Post-Surgery Treatment Options for Stage I Breast Cancer: Key Considerations

Post-treatment for Stage I Breast Cancer?

Hello Doctor, my wife was diagnosed with breast cancer earlier this year at the age of 42.
The pathology report after surgery is as follows: ER: 98+ PR: 98+ Her2: 2+ FISH: Negative Ki67: 9% Tumor size: 1.9 cm.
During lymph node surgery, 4 nodes were removed and tested, with no metastasis found.
A full-body examination showed no signs of metastasis.
I would like to ask the following:
1.
The attending physician informed us that chemotherapy is not necessary and that taking Tamoxifen for five years is sufficient.
They mentioned that if we are concerned, we could consider genetic testing.
Would you recommend doing that? Will not undergoing chemotherapy increase the risk of recurrence?
2.
If chemotherapy is not administered, would you recommend adding an aromatase inhibitor or ovarian suppression therapy?
3.
The doctor mentioned that there are some residual cancer cells found, with a small amount reaching the underlying muscle, but they do not plan to perform a second surgery and will proceed with radiation therapy instead.
Does this indicate metastasis? Can radiation therapy completely eliminate the residual cancer cells? Why is the physician reluctant to perform another surgery to remove all the cancer?
4.
The doctor stated that my wife's cancer cells are well-behaved and classified as Luminal A, with a low risk of recurrence.
If she takes good care of herself, what is the estimated recurrence rate?
5.
Are there any specific dietary or lifestyle considerations we should be aware of? The doctor seems to be in a hurry during appointments (likely due to a high patient volume), and I have not been able to ask all my questions clearly.
I would appreciate your guidance.
Thank you!

Niming, 40~49 year old female. Ask Date: 2023/03/21

Dr. Hu Ziren reply Oncology

According to the report, the type of breast cancer is associated with a low risk of recurrence.
It is recommended to follow the attending physician's advice to take Tamoxifen for 5-10 years and undergo postoperative radiotherapy, with regular follow-ups.
There are no dietary restrictions or lifestyle contraindications.

Reply Date: 2023/03/21

More Info

Post-surgery treatment options for Stage I breast cancer, particularly in the context of your wife's diagnosis, involve several key considerations that can significantly influence her prognosis and quality of life. Based on the details provided, let's address your questions systematically.

1. Chemotherapy and Genetic Testing: Your wife's pathology report indicates she has hormone receptor-positive breast cancer (ER: 98+, PR: 98+) with a HER2 score of 2+ and a Ki67 of 9%. Given these factors, her oncologist has recommended against chemotherapy, suggesting that five years of Tamoxifen (an estrogen receptor modulator) is sufficient. The decision to forgo chemotherapy is often based on the low risk of recurrence associated with hormone receptor-positive cancers, especially when lymph nodes are negative for metastasis. However, if there are concerns about her individual risk factors or family history, genetic testing (such as BRCA1/2 testing) could provide additional insights into her risk of recurrence and guide treatment decisions. If she has a family history of breast or ovarian cancer, genetic testing is particularly advisable.

2. Hormonal Therapy and Ovarian Suppression: If your wife is premenopausal, the addition of ovarian suppression (such as with GnRH agonists) may be considered to enhance the effectiveness of Tamoxifen. This approach can lower estrogen levels further, potentially reducing the risk of recurrence. However, this decision should be made in consultation with her oncologist, considering her overall health, preferences, and the potential side effects of ovarian suppression.

3. Residual Cancer Cells and Radiation Therapy: The presence of residual cancer cells, particularly if they are noted to be at the margins of the excised tissue, raises concerns about the potential for local recurrence. Radiation therapy is typically recommended in such cases to target any remaining cancer cells and reduce the risk of recurrence. While radiation can significantly decrease the likelihood of local recurrence, it may not guarantee the complete eradication of all residual cancer cells. The decision not to perform a second surgery may be based on the assessment that the benefits of additional surgery do not outweigh the risks, especially if radiation therapy is expected to be effective.

4. Recurrence Risk: Your wife's cancer being classified as Luminal A (based on the hormone receptor positivity and low Ki67) suggests a lower risk of recurrence compared to more aggressive subtypes. While her oncologist has indicated a low recurrence risk, it is essential to understand that no cancer is entirely without risk. The estimated recurrence rate can vary widely based on individual factors, including age, overall health, and adherence to treatment. Regular follow-ups and monitoring are crucial for early detection of any potential recurrence.

5. Lifestyle Considerations: Post-treatment, maintaining a healthy lifestyle can play a role in overall well-being and potentially influence cancer recurrence. This includes a balanced diet rich in fruits, vegetables, whole grains, and lean proteins, regular physical activity, maintaining a healthy weight, and avoiding tobacco and excessive alcohol consumption. Additionally, managing stress through mindfulness, yoga, or other relaxation techniques can be beneficial. It’s also important for her to stay informed about her health and to communicate openly with her healthcare team about any concerns or symptoms.

In conclusion, while your wife's prognosis appears favorable based on her pathology report, ongoing communication with her healthcare team is vital. Regular follow-ups, adherence to prescribed therapies, and lifestyle modifications can all contribute to her long-term health and well-being. If you have further questions or concerns, consider scheduling a dedicated appointment with her oncologist to discuss these topics in detail.

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