Is Chemo necassary for stage 0 breast cancer where invasion in less than 1 cm but ER/PR is negative and Her2+ve

[nids1310]

Hi, My mom underwent bilateral mastectomy after being diagnosed with stage 0 breast cancer,DCIS. Initially the surgical oncologist said that chemo will not be required as the tumor size was less than 1 cm and that has been removed but now after consulting a medical oncologist in Tata hospital Mumbai , she is being prescribed 16 cycles of chemo and then targeted therapy after every 21 days for 1 year. My mom underwent three surgeries and is very weak, she is not keen on getting the chemo done and is taking tamoxifen as prescribed earlier by our oncologist. Please suggest if chemo can be avoided completely and what are the chances of recurrence of cancer.

Right Breast : ER/PR negative and Her2 positive.

FISH test : Positive

[sumeet_shah Administrator]

My suggestion is to discuss with the Oncologist at Tata as to the reason for chemo. I believe there is some misunderstanding on your part in reading the report. They must have noted something in the report in asked for chemo. Ask them what is it. Alternatively, ask your surgeon who operated, to explain the pathology report in detail and he will tell you why the chemo. Don’t worry much. Just follow what doctors at Tata say. Your mother will do well.

[roxboxfox RadiationOncologist]

Guidelines mention...that even if tumours are more than 0.5 cms and Her 2 positive there is substantial benefit from chemotherapy

Currently if someone has tumour Suze less than 0.5 cms and Her 2 +ve

Only those subsry of pts...Oncologists do not recommend chemo.

[kirankr76]

My moms case was also similar diagnosis - but since ER/PR is negative, hormone medication cannot be given and the oncologist advised to go for 6 cycles of chemo and targeted therapy of 1 yr.

[sumeet_shah Administrator]

The above staging you have mentioned is incorrect. That’s why I mentioned about miscommunication. In stage 0, there is no invasive element. Not even a millimeter. Any invasive element will make it stage 1. Be it a millimeter or be it a centimeter. So first, get it clarified what stage it is. For stage 1, with certain markers, chemo may be indicated.

[Neha0303 in reply to sumeet_shah]

Hi Sumeet,

Thanks for your reply.

Here is the detailed right breast biopsy report for my mother received from TMH that my sister has mentioned about in the question above.

1) Right skin-sparing mastectomy - 19 paraffin blocks

Invasive breast carcinoma, no special type, grade III.

Modified R.B.Score: 3+3+2=8.

Ductal carcinoma in situ (DCIS) is identified, solid type, nuclear grade with necrosis and calcification.

Extensive intraductal component is present.

DCIS involves large lactiferous ducts of nipple.

Paget's disease of nipple is seen with ulceration.

Lymphovascular emboli and perineurial invasion not seen.

Revised anterosuperior margin is free of tumor.

Results of immunohistochemistry

ER - Negative (Internal control is positive)

PR - Negative (Internal control is positive)

Her2/neu - Positive (Score 3+)

No myoepithelial cells were detected around foci of invasive carcinoma with p63 and Calponin.

Can you please suggest us if we are missing something important here that the doctors have not explained yet.

We really want to be sure if chemo can be avoided or at least chemo cycles can be reduced for her or are of lower intensity along with targeted therapy for HER2 positive.

What will be the right plan of treatment for her is something we are confused about.

Also, is there any way we can only get her to take more medication orally.

thanks again.

[sumeet_shah Administrator]

This is not a stage 0 as has been mentioned in the heading. There is clear mention of “Infiltrating Duct Carcinoma”, though, of course, it definitely looks like an early stage. Can’t comment much on stage as this is a review report. The original report will have a few other details to stage. It is not possible for me to opine on anything more as to what treatment further, as lots of other factors have to be considered. I can only tell you, that Tata Memorial Hospital is indeed one of the best cancer Centres in India and you can follow them blindly. Still if you wish an opinion, you can take a second opinion from a ‘Medical Oncologist’ who are the ones who plan chemo. I am a surgeon and I do not give opinions about chemo; I refer to a Medical Oncologist. One thing I can clearly see above, there is some discordance in yours and your sisters understanding of the report and what it actually is. It will help you immensely in understanding the details. Of course, it is the operating surgeons duty to sit and explain it in detail. When I discuss reports with my patients, it takes me 30 to 40 minutes of intense discussion (we discuss each and every line with me explaining what it’s means and it’s significance in planning treatment), so you can clearly understand that it is beyond the purview of this forum to discuss the above report here. It will take me hours to write the details and one explanation from me will invite another three questions from you. But I would very strongly recommend you to sit with your surgeon and understand the report. Because, that will help you both understand the actual situation and what should be done for the same. Don’t have any bias against chemo. Cancer is a deadly illness. Of course, your mothers stage is definitely a very early stage, no doubt about that. Can’t take it lightly. If doctors tell, that evidence suggests chemo to be give, then please give it. Rather than focusing on not giving it, focus on building her up and helping her out of it. Apart from asking for medical opinions, feel free to share and ask for help in this forum. There are lots of people around to help you and guide you all. You are not alone, don’t worry.

[Neha0303 in reply to sumeet_shah]

ok Dr. Sumeet. Thanks for your advice and time. We will surely take more opinions with doctors and decide asap.