I had a lumpectomy followed by 4 rounds of chemotherapy and I will also have 5 to 6 weeks of radiation on my left breast and people are still wondering if I am going to have my breast removed. The answer is simple- It is NOT necessary. I do not need to lose my breast especially with the type of breast cancer I have which is Estrogen positive. It is easier to control than estrogen negative.
I do not really understand how come people that are otherwise well informed are still expecting me to have my breast off. The survival rate is not even better in my situation. Is it the media? What makes people be so uncertain of the correct treatment and how many options are available today for women? I do not know. I do know I am keeping both of my breasts. I will be closely monitored for the rest of my life for any reoccurrence which is unlikely given my treatment of chemotherapy and radiation following the lumpectomy. BELOW you can read how successful my treatment is and I am in good shape for living another 20 years.
I also want to take this opportunity to say that my breasts are not "GIRLS" or TATAs". They are a valuable part of my body like any other part of my body. I do not like them to referred to as a separate object and I actually resent that men can be fixated on them for their own pleasure. I would be pleased if no man ever grabs them again for his own satisfaction. My skin and body is a source of pleasure for me with the right kind of touch. Nothing about my body is a toy. Unfortunately, I have had too many disrespectful experiences with some men who have little impulse control and poor standards for healthy sexual interaction. I have heard way too many comments over the years about the size and shape of my breasts, whether or not they were once perky, how old was I when I got them etc... and I am fed up with all that disrespect. My breasts are not here for men to comment on anymore. And I will be successfully treated for Breast Cancer while keeping both of my breasts.
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Most postmenopausal women with small breast tumors don’t need chemotherapy to reduce their recurrence risk after lumpectomy.
To try to determine who does, a test that measures a tumor’s aggressiveness based on its DNA will be tested nationally in more than 10,000 of these women.
“The dilemma physicians have with these patients is, because they have such small tumors, it’s hard to tell who needs chemotherapy,” said Dr. Thomas A. Samuel, Medical College of Georgia hematologist/oncologist specializing in breast cancer and a study principal investigator.
If you take 100 postmenopausal women with a small tumor that has estrogen receptors – most do – and no sign the disease has spread to the lymph nodes, probably 12 to 15 of the women need chemotherapy to reduce recurrence, Dr. Samuel says.
To save those patients’ lives, all 100 have to be treated with chemotherapy, because no definitive test indicates who really needs it, says Dr. Samuel. Yet the vast majority will do well with lumpectomy, radiation and hormone therapy that keeps cells from being refueled by estrogen.
Although chemotherapy is a powerful tool, he’s seen many patients struggle with notorious side effects such as hair loss, nausea, vomiting and increased risk for leukemia and heart problems. Some patients even opt to stop treatment. “I know that a number of these patients probably don’t need it but there is no way for me to know who they are ahead of time. I think this trial will help us find who should get it and who should not.”
“The Oncotype DX™ looks at the DNA of the breast cancer cells and tells us if this cancer is more likely to spread or grow,” says Dr. Samuel of the commercially-available test that looks at 16 tumor genes and uses five reference genes as controls. “How cancers behave largely depends on what the DNA is like.”
Although it’s been on the market more than a year, the test is not widely used, possibly because its efficacy was studied in a relatively small number of women and it costs several thousand dollars, says Dr. Samuel, who used the test only twice before the study.
If the federally funded study of thousands of women over the next five-plus years backs up smaller studies, the test likely will become part of the standard of care for this group of women, he says.
The Trial Assigning Individualized Options for Treatment, or TAILORx trial, coordinated by the Eastern Oncology Group, is the first study resulting from the National Cancer Institute’s Program for the Assessment of Clinical Cancer Tests.
Enrollees with the lowest recurrence scores will have radiation therapy and hormonal treatment following lumpectomy. Those with the highest will also get chemotherapy. “The debate is in the intermediate risk group. That is where most women fall and the ones where we are not really sure what to do,” Dr. Samuel says. That majority of patients will be randomized to either get chemotherapy or not.
Dr. Samuel hopes to enroll about two patients per month; the trial likely will be open several years depending on how long it takes to get a total of 10,000 nationally. Participants will be followed for at least five years.
He notes the highest risk for recurrence is within two years after diagnosis. While the risk never goes away, it is very low after the five-year mark.
Breast cancer is most common in postmenopausal women and chemotherapy, tends to cause even more problems in older women, Dr. Samuel notes.
In fact, in this group of patients hormonal therapy is probably better tolerated and more efficacious, he says. Any patient who has a lumpectomy needs radiation therapy on remaining breast tissue. “We add chemotherapy if the tumor is big enough and we think the risk is high enough that the cancer may come back,” says Dr. Samuel. Chemotherapy must precede radiation therapy because it worsens the toxicity related to radiation. When patients get both, the treatment course can last eight to nine months. “If we can better determine who needs chemotherapy, we can shorten that time significantly,” Dr. Samuel says. Hormonal therapy comes last and can exceed five years.
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Lumpectomy followed by radiation therapy is generally considered to be as good as mastectomy for women diagnosed with early-stage breast cancer with an average risk of the cancer coming back (recurrence). Earlier research has shown that recurrence risk is about the same with either type of surgery.
A study suggests that in the real world, women diagnosed with stage I or stage II breast cancer who have lumpectomy followed by radiation have better survival rates than women who have mastectomy.
The researchers looked at the results of more than 112,150 California women diagnosed with stage I or stage II breast cancer between 1990 and 2004 who were treated with either lumpectomy plus radiation (55% of the women) or mastectomy (45% of the women). The women were followed through 2009.
The researchers compared overall survival rates and disease-specific survival rates between the two groups of women. Overall survival is how long the women lived, no matter what they died from. Disease-specific survival is how long the women lived before they died from breast cancer.
Overall survival was 19% higher for women who had lumpectomy plus radiation compared to women who had mastectomy. This suggested benefit wasn’t affected by the women’s age or the hormone-receptor-status of the breast cancer.
For women who had lumpectomy plus radiation compared to women who had mastectomy, disease-specific survival was:
- 14% better in women who were 50 and older and diagnosed with hormone-receptor-positive disease
- 7% better in women 50 and older and diagnosed with hormone-receptor-negative disease
- 12% better in women who were younger than 50 and diagnosed with hormone receptor-negative disease
- 6% better in women younger than 50 and diagnosed with hormone-receptor-positive disease
It’s not clear why women who had lumpectomy plus radiation had better survival rates than women who had mastectomy.
This study was a population-based study, which means the researchers used information that was collected before the study was planned. It also means that the women weren’t randomly assigned to get either lumpectomy plus radiation or mastectomy. So the women who got mastectomy may have had other health problems that may have affected the type of surgery they had. These other health conditions also may have affected their survival. Population-based studies aren’t considered as good as randomized clinical studies.
This study also didn’t look at:
- the type of health insurance the women had (if any)
- the distance to the nearest radiation treatment center
- how many reconstruction surgeons were available to each woman
- HER2 status of the cancer
- whether the women had earlier radiation to the chest wall
- the aggressiveness of the cancer
- other health conditions (diabetes, circulatory problems, or a bleeding disorder, for example)
All of which are known to affect the lumpectomy vs. mastectomy decision-making process.
If you’ve been diagnosed with early-stage breast cancer, you and your doctor will talk about a surgical approach that makes the most sense for you and your unique situation. You will take into account a number of factors, including:
- your preferences
- any other health problems you have
- ALL the characteristics of the cancer
- how close you are to treatment facilities
Whichever surgery you choose – lumpectomy plus radiation or mastectomy – know that much research has shown that both are equally effective in removing early-stage breast cancer and reducing the risk of it coming back.
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Study: Chemotherapy Effective Before or After Lumpectomy
A new study finds that long-term outcomes after breast-conserving surgery are the same, regardless of whether chemotherapy is given before or after surgery. Instead, the study suggests that biological factors have a greater impact than the time of chemotherapy. Breast-conserving surgery (also called lumpectomy) with chemotherapy may be a viable option for women with stage 2 or 3 breast cancers rather than mastectomy, according to the study.The study included surveying almost 3,000 women treated for breast cancer at MD Anderson from 1987 to 2005. Seventy-eight percent of the women surveyed had surgery before chemotherapy and 22 percent received chemotherapy first. According to MD Anderson, 5 and 10-year outcomes were excellent for both groups. Of those who had surgery before chemotherapy, 97 percent were disease free without a cancer recurrence after 5 years, and 94 percent after ten years. For those who had chemotherapy before surgery, the disease-free, recurrence free survival rates were 93 percent after 5 years and 90 percent after 10 years. Chemotherapy resulted also resulted in 20 percent cancer-free cases and lowered cancer stage in almost half of patients who had Stage 2 or 3 cancer before chemotherapy, which the researchers say suggests that lumpectomy with chemotherapy may be an effective option for many women. “Even women who present with clinical Stage 2 or 3 breast cancer may have good results with breast-conserving surgery after chemotherapy and not need a mastectomy,” said Elizabeth Ann Mittendorf, M.D., assistant professor in the Department of Surgical Oncology and lead author of the study, in the center’s news release. “The molecular characteristics of the tumor and other factors have an impact on treatment success, but not the order in which chemotherapy and surgery are given.”“Since 2005, treatment techniques have improved, including the ability to add targeted therapies to chemotherapy,” she said. “In the future we will look at the effects of newer agents, and we anticipate the results will be even more favorable for women who received these treatments before surgery.”The results of the study were presented at the 2011 Breast Cancer Symposium.Additional Resources and References• The September 8, 2011 MD Anderson news release, “Chemotherapy is as Effective Before Breast Cancer Surgery as After,” was published athttp://www.mdanderson.org/
