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Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 44369
Experience:  Experienced Oncology Physician trained in New York City. I'm ready to help.
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I have recently had a double mx, due to DCIS on my left

Customer Question

I have recently had a double mx, due to DCIS on my left breast having suffered ER grade 3 4 cm tumour 4 years ago in my left breast ( 4 nodes involved). The histology report from my breast tissues advised of a 6mm small invasive her2 positive tumour in my left breast. Sentinal node biopsy clear and there was a good clear margin around the tumour. It's a bit of a long wait to see my Onc so was looking for an opinion as there seems to be no rush this time round deciding if I need Chemo or not. Can you give any advise?
Submitted: 1 year ago.
Category: Oncology
Expert:  Dr. David replied 1 year ago.

This is Dr. David

you need testing to check for BRCA1 and 2 mutation since you are having breast cancer so young.

if you have children or daughters, this will be important genetic information for them.

you might benefit from oncotype genetic testing of the 6mm small left sided invasive breast cancer which was her-2/neu positive.

that could give more information about your systemic risk from that small invasive breast cancer.

to see if you might benefit from chemotherapy and herceptin or possibly just herceptin therapy

it sounds like you will benefit from tamoxifen therapy either way

let me know if you have questions.

Customer: replied 1 year ago.
I have bee on tamoxifen previously after the last tumor. I have been told tamoxifen has no effect on her2 piositive diagnosis.
My oncologist has told me they are not licenced to give herceptin without a course of chemo 1st.
My husband and I also want to try for a baby!
Expert:  Dr. David replied 1 year ago.

if you are BRCA1 or 2 positive the longer you keep your ovaries in, the longer your risks are for ovarian cancer.

if you have a high oncotype score, you could be at risk for metastatic spread of your breast cancer, even if it is small and even if it didnt' spread to lymph nodes. herceptin is usually given with chemotherapy to decrease risks of cancer spread to the rest of your body

women who have breast cancer before age 50 have a much higher risk of having an aggressive breast cancer.

you don't want to avoid cancer therapy you need to try for a baby and then develop metastasis when you have this baby.