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This question was answered on Thu 02, Oct 2008 06:59am by Dr Paul S, MD

Very small breast cancer; is not doing chemo safe?


    
Asked by eshinall (Female; 38; Recently diagnosed with 3 small areas of infiltrating ductal carcinoma, extensive DCIS and extensive LCIS. Had bilateral mastectomies on 9/11/08.; Relevant drugs:Just started Tamoxifen today (10/1/08). ) on Wed 01, Oct 2008 02:30pm

Hello, I am 38 years old, pre-menopausal, and was recently diagnosed with 3 small areas of infiltrating ductal carcinoma (IDC), and the largest spot was only 1 mm X 2 mm (ie. 0.1 cm X 0.2 cm). The other 2 areas were smaller. I also had extensive DCIS and LCIS so opted for bilateral mastectomies which are complete. The IDC was ER /PR , Her2neu- and Grade 2. 7 lymph nodes were checked on the side with IDC and were all cancer free (0/7 nodes cancerous). My other breast had the sentinel node checked and was also negative. There is some debate about whether the largest IDC had vascular space invasion, 1 pathologist says yes and 2 say it was something called 'retraction' and it was really vasacular space negative. The oncologist originally offered chemotherapy but after the 2 pathologists said it was vascular space negative, he changed his mind and put me on Tamoxifen only. My question is what would my prognosis be with or without chemotherapy in this instance? What would be my prognosis if I really do have vascular space invasion and they mis-diagnosed me and I don't get chemo when I really should have it? I am scared of NOT having chemo. I am a single parent and don't want metastasis or recurrence.
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Answer by Dr Paul S, MD  on Thu 02, Oct 2008 06:59am:

Hi. In general, microinvasive IDC's can derive very minimal benefit from chemotherapy. However, in your situation, you have three areas of these microinvasions and the data derived from clinical trials and studies may not apply in your situation. Also there is a question about the lymphovascular invasion and I believe it is better to be on the safer, but more aggressive side of treatment. Also, you have a triple negative disease (ER/PR/Her2 negative) which is believed to be a more aggressive set of characteristics. Moreover, IDC's diagnosed in young women (less than 40 years old) would also tend to be more aggressive. With all of these in mind, I would be more inclined to offer chemotherapy, but I would suggest you discuss this more in depth with your oncologist. Regards and God bless.

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Follow up:

Clarification by eshinall on Thu 02, Oct 2008 09:33pm: 
Hello, I must have mis-typed. My IDC was ER positive (50%) and PR positive, Her2neu Negative. I am currently
taking Tamoxifen.
Does the fact that 2 of the infiltrating areas were smaller than 1 mm X 2 mm make a difference in recommended
treatment?
My oncologist told me the same thing--that microinvasive cancer has only small benefit from chemotherapy. WHY?
Is that because the risk of recurrence is so small?
How many opinions should I take regarding the questionable lymphovascular invasion?
Please help.
Thank you.

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