What does it mean treating BC aggressively?

Writing on behalf of my mum who was diagnose with BC about a month ago. She has remained very positive since finding out and is ready to do whatever it takes to beat the cancer. I know deep down she is frightened because every now and then I get a glimpse of the fear in her eyes and it breaks my heart.
She read somewhere that if BC is treated aggressively enough then it can reduce the risk of a reoccurence. Is this true? And what does it mean by treating it aggressively?

Hi Kat77

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Very best wishes


BCC Moderator

Hi Kat
So sorry to hear you mum is having to go through this. I think that treating cancer aggressively probably means that after surgery, throwing everything at it. Depending on what grade the tumour is/was, whether it is hormone sensitive, HER2 sensitive or triple negative. In most incidences, this would mean chemotherapy (with herceptin if HER2 positive) radiotherapy, and if it is hormone positive, a tablet for at least five years. If there are lymph nodes involved, they would be removed at the same time as either WLE or MX. Sometimes they might be removed separately. it really depends on the situation and the type of breast cancer. When you both find out what treatment is necessary, and that treatment begins, she will feel less afraid as it is the not knowing that is scary. You are being a terrific daughter by trying to find out these things on her behalf.
Sending you both big hugs, and good wishes.
Poemsgalore xx

Hi Kat, I’m 42 and was diagnosed with grade 3 BC a month ago, not sure what grade your mum’s is but I was told that mine would be treated aggressively, in my case this means 8 x FEC-T, surgery and radiotherapy, there are women on here that are having 6 x FEC-T but lots are having 8 like myself which I think maybe needed for more aggressive grades of cancer although this is all fairly new to me too, but I’m sure some other ladies will be along soon to offer advice. We all know exactly how ur mum’s feeling and ur support will help her massively, as I would be lost without my son, hugs for u and ur mum;) x x

Hi Kat, I have been told the same and am led to believe it is to throw everything at the cancer and reduce the risk of reaccurance, take this as a positive has horrible as all this process is when we all come out the other side we will thank them all for everything being thrown our way. keep posting on here and let us all support you and your Mum as I am appreciating all the support I am getting All Best Wishes Meg x

Hi Cazzer.
Just to let you know my situation. Ductal Invasive, 3cm, grade 3, 100% ER positive, 70% PR positive, 3 lymph nodes removed, 1 containing cancer cells, and vascular invasion. I had MX and SNB. chemo, 6 Fec-T. I refused rads due to a lung condition but was told that because of MX less than 20% risk of recurrence but 50% risk in lymphs, for which i could have ANC. I am now taking Anastrozole for the next five years at least.
As you know, grade 3 is the most aggressive but as you are younger than I am (62) you might have been offered more chemo sessions. I’m not sure about that though. Good luck with your treatment.
PG xxx

Thank you to everyone for your response.
Mum is having chemo before surgery, as her grade 3 tumour is too close to highest wall and they don’t think they will be able to get clear margin if they operate now. She is having 4xEC and then 4xT plus Herceptin. Would this be considered aggressive treatment? Doctor said mum might not need radiotheay but will make a decision when shes finished her chemo. Should i suggest to have it anyway just to kill off any stray cells?
I have been doing lots of reading to have a better understand of BC so I know what to expect during mums treatment.

Hi Kat. My response is pretty much the same as everyone else’s ‘throw everything at it’ I’d say.
It’s too early to say wether rads will be needed as your Mum is having chemo first it may shrink the tumor considerably she may not need it. Just take each day as it comes and keep coming here where you’ll get great support from lovely women who know what you and your Mum are going through.
One request! Stick to this site and Macmillan for information as Google can bring up American websites or out of date info which can be misleading or incorrect.
All the best and keep in touch
Emma xx

Thank you for your post, Emma.
Yes I have only read info on official websites. I know there’s a lot of misleading information on the Internet. I knew nothing about BC before mum’s diagnose. During the first couple of appointments with mums doctor I had no idea what they were talking about. Now I am better informed especially since joining this forum so thank you to you all lovely ladies.
Kat xx

Hi Kat
Yes, I would say the chemo your mum has been offered is treating her cancer aggressively. You don’t say how old your mum is, but in my opinion, after she has had surgery, ask the oncologist or radiographer what percentage of risk of a recurrence your mum has at that point before deciding on whether to encourage her to have radiotherapy or not.
As I mentioned above, I had surgery (MX and SNB) then chemo. It should have been 3 FEC followed by 3 TAX but ended up having 3 FEC, 1 TAX, then 2 more FEC. When it came to deciding on radiotherapy I asked what my risks of recurrence were. Because I’d had MX I was told less than 20% risk in chest area. Because I had nodes affected, 50% in lymphs for which I could have Axillary clearance. So, no radio. I didn’t really want it as I have a lung condition (Bronchiectasis). As my tumour was Oestrogen and Progesterone sensitive, I am now taking Anastrazole for at least 5 years. But I was HER 2 negative, so Herceptin wouldn’t have done me any good.

Wishing you and your mum all the best.
Poemsgalore xx

Interesting to know that radiotherapy can possibly be avoided. My surgeon presented it as a given. As I’ve had a mx and ANC, and will be having chemo, perhaps I’ll think carefully about radiotherapy. I’ll see what my Onc says, when I eventually get an appointment, but there’s no point in overkill (sorry!) - belt and braces all very well, but why put yourself through treatment which may not be that beneficial? I realise that every case is different, but options are important.
Annie x

Hi girks in my case been told radiotherapy very beneficial , as good as chemo, also tamoxifen very beneficial. Obviously everyone’s different but I’m going to have it all xx I’m still too hot Annie , been in garden and laying on top of bed now, still got ga head!! Hope it’s gone by morning xx

Hi all,

I’m two years past treatment now so don’t post much, but I had FEC-T, three of each. I might be wrong, but I think when they give four of FEC and four of T (as seems to be getting more common) it’s the same total dose as having three of each, but treatment is a slightly lower dose so is more easily tolerated and gives fewer side effects.

As I said, I might be wrong but I’m sure I read that somewhere. :slight_smile:

Jane xxx

Thank you all for your responses. I am learning so much since joining this forum.
The oncologist said that if mums tumour shrink small enough she might be able to get away with just having WLE but mum is thinking having a mx, as she thinks as long as she has her breast the risk of recurrence is there.
i feel I need to find out as much as I can so mum can make a informed choice.
Kat xx

Another question. Sorry if I sound a bit stupid but can secondary BC only happen if you have a recurrence? From some of the threads on the forum it sounds like you could be in the clear and then go on to develop secondaries, or maybe I got it wrong.
Kat xx

Meant to say earlier if I’d had mx not wle he said wouldn’t necessarily need radiotherapy

What a lovely daughter you are!
You will find that the more you learn about bc, the more you realise what a complex disease it is!
Many different characteristics can deem a bc to be termed aggressive, and as such be treated more aggressively - the type of bc it is, ie IBC, the receptors it has ie ER/PR-, HER2+, or it is TN - these are all aggressive factors. Then we get into the stage and grade, lymph node involvement, vascular invasion…
Generally radiotherapy is not required following mx, nor if less than 1 lymph node is involved - it is not given as with all treatment there is risk of long term damage.
Be assured your mums oncologist will treat her in the most appropriate way.
PS - Bc is a sneaky begger, it can lie dormant for decades only to reappear. And then it all depends on how it reappears and whether it has spread outside the breast or axillia. Sadly, once it escapes the breast or axilliary nodes, then that is what is termed secondary bc, and that is only treatable, not curable…
Good Luck got your mum, Sue xx

I am not an expert, but as far as I have gleaned …

After you have the cancer surgically removed and treated, it is possible to get a local recurrence, ie maybe a teensy bit of the same cancer has got left behind and grows again. This can happen after a wide local excision (lumpectomy) or even possibly in the scar area following a mastectomy.

However, if this original cancer comes back, it is often undetected until after it has spread, ie developed secondaries, or metastatic cancer. If it has only spread as far as the nodes, I believe it is not considered metastatic. Metastatic cancer in the body is still “breast cancer”, whether it forms tumour in the liver, lungs, brain or wherever.

The other possibilty is a new primary. And this can be in the same breast after a lumpectomy, or in the other, previously healthy breast. This new primary is a new distinct cancer in its own right, and may or may not have the same characteristics as the original.

Once you have breast cancer in one breast you have a very slight increased chance of getting it again (ie a new primary), to the order of 3-4% higher than if you’d never had cancer. I believe this risk is higher in ladies with Triple Negative cancers, and for those with the genetic disposition the risk is multiplied considerably.

If I have got something wrong, which apparently I frequently do, please somebody feel free to correct me!

You have explained all this really well. The only thing I would add is that it is also possible get metastatic cancer without having a local recurrence. If this happens, the breast cancer just comes back somewhere else (eg bone, liver etc).

Hi Kat,
Hope you and your Mum are keeping positive. I was in the same situation as your Mum when I was diagnosed 6 years ago - the tumour had attached itself to the chest wall so I had to have chemo first prior to surgery. Mine was grade 3 and as I was only 35 I was assured I was being treated as aggressively as possible. In my case this meant chemo of 4xAC then 4xT, followed by surgery and then radiotherapy. I was HER- so didn’t get herceptin, but was ER+ and have been on tamoxifen since January 2008. There was some discussion about whether radiotherapy was necessary following MX, but the decision was made to go for it anyway. I’m not too clear what the justifications were - by this point my brain was fairly fogged - but I believe it was to do with the location of the tumour being so close to edge of the breast tissue and attached to the chest wall it was felt useful to irradiate the chest wall. As others have said, radiotherapy carries it’s own risks, including possible permanent lung and heart damage, so I’m sure your Mum’s oncologist will weigh the risks against the benefits before recommending a course of treatment.
I originally had a WLE but there were a couple of other areas of dodgy tissue that had developed in my breast in the meantime which turned out to have cancerous or at least pre-cancerous cells, so I had to go back and have a MX. If I’d actually been given the option I don’t know if I’d have gone for MX but having had one I’m glad it’s gone. It’s a very personal decision and I don’t know statistically if MX gives you a better chance of avoiding a recurrence or not. Sadly, as I have recently discovered myself, even a MX does not guarantee you will not get a local recurrence of the breast cancer.
Sending you and your Mum lots of positive vibes and good wishes, and hoping for the best possible outcome.