chemo or not?

You have way more small interest you are pondering. I was diagnosed Stage IIA/ Er+, PR-/HER2+, then 3 weeks later a genetic test revealed i had Brca2. My tumor was 5cm. They never spoke oncotype to me. I am at City of Hope in Ca.
Who told you about your distant risk at 9 years is 12%. Are the tumors in the same breast? I did have chemo first to shrink the tumor. It shrunk 1/2. I was supposed to have radiation, but the Radiation oncologist had his dr give me the low down on what the process would be and then i met with him. He said my cancer is in 2% of the population. Based on the statistics the oncologist said would give me a 2% better chance of the cancer not returning. He also said if i was family, he said the side effects may be worse than 2%. He would tell me not to do it.
It is only a choice you can make. Visit breastcancer.org too. Only women with breast cancer share and many have walked this road before us. Same as Mayo, but more to read. As more questions from your oncologist of why chemo over radiation.

Hi! @ justbreathe11 :

I am so sorry for what you've been through lately! My prayers go for you and your family upon reading this post...

I am not any health expert; but I too, had been diagnosed with IDC and ER+ PR+ Her2- back in 2023; and I am a bit puzzled and struggling to understand your oncologist's consideration for you to have chemo treatment or not. For as far as I know, the Oncotype test should help doctors and their patients decide whether chemotherapy may be effective for that patient and how to treat breast cancer after the surgery. In my own case, my oncotype score was "20", and that report clearly stated that the potential benefit for taking Chemotherapy treatment is < 1%; based on this report my oncologists and I decided not to have any chemo treatment with a peace of mind. Do you have your Oncotype report available to you? Perhaps you may ask your medical oncologist to go over the oncotype report with you or seek a second opinion?

This is just my 2-cent, my friend. You'll be in my thoughts and prayers, pray for wisdom, hope, love and peace of mind from above.

Best wishes to all!

@just breathe11 I had a similar decision for different reasons. I am just another patient so will share my experience and some studies, but your doctor is the resource to discuss this with.

My tumor was technically stage one (grade 3) with lymphovascular invasion, which I have read is equivalent to one positive node. However, LVI is not taken into account with staging or with the Oncotype. My Oncotype score was 8. I read on the report that my risk was cut in half with tamoxifen (I took an AI ). I also had ambiguous HER2 (retested 3 times, ultimately negative but barely). mixed ductal and lobular- complicated! Tumor board and one other oncologist said no radiation or chemo. Fourth opinion offered chemo and discussed in depth, did more testing (repeat Oncotype from surgical specimens, the original Oncotype was from biopsy which was mainly ductal and the tumor was mixed), 60 cells to test HER2 vs the usual 20 cells etc.). I was told 1 in 5 radiologists would recommend radiation. No pressure, all up to me. It was very stressful so I get where you are. I did only letrozole- 5 years. At 5 years I did a Breast Cancer Index test that showed high risk of recurrence but no further benefit to extended AI. I am ten years out, knock on wood.

So you are stage 2 because your tumors are over 2cm, is that right?. Assuming you have no positive nodes.

Intermediate scores are tough. The TailorX study answered some concerns for people with intermediate scores https://www.cancer.gov/news-events/press-releases/2018/tailorx-breast-cancer-chemotherapy

An excerpt: "Women in the trial who had a score in the intermediate range (11­–25) were randomly assigned to receive hormone therapy alone or hormone therapy with adjuvant chemotherapy. The goal was to assess whether women who received hormone therapy alone had outcomes that were as good as those among women who received chemotherapy in addition to hormone therapy." And ""Until now, we've been able to recommend treatment for women with these cancers at high and low risk of recurrence, but women at intermediate risk have been uncertain about the appropriate strategy to take," said Jeffrey Abrams, M.D., associate director of NCI's Cancer Therapy Evaluation Program. "These findings, showing no benefit from receiving chemotherapy plus hormone therapy for most patients in this intermediate-risk group, will go a long way to support oncologists and patients in decisions about the best course of treatment." It also said that 70% of breast cancer patient do not need chemo.

That said, and this may be older info:
https://thewell.northwell.edu/womens-health/breast-cancer-oncotype-score
Intermediate score (16-25): This range can feel a little trickier. If your score is in this middle zone, you and your oncologist will need to take a closer look at factors like your age, menopausal status, overall health, lymph node involvement, and specific characteristics of your tumor to decide if chemotherapy makes sense.

Three doctors I saw (Dane Farber and other major cancer centers) went by my Oncotype and one doctor discussed chemo and gave me the choice. I appreciated the deeper consideration of my grade, HER2 status and reliability of the Oncotype from biopsy. In the end I felt comfortable declining chemo with the low effectiveness as reported on the Oncotype and my other health issues. It really helps to have a doctor who will discuss all this with you. And the Oncotype report is really helpful. I came to understand that sometimes chemo isn't effective due to factors other than the severity of a case, though fast growing tumors tend to respond the best I was told. The Oncotype includes proliferation rate. Not sure why a grade 3 tumor got a low score but the company told me that was not as uncommon as expected. Good luck!

I took chemo and radiation before my surgery and my tumor was reduced to pretty much dust by the time they went in to remove it. They removed several more lymph nodes and I am doing well.

Thank you for your response @katgob. My oncologist gave my those numbers, based partly on my oncotype but also factoring in some of my personal metrics. I will take a look at breastcancer.org. Thanks for the recommendation.

Thank you for responding @lifetraveler. I think the 12% comes from factoring postmenopausal women out of the study used for oncotype and considering my own metrics. Whether or not to get chemo is my decision because it's not obviously a yes or no with the current research. I really appreciate the support and prayers.

Thank you @windyshores for the detailed information. I think because I'm premenopausal, the oncologist was looking specifically at the cohort of premenopausal women in the TailorX study, and factored in some of my specifics, like the larger tumors. It's really my decision whether or not to do chemo, and then I would have radiation and endocrine therapy. I am leaning towards doing it to have the peace of mind. I'm 45 so that recurrence risk would only be my mid 50s so to me, cutting the risk in half would be very reassuring. (On the other hand, I really do not want to experience everything that comes with chemo!) I really appreciate youre response.

@justbreathe11 what does the Oncotype report say about the amount that chemo reduces risk? It's tough deciding!

I second the recommendation to look at breastcancer.org.

@windyshores According to my oncologist, chemo reduces the 9 year distant risk from 12% to 6-7%. It's possible endocrine therapy alone would do that but it's not really known for my subgroup (premenopausal, ER+ HER2-, etc.)

What does the Oncotype say?

My outcome on the Oncotype report was actually worse with chemo, despite the grade 3 and presumed fast proliferation rate. Is your tumor grade 3?

I got 4 opinions!

I wonder what being borderline hormonally implies for treatment!. Your doctor considers you premenopausal and knows about that situation but I wonder if your risk is lower than, say, a 35 year old. Curious what your doctor says about this .

Thinking ahead to decades in the future is hard, when starting at a younger age! I was 63 and even then I thought ahead for awhile.