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Dr. David
Dr. David, Board Certified Physician
Category: Medical
Satisfied Customers: 42815
Experience:  Experienced Physician trained in New York City. I'm ready to help.
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Dr., Please read this and tell me what is wrong with it: 23

Customer Question

Dr. David, Please read this and tell me what is wrong with it: 23 August 2015 04:54 Dr. C. Dr. C. Doctor Yes, it's possible to have an estrogen receptor change as well. For the same reasons that the HER status can change. Here is a link to a study showing
that possibility: http://jco.ascopubs.org/conten… Unfortunately, everything that is true regarding HER change from + to - is also true for estrogen receptor change from + to -. Although slow growing and indolent and easy to treat by blocking estrogen, they
can change to negative regardless of slow growth. There are similarly no large enough studies to get a sense of whether this is more likely to go from + to - versus - to +. Both are possible. So unfortunately, you're not out of the worry zone about this. But
remember what I said above.
Submitted: 1 year ago.
Category: Medical
Customer: replied 1 year ago.
Maybe it's that this study didn't consider people with really really high estrogen positivity like mine, which is unusual?
Expert:  Dr. David replied 1 year ago.
This is Dr. David
how does this information help you
you don't have evidence of progression of your breast cancer currently
you haven't had CT scans or PET scans showing evidence of your cancer coming back or spreading
how is worrying about your breast cancer ER+ turning to ER negative helpful to you?
what are you going to do different?
nothing
you will continue to take your AI therapy.
and you have to see your doctors in September.
Customer: replied 1 year ago.
But, do you think this doesn't apply to me because I have the highest er positivity possible--we just said that mine would be unlikely to mutate?
Customer: replied 1 year ago.
Or are you taking that back?
Expert:  Dr. David replied 1 year ago.
these articles don't apply to you because you don't have evidence of a recurrence or progression of your breast cancer.
Customer: replied 1 year ago.
But what about what I just said--that I have such high er positivity that mine wouldn't mutate. You just told me that slow, indolent cancers are "able to divide without mistakes". Maybe the er positive cancers in that study mainly stained 1 and 2.
Customer: replied 1 year ago.
Those studies were looking at people like me and predicting the likelihood of progression. So theoretically they could apply to me.
Customer: replied 1 year ago.
Except maybe not because of my high positivity.
Customer: replied 1 year ago.
help!
Expert:  Dr. David replied 1 year ago.
I don't have the full study to review.
that second study looked at 459 patients and only found 119 who had multiple relapses and studied the hormone status in those 119 patients
chances are you are going to be in the 340 patients who don't get relapses and don't have ER changes.
Customer: replied 1 year ago.
but how many ER positive had just one relapse? a lot.
Customer: replied 1 year ago.
All I know is I thought I was "special" because my ER status was so high and was so UNLIKELY to mutate. Now I read this. I need to understand why I don't fit with these women.
Customer: replied 1 year ago.
I didn't mean to even ask this doctor a question--I only did it because you hadn't answered me yet.
Expert:  Dr. David replied 1 year ago.
the studies don't show this
chances for relapse for you over 5 years is small, less than 20% we have talked about your relapse rate
Customer: replied 1 year ago.
The studies don't show what?
Customer: replied 1 year ago.
They seem to show that ER+ can change to ER-. I need to understand if it is likely that I won't be one of those BECAUSE MY ER STATUS IS PARTICULARLY HIGH AND INDOLENT????
Expert:  Dr. David replied 1 year ago.
the studies don't show how many ER positive woman have one relapse.
Customer: replied 1 year ago.
They seem to show that ER+ can change to ER-. I need to understand if it is likely that I won't be one of those BECAUSE MY ER STATUS IS PARTICULARLY HIGH AND INDOLENT????
Expert:  Dr. David replied 1 year ago.
that is unlikely for you
I have given you the number of patients studied in the studies.
but statistics and reason and logic is not reaching your anxiety mind right now.
Customer: replied 1 year ago.
can you just say back to me what you said earlier, about how people with high er status have indolent cell divisions and how slow cell divisions lead to divisions without mistakes. I just need to hear it again to fix this I think
Customer: replied 1 year ago.
please?
Customer: replied 1 year ago.
Dr. David, where did you go?
Expert:  Dr. David replied 1 year ago.
people with high ER positive breast cancer have indolent cell divisions and slow divisions lead to divisions without mistakes
Customer: replied 1 year ago.
you really really believe and know that?
Customer: replied 1 year ago.
despite this study?
Expert:  Dr. David replied 1 year ago.
that is what you know and what calms down your anxiety
I tried to explain to you the study
but it doesn't sound like you are interested in these studies.
Customer: replied 1 year ago.
but I just want to make sure you believe it--do you?
Expert:  Dr. David replied 1 year ago.
it doesn't matter what I believe
what matters is getting your anxiety levels down so you can get to your next doctors meeting
you need to stop worrying about your breast cancer cells
there is nothing you can do about it except continue to take your AI therapy.
Customer: replied 1 year ago.
wait so now it turns out you don't believe that slow divisions lead to divisions without mistakes??????
Customer: replied 1 year ago.
you told me earlier that you did believe it and knew it to be true
Customer: replied 1 year ago.
I hope you're not writing things you don't think are true???
Customer: replied 1 year ago.
Dr. David?
Customer: replied 1 year ago.
please answer me
Expert:  Dr. David replied 1 year ago.
I have told you we don't have research to show if ER 3+ breast cancer cells divide faster or slower than other cells or mutate at faster or slower rates than other cells.
Customer: replied 1 year ago.
you lied to me earlier
Customer: replied 1 year ago.
Please fix this, I don't know what to believe. I was so happy when you told me that "if they divide slowly they are able to divide without mistakes". Now you have me all confused and worried.
Expert:  Dr. David replied 1 year ago.
you need to stop worrying about your breast cancer cells and their mutation rates
you need to know that lobular cancer has better prognosis than ductal
we did the md anderson nomogram and you have an 80% chance of disease free survival in 5 years.
you are taking AI therapy
you have done all the things you need to be cured of your breast cancer
you never developed necrosis or any more cellulitis.
Customer: replied 1 year ago.
now you haven't answered my question--I want to know if you think high estrogen positivity leads to indolence which leads to lack of mistakes which divisions occur
Customer: replied 1 year ago.
please hurry
Expert:  Dr. David replied 1 year ago.
I told you already, we don't have enough research to be able to say this.
Customer: replied 1 year ago.
I can't even pay you for this. You lied to me earlier. How could you do that?
Customer: replied 1 year ago.
You've left me feeling confused and terrible.
Customer: replied 1 year ago.
first you tell me that slow division leads to accurate replication and then you take that away.
Customer: replied 1 year ago.
what do you really believe?
Expert:  Dr. David replied 1 year ago.
I am just telling you the thruth about breast cancer knowledge.