What Are My Chances?
Much of the time, it is clear and straightforward whether or not a woman needs chemotherapy for newly diagnosed breast cancer. Someone with a 4mm low grade, ER positive, node negative tumor is not going to need chemotherapy; hormonal therapy will be enough. Someone with a 3 cm high grade, triple negative, node positive tumor is surely going to be told that chemo is in order. But there are gray areas in between and women in those areas struggle to make the right decision. I met yesterday, as an example, with a woman who had a small primary tumor but turned out to have one positive lymph node; she and her doctors are awaiting the results of an Oncotype DX test, and, hopefully this information will make the choice more clear.
When I talk with women who have been told that it is "six of one and half dozen of the other" (actually, I doubt that an oncologist ever says exactly that) re: chemo, it is brutal to make the decision. Often I suggest that someone identify what, for her, would be the worst possible outcome (for some, that would be opting out of chemo and later having a recurrence while for others it might be having chemo and later developing a rare and horrible long term effect), and then make the choice that avoids that situation. Other times, I have described my grandmother's technique for making hard choices: flip a coin. The secret is that it is not how the coin lands, but how your stomach feels about the way it lands. Sounds ridiculous, I known, but it usually works for me.
This is an article from Cancer Net about using a genetic test of predict recurrence and, therefore, help with this decision:
Calculating a Recurrence Score Helps Predict Survival for Patients With Breast Cancer That Has Spread to the Lymph Nodes
Using a specialized 21-gene test of a breast tumor's genes, researchers found that the result, called a Recurrence Score (RS), predicted the prognosis (chance of recovery) for patients with estrogen-receptor positive breast cancer that has spread to the axillary (underarm) lymph nodes. Previous studies have shown that these 21 genes help predict the risk of recurrence (cancer that comes back after treatment) and the risk of death from cancer for women with breast cancer that has not spread to the axillary lymph nodes.
In this study, researchers examined the tumors removed during surgery for 1,065 women with estrogen-receptor positive breast cancer that had spread to the lymph nodes who had received chemotherapy plus hormonal therapy after surgery as part of a previous study. Then, the researchers calculated a RS based on the 21 specific genes in each tumor. A low RS is associated with a better prognosis and a high RS is associated with a poorer prognosis. This RS was then compared with how long each patient lived after diagnosis.
Researchers found that 76% of the patients who lived at least 10 years with no signs of the disease had a low RS, compared with 48% of those with a high RS. They also showed that 81% of the patients who did not have the disease return in a distant location within 10 years had a low RS, compared with 56% for those with a high RS. In addition, 90% of patients who lived at least 10 years after diagnosis had a low RS, compared with 63% for those with a high RS.
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