Advice needed: Should I undergo chemotherapy after my lumpectomy?

I am struggling with the same decision about chemo. Risk of cancer either way. Chemo drugs carry a risk of cancer.

Lumpectomy, ER/PR positive, no lymph node involvement. Have refused adjuvant therapy, as radiotherapy carries no survival advantage and endocrine therapy barely 1% over 5/10/15 years (ref Predictbreast3 online) . Without available statistics on recurrence stratified by age, general health, tumour type etc and only a global 39% for all women , my thinking is this: At 68 years old, quality of life is more important than quantity and if at minimum there is a 61% chance that adjuvant therapy will not do me any good and will only do me harm, then thanks, but no thanks. I am, however, working with a nutritionist to eliminate as far as possible carcinogenic agents from my diet and environment. C/x

Peggy, I have comparable situation. These are tough choices and no bad one in my view - differing personal factors. I have decided to accept chemo rec ( 4 cycles over 12 weeks). I have BrCA2 gene so know this confers even higher risk than is shown in the Oncotype score . I have the time to do this as retired and family raised. In talking with my spouse we decided to live with the knowledge I did what I could. Will stop chemo if I cannot manage but feeling hopeful ! I wish you the best and give yourself grace in choosing your path !

Hi Peggy, I am 52 and I had exact same as you but grade 3 and Oncotype score 44. I did lumpectomy, radiation, hysterectomy and aromatase inhibitor. I declined chemo!

I had the exact same but I’m 66. After much research a friend that is an Oncologist as well as two internists all suggested to go with chemo. My score was 26 There is no going back. If you don’t do the chemo now then there is no option to do it later if there was to be a recurrence.

I am 79 years old with the same numbers and cancer type as you. However, my onco type score was 18 Dr said any score under 26 does not require chemo at my age. I will start three weeks of radiation next week.

I was actually told that if I was 10 years older that chemo wouldn’t be recommended

I did Peggy. I had 8mm IDC Stage 1, ER+ PR+ HER2 negative. My Doctors and I were stunned that the Oncotype score came back as a 29. My onco originally said ok we need to do chemo. I requested the Mammaprint which we did and that came back low risk of any chemo benefit. After getting 10 consults(Tumor board) and 3 different onco doctors, all recommended no chemo. We subsequently ran the RSCLIN which said I had a 3% benefit of taking chemo. I did not take chemo and it will be 5 years in April. Did I make the right decision, I have no idea. But getting the mammaprint, numerous other dr opinions and running the RSCLIN, gave me favorable indicators that it may be the right decision.

My doctor did not do an oncotype because 1a,tiny tumor no lymp nodes so all those things indicate chemo not necessary but now I am wondering why she didn't do it . I did whole breast radiation which went well.

Almost the same diagnosis. Chemo wasn’t even mentioned I did radiation was prescribed letrozol. My radiologist said he could reduce my risk of recurrence and Mets as much as letrozole could without the side effects so I opted not to take it. Talked to my oncologist and because of my other health issues she was supported my decision. You have time to decide. Do your homework and ask questions

Should I ask doctor why they didn't do oncotype? I didn't realize that it gives recurrence risk. I want to know that information.

Hi Cat, My understanding is that Oconotype can be done only for early stage, HR positive, HER2 negative DCIS. If that matches your diagnosis, it doesn't hurt to ask.

I believe he recommended chemo because your uncle type test is higher than 26.

Hi Cat. Before My Oncotype score ( 27) and Mammaprint score ( high Risk 1) came back I was to do the same plan as you - radiation then anti estrogen meds. Once I had those scores all consultants supported chemo 4 cycles. I also learned I had BRCA2 gene mutation so this information helps. As others note Oncotype can do ER+, Mammaprint can do ER+ or ER- recurrence risk

My gene test in 2019 was negative

I had similar pathology in Oct. of 2022. .8 mm tumor found during routine mammogram. They initially said so small probably just lumpectomy and radiation as they always do that with a lumpectomy. After surgery because of an oncotype score of 31, I was told distant risk of metastasis in 9 years was 20% which he felt was way too high. I was so distraught! Other pathology was ER + over 90%, PR 10%, Her 2 negative, micropapillary no lymph node and no vascular involvement and less then 1 cm. Grade 2, KI-67 of 19%. I believe official staging was TNM Staging: pT1b, (sn)N0, MX Stage at Diagnosis: IA. My oncologist highly recommended 4 rounds of doxatacel/ cyclophos. chemo and after that 16 rounds of radiation and letrozole for 6 to 10 years. I did as suggested and actually tolerated everything pretty well which I am certain you would as well. I was told lowered my reoccurance risk from 20% to between 5 to 10% which is a 50% reduction. Well worth it in my opinion. Obviously chemo is no joke and I did lose all my hair but with new medications I don't think I even has any nausea. Only significant side effect I remember is fatigue and hair loss. I was 57 yrs old at diagnosis and very active so hoping for a long disease free life which I am praying for for all of you! I did have a question about the other test you said gave you a 9 % future risk as a oncotype of 30 would been a 19% risk? I am curious if this is a new test as I don't think I had that done. Who knew until we had to know that there was so much to know about cancer. I thought stage 1 was stage 1 and had no idea all this other stuff came into play. Best wishes. Happy to answer any specific questions you may have about the treatment I had.

Making treatment decisions after surgery can feel overwhelming, especially when weighing the potential benefits and risks of additional therapies. Many community members face similar crossroads and find it helpful to discuss their concerns with their medical team, ask about getting a second opinion, or connect with others who have navigated comparable treatment choices. The decision is deeply personal and depends on many individual factors that only medical professionals familiar with the complete medical picture can properly evaluate.