Sunday, February 18, 2024

Do All Breast Cancers Need Chemo

Thousands Could Avoid Chemo

Having chemotherapy for breast cancer – patient guide

You may have read the news that a ‘test means fewer women will need chemotherapy’.

The news reports follow a study, called TAILORx, of a test widely used on the NHS.

The test Oncotype DX predicts whether someone would benefit from chemotherapy.

The test is suitable for women whose breast cancer:

However, there’s a significant grey area of women for whom the benefit is unclear. The researchers looked at this intermediate group. They concluded that for most women in this group over the age of 50, chemotherapy didn’t have any benefit, and hormone therapy alone led to similar survival rates. For some women under 50 in this group, chemotherapy could also be spared.

This means that several thousand women a year could avoid having chemotherapy, which can cause a range of often unpleasant side effects.

You can read a more detailed analysis of the study on the NHS Choices website.

Immune Checkpoint Inhibitors For Breast Cancer

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses proteins on immune cells that need to be turned on to start an immune response. Breast cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Drugs that target these checkpoint proteins, help restore the immune response against breast cancer cells.

What Matters Most To You

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have chemotherapy after surgery

Reasons not to have chemotherapy

I want to do everything possible to treat the breast cancer.

I would rather wait and see if the cancer comes back before I have more treatment.

I would have strong feelings of failure if the breast cancer returned.

I know there’s no way to know for sure whether chemo would keep the cancer from coming back.

I want to have the added treatment and be done with it.

I would be comfortable having frequent follow-ups, without the added treatment.

I feel ready to deal with the possible side effects of chemo.

I am very worried about the side effects.

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Are There Ways To Prevent Hair Loss With Chemotherapy

Not everyone loses hair when receiving chemotherapy, but many people do. Some peoples hair only thins. Others lose the majority or all of their hair.

Using a cold cap can reduce hair loss. Cold caps cool your scalp before, during and after chemotherapy treatment. Cooling tightens the blood vessels in your scalp, potentially reducing how much chemotherapy goes to your hair follicles.

People may choose to wear a wig as a result of hair loss. Some private insurance companies may help cover wig costs if your doctor prescribes a cranial prosthesis or hair prosthesis. Medicare Parts A and B do not cover wigs, but the costs may be tax-deductible.

What To Expect After Chemo

How Many Chemo Treatments For Breast Cancer

Once youâre home, you need to take care of yourself and take steps to manage chemo side effects. These include:

  • Take medications the doctor prescribed for side effects.
  • Stay away from anyone with a cold or infection â chemo makes it harder for your body to fight germs.
  • Drink lots of fluids for the first 8 hours to move the medicine through your body.
  • Manage bodily fluids and waste that may have traces of chemo. Usually, this means flushing the toilet twice.

Youâll see your doctor every 4 to 6 months for the next 5 years after treatment ends.

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Listen To This Article

Dr. Seema Doshi was shocked and terrified when she found a lump in her breast that was eventually confirmed to be cancerous.

That rocked my world, said Dr. Doshi, a dermatologist in private practice in the Boston suburb of Franklin who was 46 at the time of her diagnosis. I thought, Thats it. I will have to do chemotherapy.

She was wrong.

Dr. Doshi was the beneficiary of a quiet revolution in breast cancer treatment, a slow chipping away at the number of people for whom chemotherapy is recommended. Chemotherapy for decades was considered the rule, the dogma, for treating breast cancer and other cancers, said Dr. Gabriel Hortobagyi, a breast cancer specialist at MD Anderson Cancer Center in Houston. But data from a variety of sources offers some confirmation of what many oncologists say anecdotally the method is on the wane for many cancer patients.

Genetic tests can now reveal whether chemotherapy would be beneficial. For many there are better options with an ever-expanding array of drugs, including estrogen blockers and drugs that destroy cancers by attacking specific proteins on the surface of tumors. And there is a growing willingness among oncologists to scale back unhelpful treatments.

The result spares thousands each year from the dreaded chemotherapy treatment, with its accompanying hair loss, nausea, fatigue, and potential to cause permanent damage to the heart and to nerves in the hands and feet.

Will I Need Chemotherapy After A Total Mastectomy

A total mastectomy is the surgical removal of the entire breast to treat breast cancer. A physician may recommend this treatment on its own or in combination with another therapy, such as chemotherapy. When chemotherapy is provided after surgery, it is called adjuvant chemotherapy. Whether or not chemotherapy is recommended following a total mastectomy will depend on many different factors, including the patients overall health, age and medical history as well as the type, stage and nature of the breast cancer.

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How Did/do You Feel After Every Chemo Session Tips Also A Bit Of A Vent

This might be a bit of a long post so sorry and thanks for reading in advance!

To start off Im 27 Female to Male Transgender. Ive been on hormone replacement therapy since 2018 but stopped when my doctor told me to when I got my diagnosis on September 22. Im currently approaching week 5 of chemo. So far I have made a review of every day after each chemo session in my phone notes. Consistently, days 3 & 4 are the hardest for me. This past week day 2-5 have been absolute torture.

Today I got up & went to the bathroom & I was in there for quite a bit . Afterwards I decided that I would spend it with my cats & started doing small tasks like sweeping & scooping litter boxes. I had to sit down several times while doing both tasks & am currently sitting down writing this.

I also noticed that I get hot flashes quite often & I have to take off a layer like my sweater, beanie, or socks to feel relief but then I get cold & have to cover something up just a little so Im not freezing. The hot flashes only really started this past week & a half and its honestly so annoying. Last night I was on the verge of sleep & suddenly I was wide awake & didnt get to sleep until about 3 am.

Is Chemotherapy The Only Treatment For Breast Cancer

Do All Lymph Node-Positive Breast Cancer Patients Need Chemotherapy?

No. Occasionally, chemotherapy is the only breast cancer treatment, but most often, healthcare providers use chemotherapy with other treatments, such as:

  • Lumpectomy: Removing the tumor and a small amount of surrounding breast tissue.
  • Mastectomy: Removing one or both breasts.
  • Hormone therapy: Taking medicines that lower estrogen or block estrogens effects on cancer cells.
  • Targeted therapy: Taking medicines that target the changes in cancer cells to destroy them or slow their growth.
  • Radiation therapy: Using high-energy X-rays to destroy cancer cells.

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Feeling Unwell Or Tired

Many women do not feel as healthy after chemo as they did before. There is often a residual feeling of body pain or achiness and a mild loss of physical functioning. These changes may be very subtle and happen slowly over time.

Fatigue is another common problem for women who have received chemo. This may last a few months up to several years. It can often be helped, so its important to let your doctor or nurse know about it. Exercise, naps, and conserving energy may be recommended. If you have sleep problems, they can be treated. Sometimes fatigue can be a sign of depression, which may be helped by counseling and/or medicines.

What Is The Prognosis For Triple

A good treatment result depends on several factors. Chemotherapy is what can really make a difference in the outcome. The size of the invasive part of the tumor, and the number of involved lymph nodes can also greatly influence your prognosis, Sun says, but adds that if the cancer has spread , the prognosis is less certain.

There is hope, even with this serious diagnosis, and staying optimistic is essential. It can be stressful and scary to go through chemo, but positive thinking can make a difference. You have to believe that its doing you good, and for most people, it does.

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Can I Skip Chemotherapy

After surgery, some cancer patients can safely skip radiation or chemotherapy, according to two studies exploring shorter, gentler cancer care. Researchers are looking for ways to precisely predict which cancer patients can avoid unneeded treatment to cut down on harmful side effects and unnecessary costs.

What Is Targeted Therapy For Her2


When a cancer is HER2-positive, it means that the cancer cells make too much HER2 protein, which can cause tumors to grow more rapidly than with other forms of breast cancer.

Drugs that target the HER2 proteins are the primary treatment for this type of breast cancer, given along with chemotherapy. Your oncology team may refer to these medications as targeted therapy or HER2-directed therapy.

Trastuzumab and pertuzumab are the most commonly used drugs used to treat HER2-positive breast cancer. Neratinib is another drug that is sometimes given after trastuzumab.

Some other targeted therapy drugs, such as lapatinib or ado-trastuzumab emtansine , are mainly used to treat more advanced HER2-positive breast cancers.

Herceptin and Perjeta are given at the same time as chemotherapy through an IV. HER2-directed therapy is usually given over a longer period of months than chemotherapy.

Herceptin alone is usually continued after chemotherapy has finished, every three weeks for a total of one year.

Side effects for HER2-targeted therapies may include:

  • redness at the IV site

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Is Radiation Therapy Safe

Some patients are concerned about the safety of radiation therapy. Radiation has been used successfully to treat patients for more than 100 years. In that time, many advances have been made to ensure that radiation therapy is safe and effective.

Before you begin receiving radiation therapy, your radiation oncology team will carefully tailor your plan to make sure that you receive safe and accurate treatment. Treatment will be carefully planned to focus on the cancer while avoiding healthy organs in the area. Throughout your treatment, members of your team check and re-check your plan. Special computers are also used to monitor and double-check the treatment machines to make sure that the proper treatment is given. If you undergo external beam radiation therapy, you will not be radioactive after treatment ends because the radiation does not stay in your body. However, if you undergo brachytherapy, tiny radioactive sources will be implanted inside your body, in the tumor or in the tissue surrounding the tumor, either temporarily or permanently. Your radiation oncologist will explain any special precautions that you or your family and friends may need to take.

What Types Of Breast Cancer Should Be Treated With Chemotherapy

Almost all women with HER2-positive cancers still need some amount of chemotherapy. And women with triple-negative tumors still need a relatively intensive course of chemotherapy, Dr. Lustberg says.

Chemotherapy may also be used to treat certain larger HR-positive cancers that have spread to lymph nodes, even if the tumor is estrogen-positive. “Specialized testing can determine which of these breast cancers will benefit from chemotherapy,” Dr. Lustberg says. Because of the personalized therapy made possible by these predictive biomarkers, the use of chemotherapy in lymph node-negative and positive HR-positive cancers has decreased in recent years, with excellent clinical outcomes.

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Chemo And Radiation Do Different Jobs

Chemotherapy is to wipe out cells that are floating around in your blood or lymph and this is a systemic treatment. Radiation is to take care of where the cancer was or is and wipe out the cancer. It is a localized treatment.

You should have both to give yourself the best odds.


What Is Metastatic Breast Cancer Anyway

Will I need Chemotherapy for My Breast Cancer?

Metastatic breast cancer, or stage IV breast cancer, is cancer that originated in the breast, but now, the cancer cells have spread beyond the breasts and lymph nodes to other parts of the bodymost commonly, to the bones, lungs, liver, or brain.

Women who are diagnosed with metastatic breast cancer have typically recovered from breast cancer only to develop new symptoms years later, such as bone pain, shortness of breath, unexpected weight loss, or persistent fatigue, which signal the cancer cells have spread, says Danae Hamouda, M.D., associate professor of medicine and fellowship program director of hematology and oncology at The University of Toledo. It is less common for women to be diagnosed with metastatic breast cancer without a prior history of a breast cancer diagnosis, she says, adding that approximately one in 20 women receive an initial diagnosis of metastatic disease.

But not everyone who gets breast cancer later develops metastatic breast cancer. Its estimated that somewhere between 3 and 30% of women who are diagnosed withand cured ofbreast cancer will later be diagnosed with metastatic breast cancer, according to Hamouda.

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How Long Can You Wait For Radiation After Lumpectomy

Radiation therapy usually begins three to eight weeks after surgery unless chemotherapy is planned. When chemotherapy is planned, radiation usually starts three to four weeks after chemotherapy is finished. You will likely get radiation therapy as an outpatient at a hospital or other treatment facility.

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Starting With Neoadjuvant Therapy

Most often, these cancers are treated with neoadjuvant chemotherapy . For HER2-positive tumors, the targeted drug trastuzumab is given as well, sometimes along with pertuzumab . This may shrink the tumor enough for a woman to have breast-conserving surgery . If the tumor doesnt shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy is often not an option for stage III cancers, so an axillary lymph node dissection is usually done.

Often, radiation therapy is needed after surgery. If breast reconstruction is done, it is usually delayed until after radiation is complete. In some cases, additional chemo is given after surgery as well.

After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab followed by surgery and then more trastuzumab for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses. For people with hormone receptor-positive cancer in the lymph nodes who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral drug called neratinib for a year.

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Your Life Expectancy After A Metastatic Breast Cancer Diagnosis

Once breast cancer has spread beyond the local area and is metastatic, it is treatable but no longer considered curable, says Hendershott. Eventually, treatments will fail. Metastatic breast cancer typically spreads microscopically to numerous areas, of the body, mutating in ways that eventually allow them to escape the medications used to treat them, Hendershott explains.

While the average survival rate of a breast cancer diagnosis is 90% over five years, that statistic tumbles for metastatic breast cancer, dipping to just 29% in the same time period, the most recent data shows.

Many women with metastatic breast cancer will live only a handful of years, says Hendershott. But about one-third will live at least five years after their diagnosis. And there are people who have been living with stage IV breast cancer for more than 15 years, she says.

But survival rates are hardly cut-and-dry: How long a woman lives after a metastatic breast cancer diagnosis depends on a variety of factors, including her age at diagnosis, whether she has existing or underlying medical conditions, the type of breast cancer she has, where it has spread in her body, and the amount of cancer throughout her body, according to Hamouda.

While getting diagnosed with metastatic breast cancer means you will almost certainly eventually die of breast cancer, the timing is unclear, Hendershott says.

What Happens During Chemotherapy For Breast Cancer


Most people receive chemotherapy for breast cancer through one of their veins . You may receive chemotherapy as one short injection or as an infusion. Infusions last longer and usually take place in a hospital or specialized infusion center.

When you get to the infusion center, your nurse administers your chemotherapy drugs and any additional medications you need. For example, you may also receive an anti-nausea medication before the chemotherapy drugs.

During the infusion:

  • Your nurse accesses your CVC or starts an IV.
  • You may read, watch television or visit with others during your treatment. Chemotherapy infusions may last a few hours or more.
  • Your nurse flushes the IV line or CVC with a saline solution and removes it.
  • You wait in a recovery area for about 30 minutes to make sure you do not have a negative reaction to treatment.
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