Denisedds is revealing her age a bit if she remembers when chemotherapy was not recommended for node negative breast cancers. That was the 1980's
With a 1.25 cm primary lesion + clear margins and a good axillary lymph node sampling showing no positive nodes, the likelihood ~ 90% that the breast cancer cells have not spread via the bloodstream.
That still leaves a ~10% risk that the cancer cells have spread and will cause recurrent disease in the next 5, 10, 15, or 20 years. So, if this person receives adjuvant chemotherapy, she may reduce that ~10% risk of recurrence to maybe 5%. A 90% chance that she is cured without chemo vs a 94 to 95% chance that she will be cured with chemotherapy.
And here's the rub, Dave. Roughly 9 out of 10 women with this stage disease do not need the chemotherapy with all the expense and the toxicity which you are well aware of. But we do not know which ones are already free of microscopic disease. So we now treat 10 women to possibly help 1. I greatly disliked this part of oncology - the guessing that is a part of the process. It would take an hour to explain this to a patient and her family. Then they would have to decide what risk they were willing to take. They would usually ask me, "What would you do?" I could not answer that. Only a person faced with this risk can really answer this. How much is one willing to go through to optimize the chances of remaining free of future breast cancer recurrence?
Even more difficult is the fact that even people who go through aggressive adjuvant chemotherapy for breast carcinoma cannot be sure they are truly cured until about 20 years go by. I think you know this all too well.
In adjuvant breast cancer therapy, we are treating disease we cannot see - disease which might or might not be there. Only when recurrent breast cancer develops years later do we know which women had microscopic spread before the primary lesion was removed. Once breast cancer recurs with visible metastatic lesions, it is no longer curable with chemotherapy. The time to treat it with systemic chemotherapy is when it is too small to be seen with any scans known to man.
The choice is up to the patient and the family
- but the current recommendation is to treat 10 to possibly help 1.
In the 1980's we felt that a ~90% cure rate without chemotherapy was enough.
Now the recommendation is to treat all to help a few.
What do you think?
Also, what age is this person? That makes a difference too.
Please note that recurrence rates for stage one, node negative disease vary from study to study. As Denise says, triple negative is not good.
The data I have used is for purposes of example to make my points - but these are close figures. If we go into all the variable data from many studies we wind up confusing people even more.
The choice of regimens is another guess. Denise says that the regimen would not be as aggressive as you wife's treatment. That may or may not be true. It depends on the oncologist. I favored a milder chemotherapy approach for people who already had a 90% chance of being cured with local treatment alone. I did not want 9 of 10 women who were already cured to have Taxol toxicity - usually neurologic damage - for the rest of their lives - nor heart damage from the Adriamycin. I may have missed some chances for cures by using milder regimens. The guesswork is a major stress for oncologists who care.
Added note - "Inverse Mushroom Cloud" has an excellent personal response. Only people who have "been there" can tell you what it's like. You and your wife have been there. I suspect you will be a great help to this friend.