Providing free online community support to people affected by breast cancer

Forums » Your Treatment Experiences

• Shirl12

  

  • 1 posts
  November 23, 2013 11:28:03 AM WATime

  Report

  Hello all, I'm thinking of getting a second opinion following my appointment with the medical oncologist re hormone therapy. I am 44 & was diagnosed with Stage 3, Grade 3 Breast cancer and have undergone a mastecomy & axillary clearance (14/21 nodes postitive) and 6 cycles of Chemo (FEC-D) and soon to start radiotherapy. The Dr only offered Tamoxifen as hormone therapy and did not allude to any ovarian suppression therapy. She looked a little taken back when I asked "what about estrogen suppression". After 10 seconds of silence, she said that there was "no evidence that it is effective". I am left unsatisfied with this explaination. I am no expert obviously, but I am premenapausal and still have very regular periods. I even had the first 2 periods during chemo. If there is "no evidence", why does every pamphlet and breast cancer booklet refer to ovarian suppressing in younger and premenapausal women. I am also disappointed that after going thru the 6 cycles of chemo and moving to hormonal treatment, I have only seen the consultant once, at the first visit. Having a relationship with your treating Dr is part of feeling comfortable regarding decisions made about your treatment in my opinion, which is difficult when you see a different junior Dr at each visit, but that is for another blog. Am I being a difficult patient. What have others in similar circumstances experienced?

  Mother of 3 diagnosed at 43 with Stage 3, Grade 3 Invasive cancer. 9mm  Mastecomy & axillary clearance. 14/21 nodes positive. Chemo x 6, Tamoxifen and soon to start radiotherapy.

• Glenys

  

  • 162 posts
  November 23, 2013 7:25:15 PM WATime

  Report

  Hi Shirl
  By no means are you being a difficult patient! The most important aspect is to understand why certain treatments are or are not recommended for you, which of course then allows you to appreciate this and not end up feeling that you may not be receiving optimal treatment. This is your basic right.
  
  I've researched this further, and have found the literature available generally reflects that ovarian suppression (OS) has not been shown to have added benefit when chemotherapy & Tamoxifen are given for pre-menopausal women with bc, except possibly for women under 35yrs (although even this is controversial). There is good evidence that OS improves outcomes for hormone-positive bc in premenopausal women where chemotherapy and/or Tamoxifen are not used - therefore supporting that OS has a role to play in certain circumstances (hence the information about this in pamphlets & booklets).
  
  You've mentioned you are still premenopausal with regular periods ..can I clarify if you are still having regular periods since chemotherapy finished? Or if periods stopped after the first 2 during chemo? If you don't recommence having regular periods then you will have chemo-induced ovarian suppression already, although this would not be certain until 12 months of no recommencing of menstrual periods. If you do have regular periods after chemotherapy, then the question of suppressing the ovaries may be more of an issue, although again this is controversial in the literature.
  Several articles that hopefully will help to provide explanation for the approach this Medical Oncologist has taken: http://www.rcog.org.uk/womens-health/clinical-guidance/breast-cancer-and-oophorectomy-query-bank ; http://jnci.oxfordjournals.org/content/99/7/516.full ; https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=75982
  
  Trying to fully comprehend the complexity of this subject and determine the best approach in recommending treatments is difficult even for the experts, let alone the rest of us! I completely agree with you that having confidence in your treating specialist is critical to feeling comfortable with decisions regarding treatment. Unfortunately in the public system you may not always see the Consultant, although the doctor you do see should have a level of seniority in the team, and therefore good understanding. You can always ask to see the Consultant if you wanted to discuss a particular aspect (as I gather you haven't had this opportunity to speak with Consultant since your first visit).
  And yes, you can certainly seek a second opinion from another Medical Oncologist if you are not comfortable or clear on recommendations. I would always encourage this where the matter is not cleared or you are left feeling uncertain about this. I myself have done this for health matters where I was not confident with the plan of management, and was able to then feel much more comfortable I was receiving good advice.
  
  Hoping this will help for you Shirl, and very happy to discuss any further.
  Love Glenys (Click Breast Care Nurse) xx
  

  The Click Breast Care Nurse 

• Mazzi1984

  

  • 6 posts
  November 26, 2013 2:49:23 PM WATime

  Report

  Hi Shirl,
  
  Just a quick one from me........ Good to have you here for a start :-)
  
  Secondly your comment caught my eye - "what about estrogen suppression". After 10 seconds of silence, she said that there was "no evidence that it is effective". - I had that exact reaction from a male oncologist. I was very angry and disappointed as he went back to talking about the Tamoxifen after I had told him to stick his chemo hee hee.
  
  I am off to see another oncologist on Thursday at another hospital to see what their view on the subject is !
  I believe that it is the right course of action for me and I will believe it until someone firmly tells me one way or the other why it's not. In my opinion when I bought up the subject he either didn't know, guessed or just wanted to change the subject.
  
  In short - don't be afraid to speak up, step on a few toes and challenge these people to look outside the window and see the bigger picture! It's your life - you're future !!
  
  MZ
  XXX

  **Updated** 29yr old. Ductal right breast. 1st Oct lumpectomy. Unclear margin. Grade 2. 22nd Oct Bilateral mastectomy - no recon. Moving on happy.
• Glenys

  

  • 162 posts
  December 4, 2013 3:42:17 PM WATime

  Report

  Hi Shirl & Mazzi - just wondering how things are going for you both? Did you manage to get another opinion Shirl? How did your visit to the 2nd Oncologist go Mazzi?
  Would love to hear how you are both feeling about this now ..
  Love G xx

  The Click Breast Care Nurse 

• Mazzi1984

  

  • 6 posts
  December 4, 2013 9:25:04 PM WATime

  Report

  Hi Shirl and Glenys,
  
  Things are going well. As I mentioned to you Glenys I have had a recent kick up the bottom and have decided to go for the chemo option. Slight bump in the road with the 1st partial dose but they are going to mix me up a new and me friendly batch and off we go Monday next week :-)
  
  Shirl, I sought a 2nd opinion and bought up the idea of ovary supression. I was told that due to my cancer only being present in one breast and there no history of ovarian, utrine or any cancer for that matter there would be very little reason for me to go to that extent of treatment. Also the registrar said that there has not been a definitive proof that it will reduce the risks.
  
  Let us know how you're going.
  Would love to hear from you :-)
  
  MZ
  XXX

  **Updated** 29yr old. Ductal right breast. 1st Oct lumpectomy. Unclear margin. Grade 2. 22nd Oct Bilateral mastectomy - no recon. Moving on happy.