; nothing to do with me I hasten to add.
This side of my family is riddled with cancer. Not just my father who died from a sarcoma when he was 37, but his brother, my uncle, died from leaukaemia the year before at age 32. I have always understood that the type of leaukaemia he died from was unusual as it was an acute form normally seen only in young children. My grandfather died from prostate cancer, although he was 80 at the time. His mother died from cancer at aged 64 but nobody seems to know which type. My father’s mother died from melanoma but was ripe in years and her mother from thyroid cancer, but again she was older, aged 78. Those are just the ones I know about. Just remembered, I have another cousin on the paternal side who had Hodgkins in his early 40’s and is now being treated for lung cancer.
I have very real concerns for my two daughters and want to see them screened from an earlier age, but first I need to get someone to acknowledge there is a problem. Something is going on in this family. I have another sister who is fortunately cancer free but she has been moved to annual screening in the light of my diagnosis. She is a nurse and lives in the US so that may have influenced the decision to screen her annually.
Do you have a web link that will take me to the BRCA3 study?
You work near Dalry, it’s a small world. My grandfather lived in Caledonian Place, just off the Dalry Road.
Hi-hope you don’t mind me joining.
I have had 3X fec and have 3 tax to come starting tomorrow. Would love to know about the BRCA 3 trial as every woman in my mum’s family has had BC before aged 45 for last 100 years +. My mum was 29, then 34, her two sisters were 44, her four cousins and 2 aunties were also early 40s and her mum and grandma 41. I’m now 40 and have two teenage girls. Mum and her sister (the only two survivors sadly) have had genetic testing and do not have BRCA 1 or BRCA 2 gene. I am going to be tested after chemo. Have seen genetic counsellor and she agrees the incidence is too high for there not to be a gene but they can’t identify it yet. meanwhile i am pushing for double mx as i feel it would significantly reduce my risk of another primary a few years down the line. Onc not keen and says I am a young woman blah blah blah… Yes and I want to be an old woman one day mate!
Any and all advice very welcome
Rachel x
PS Lynne -glad to find you on here. Missed you on May thread x