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Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 42277
Experience:  Experienced Oncology Physician trained in New York City. I'm ready to help.
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I am a breast cancer patient and I am trying to decide

Customer Question

I am a breast cancer patient and I am trying to decide whether or not to have chemotherapy
JA: Are you keeping a personal medical record while dealing with this?
Customer: Kind of
JA: Anything else in your medical history you think the doctor should know?
Customer: Otherwise healthy 49 years old, ++-, lumpectomy on left breast. 1.5cm tumor IDC with lobular growth pattern. Stage I, Grade 1. Ki67 23%. No lymph node involvement. Oncotype dx score 19. Will receive radiation and Tamoxifen. Trying to decide whether or not to take TC chemo.
Submitted: 2 months ago.
Category: Oncology
Expert:  DrThomasMd replied 2 months ago.


I understand the concerns.

However, statistically your outcomes are better with the entire protocol.

I am sure your doctor has recommended this.

What is the problem with the decision.

If you tell me that, perhaps I can help?

Customer: replied 2 months ago.
But the Oncotype only gives me a slight advantage to having chemotherapy. I was hoping to get an answer regarding if the chemo is worth the risks that come with it, for a small percentage chance that it might work.
Expert:  DrThomasMd replied 2 months ago.

It is not just chemo, it is the combination, which is more than the sum of the parts.

The tamoxifen follows up and works after the chemo, adding more advantage.

What does your oncologist recommend???

Customer: replied 2 months ago.
He says it is up to me - either way is fine.
Expert:  DrThomasMd replied 2 months ago.


I think you should consider that this protocol is not very toxic. Not like it used to be.

And, in fact, your chances are increased, even if just a little.

If the oncologist sees no difference, then OK.

The whole idea is to avoid recurrence.

Ask him exactly how much your risk of recurrence is with, and without.

That hopefully will clarify things for you.

OK, so you might have more questions or want to give me more information: Please use reply to expert if you have further questions. Also, please click a positive rating [hopefully excellent (5)—that’s how we are paid, per rating]. If you forgot something, just use reply and come back. I am here

Customer: replied 2 months ago.
9-15% without, 6-12% with chemo
Expert:  DrThomasMd replied 2 months ago.


So as much as a 9% difference. maximum.

6 % chance v. 15%, worse case scenario.

Of course, it might be as little as a 3% difference.

Careful monitoring in either case.

Please click a positive rating

find me as needed.

Expert:  Dr. David replied 2 months ago.

This is Dr. David

I am a cancer doctor.

I'm glad you had an oncotype test.

I would get the chemotherapy.

TC chemo would not cause you to loose your hair.

there is no adriamycin in the mix.

it improve your control of systemic disease.

tamoxifen can help decrease risks for systemic spread of disease as well.

after chemo, you could become menopausal and then you will need a AI or aromatase inhibitor therapy.

radiation is still needed if you had a lumpectomy.

I think the chances of the chemo benefiting you is greater than the risks from the chemo

you can also use the negatives to try to help you make the decision

would you be more upset if you didn't get the chemo and a metastasis from your breast cancer or if you got the chemotherapy and had some mild neuropathy from the chemotherapy?

most patients would be more upset if they didn't get chemo and had a recurrence of their breast cancer.

let me know if you have other questions.

if done for now, please leave positive rating of 3-5 stars so I can get credit for helping you today

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you can always reach me directly with "a question for Dr. David" in the medicine or oncology categories if you have other questions

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