Would chemo have helped my sister ?

Hello All
I was diagnosed in December with Grade 2 Invasive Ductal Carcinoma, I had a lumpectomy and SNB and have just started a 3 week stint of Radiotherapy.
I lost my beloved sister to BC in November. She had been diagnosed initially in 2001 with Stage IIB/Grade 1 Invasive Lobal Carcinoma, the lump was 70mm and no nodes were affected. She had a mastectomy and reconstruction and radiotherapy. She was prescribed Tamoxifan for 5 years but stopped taking it after 18 months due to side effects.
Her cancer returned in 2010 and had spread to her bones.
What I’m wondering is, due to the size of her lump should she have had chemotherapy ?..I was shocked that she had stopped taking the tamoxifan as I hadn’t realised this ?
I thought that for a 70mm lump she would have been given chemo, and I wonder if her chances would have been better if she had had it ?
I’ve only just found her original diagnosis after clearing her flat.
Many thanks in advance

Dear Feebs

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Hello Feebs,

Firstly, I am so sorry to read fo your sister’s death, and of your own diagnosis with breast cancer.

I don’t know the answer to your question, but I do know that my own team said on day one that whilst they were treating with curative intent, they could give no guarantees. It is impossible to say that if your sister had had chemo she would not have developed seocndary cancer; almost all of us know, or have known, people who had everything and it still came back. We also know people who had ‘poor prognosis’ and go on to live long, healthy, cancer free lives.

As far as I can ascertain, tumour size is, of itself, not the most important factor inmaking a decision for chemo, grade and node status are far more significant. With a grade 1 tumour and no evident nodal involvment, there would, on average, be far less benefit from chemo than if it was, say, grade 3 and 1 node involved. My understanding is that unless chemo will give a predicted 3% absolute increase in survival to five years, the risks outweight the benefits, and it is not indicated; for most grade 1 tumours, the potentialo benefit will be far lower than this.

Try not to let the ‘what if’ fairy (who is very evil) plague you with doubts and questions. Your grief is still raw, and your sister gretaly missed. Nothing now can change the outcome, and worrying unduly about ‘might have beens’ risks causing you unhappiness and anxiety you really don’t need. Your love for your sister shines out of your words - and that’s why you are asking these questions, I understand that, but please try to focus on the legacy of love and happy memories as much as you can.


Hiya, I’m sorry to read about your own diagnosis and that you have already lost your sister to breast cancer. I imagine that it must make it even harder to face it yourself now. I agree that a 70mm tumour is quite a size, and your sister would most probably have been offered chemo if it was a grade 3, or probably even angrade 2 cancer. However, grade 1 cancers do not usually respond as well to chemotherapy, the cells don’t turn over as quickly and chemo hunts down fast turnover cells, so grade 1 cancers don’t always respond to chemo. If she was highly oestrogen positive then she might have gained more benefit from the tamoxifen than through chemo. The other option is that she may have been offered chemo but refused to have it. This happened to my friends auntie who was in her 30s when diagnosed. She had surgery but refused to have the chemo , radiotherapy or tamoxifen as she was too scared. She developed secondary cancer and died, leaving two teenage children who then moved in with my friends family. Her mum only told my friend about this when I was diagnosed , as my friend was terrified that the same outcome was inevitable for me. They were protecting them from thinking badly about their mum/auntie who had died because she didn’t accept the treatment. I’ve no idea if this may have happened for your sister too, we don’t know what her team recommended. It doesn’t follow that she died because she didn’t have chemo, and that yo are therefore similarly at risk (I’m not sure if thismis what you are thinking butni know I’d be driving myself mad thinking that!), your medics will have assessed the right thing for you based on your pathology and circumstances. Of you are unsettled, and are wondering whether you should have had chemo, why not ask for a second opinion? Grade 2 cancers are odd ground, some are more like grade 1s and some more like grade 3s. I’m not sure I’ve helped, I’ve confused myself!

As the others have said, the grade and node involvement are far more important than tumour size when it comes to deciding about treatment. Also I think people tend to underestimate the benefit of tamoxifen. That can make a big difference. But in all cases we are talking about statistics, which are about large groups of people, not individuals. You cannot 80% live - you either live or die. Sorry to put it so bluntly, but that is how it is. Having an 80% chance of surviving still means that 20% will die - the 80% survivial rate is of no comfort at all if you as an individual fall into the 20%. And no-one can predict which side of the line any of us will fall. All we can do as individuals is do everything we can to increase our own personal chances - both in terms of medical treatment and lifestyle choices.

Thank you all so much for your replies. I think I was just driving myself a bit mad thinking ‘what if’ in terms of my sister, she was initially diagnosed in 2001 and didn’t let us into all the details of her diagnosis and treatment. I’m not sure if she was offered chemo, but I know that if she was she would have resisted it as she had a lifelong phobia of vomiting (bless her).
I’m just grateful for the advice you’ve all given me as I had thought that as she had quite a sizeable lump that she would have been offered chemo but as you all say, all treatments are different and there are all sorts of different things that are taken into account.
I’m just at the start of my radiotherapy and feel very lucky to have been caught early (19mm lump, grade 2 with no nodes involved and clear margins), but my sister’s death is still very raw, I actually got my results the day after her funeral and was imagining the very very worst.
Thank you all again so much for your responses, it really helps me make sense out of it all xx