HER2- and ER/PR+

Hello, I noticed that you have been a member for a while. I am glad you asked about your new diagnosis.
Your treatment plan will be decided by a lot of different factors. The size of your cancer and if it has spread. The biopsy will determine the grade or how aggressive it is. There are tests now to help determine if chemo is helpful, radiation is another alternative that might be discussed. Then there is endocrine therapy that might be recommended. Please remember you are part of the decision making team, and you should ask every question you have. It can be scary and overwhelming when the diagnosis first comes, so please feel free to lean on the collective here to help with that. You are not alone!
Can you share with me more about yourself and your cancer? How was it found?

It was found on mamagram i had. It was 1 cm. and i had 2 lymph nodes removed. They were clear. I see the radiation dr next tuesday.

I also want to know about letrozole. They have mentioned me taking tamoxifen and letrozole.

@beautybldr did you have lumpectomy or mastectomy? If lumpectomy then radiation will be discussed. If mastectomy, radiation is less likely.

Do you know the grade of your tumor?

Most of us with HER2- and ER/PR+ take a medication that reduces or eliminates the effect of hormones on cancers that are fed by those hormones. Tamoxifen affects hormone receptors. Aromatase inhibitors like letrozole (Femara brand name) eliminate estrogen produced in the adrenals.
Post-menopause, most of us take aromatase inhibitors. Are you past menopause?

You will no doubt have an Oncotype Dx test done (or Mammaprint). That will tell you your recurrence risk with and without meds and the benefit or lack of benefit of chemo. Many women are now spared chemo thanks to these tests. Even with grade 3, I had no chemo: 30% of grade 3's have low Oncotype scores.

Talk to your doctor about whether this test is being done and let us know the result.

I took Femara (letrozole) for 5 years with little trouble. Some take it 7 or even 10 years but I had another test done at 5 years (Breast Cancer Index) that told me no benefit from further treatment.

I had a lumpectomy with 2 lymph nodes removed that were clear. I am a grade 1-2 and will see radologist next tues. They have sent the tissue away for the oncotype Dx test. Will be a couple weeks before we hear from it. I am seeking all info, I had lumpectomy on my left breast 8 years ago, and things have changed so much since then. This is my right breast, both were found with a mamagram.

The Oncotype will determine your treatment. With lower grade cancer there is a good chance you will avoid chemo and have hormonal treatment (though Oncotype does not always correlate with grade). If you are post-menopausal they will suggest an aromatase inhibitor.

The OncotypeDX is used to predict the benefits of chemo. It doesn't address radiation, for example. It will yield a "risk of recurrence within 9 years" number, presented as a percentage, if you take 'tamoxifen or aromatase inhibitors." It's just additional data for you and your doctors to have to help guide care recommendations but can be very reassuring as well.

I cannot edit but am changing the first sentence above to "The Oncotype will probably determine your treatment." My docs went by my low Oncotype despite grade 3, LVI and high ki67%. So in my case the Oncotype entirely determined treatment. But other docs may be different and also my diagnosis was 7 years ago so things may have changed.

The time from diagnosis to surgery for me has been very long due to several factors in my large medical group. Initial confirmation of HR, PR+, HER2 - from biopsy on 6/2 until MRI changing plan from lumpectomy to mastectomy on 7/29 has been 8+ weeks. Oncologists started me with letrozole end of June due to the delay. Vacations, loss of surgeons, low staff, covid, few surgical openings at any one of the hospitals has been frustrating. While the doctors say my disease is a very slow progression, I wonder if others have experienced time to treat the same as mine. Surgery this week, but what still lies ahead?

I was lucky in that my former PCP's practice was still a mess last year, fewer doctors and near-zero support staff, so I called a major medical facility (Cleveland Clinic) and had a new PCP within a day. As bad luck would have it, a routine mammogram 10 days later found a small tumor. I had biopsies and surgery within 2 weeks.

Had I waited for some future appointment with my former PCP, and then weeks to have mammo and ultrasound, at least another week[s] for a biopsy...then referrals to surgeon's and oncologists, I once calculated that the surgery would have taken at least three more months to get done. I never again want medical care parceled out over multiple independent medical practices. At places like Mayo and CC, once one is a patient, i.e., in the system, I feel that there's an institutional commitment to one's care that never would have occurred to me until I was in real trouble.