First of all, thank you all for being here. Its been helpful to find a place where this question is being addressed that I was struggling with on my own.
I was diagnosed with stage 1A invasive ductile carcinoma in September, 2021 [9mm, est.+, prog.+, HER2-]. I had lumpectomy surgery 10 days later. One sentinel lymph node removed and negative. All margins clear.
Then the hard part came as I read as much as I could of studies and statistics that would give me the best odds of making truly informed decisions about what to do next. Google Scholar and the translation app were invaluable. As it turns out, the OncotypeDX recurrence score for my tumor tissue came back as 9. With a 3% 'risk of recurrence, local or distant within 9 years' IF I took SERM or AI therapy. I rejected radiation which the radiologist said would reduce my 10% risk of occurrence, but only in the small area of the lumpectomy, to 2% because the genetic test showed I did not have a 10% risk. And the tumor was in the left breast and I didn't want radiation near the heart. My oncologist was insistent that I at least try anastrozole for a month and I did and had odd side effects and developed a scary pain in my hip that caused me to limp for the first time in my life. [My oncologist quoted Oncotype data incorrectly so I admit to not having total confidence in him. I spoke with senior people at Oncotype and they notified him as to what one could validly infer from the test. He and the radiologist both told me that the OncotypeDX score was based on a patient having had radiation whereas the data pool actually precluded anyone having had radiation or chemo prior to taking the test!] I am a finance professional so I can make some sense of the value of good data and defensible statistical analysis. But am woefully under-educated in the biological sciences so the past few months of reading and making sense of medical studies in terms of my personal decision has been an experience and journey of sorts. And it reconfirmed how much disagreement there is among the experts as well. A few statements resonated with me. One oncologist asked, in a study, whether it is good medicine to suggest 49 women take high-risk drugs when the projected benefit was a possible benefit of preventing only one incidence of cancer. Another two studies cited what I think is the breast cancer 'industry' best-guess statistic that, all other variables aside, anti-hormone therapy can reduce a woman's risk of estrogen-fed breast cancer by 42%. [The oncologist I saw said 'we say hormone therapy will reduce the risk by 50% to keep it simple but it's closet to 40-45%'] It's a given that depriving the body of estrogen unequivocally speeds loss of bone density. And in the majority of cases, triggers increased cholesterol levels. And appears to cause changes in epithelial tissue. (The latter two, thus, increasing risk of stroke and cardiac events.) So, again this is a personal risk/reward analysis, I don't see a payoff in triggering a speedy osteoporosis since I have moderate osteopenia and/or coronary (since I have high cholesterol and cannot take statins and the genetic marker for heart disease) for a net 2 percentage points reduction in risk of recurrence; the risk of 5% without tamoxifen or AIs versus the prognosticated 3% if I take them. I think that, if the bone density treatment drugs had far fewer side effects and if I could control cholesterol safely with statins, I would consider ignoring some side effects of the hormone therapy and bear them for the best-guess 2% risk reduction. And if I had a high risk of recurrence, the decision to skip them might be different. It's a kind of roll of the dice, but so are the drugs and their side effects and the drugs to treat those side effects.