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Candidate for hormone blocker, not chemo?

Page last modified on: November 20, 2008
Question from SCU: I had a modified radical mastectomy and lymph node removal and am now in chemotherapy. I just finished four rounds of AC and am due to start Taxol in two weeks. Considering this information as well as new guidelines coming out of San Antonio recently stating that hormone-receptor status is THE most important criterion for treatment, am I a candidate for a hormone blocker now, instead of more chemo? Also, what about radiation?
Answers —Generosa Grana, M.D., F.A.C.P.: I don't believe that the presentations at San Antonio suggested that hormone-receptor status was the most important factor in determining outcome. What they suggested was that outcomes from cancer depend on many things, among which are hormone status and HER2/neu status, along with age and other factors. The decision to use four cycles of AC followed by four cycles of Taxol has to depend on an assessment of risk—how big is the cancer, are there lymph nodes involved and if so, how many, how old are you, and then part of that decision will encompass hormone-receptor status.

So it's a much more complex question, and one you should address with your oncologist. I believe that in a woman who has positive lymph nodes, there continues to be a role for regimens such as AC followed by Taxol.
Marisa Weiss, M.D., president and founder: The traditional indications for radiation after mastectomy include having a cancer that's 5cm (about 2 inches) or larger, having four or more positive lymph nodes, and having a positive (involved) margin of recession. There are other certain circumstances where radiation may be indicated depending on your individual situation, such as a woman who has a small lump but with a lot of lymphatic or vascular invasion (breast cancer cells found in the blood and fluid channels of the breast) because that type of situation is associated with a higher risk of recurrence after mastectomy. It's helpful to get an opinion regarding the role of radiation and consider this carefully in your situation.

On Wednesday, December 21, 2005, our Ask-the-Expert Online Conference was called Updates from San Antonio Breast Cancer Symposium 2005. Generosa Grana, M.D., F.A.C.P. and moderator Marisa Weiss, M.D. brought you the highlights of the 2005 Breast Cancer Symposium and answered your questions about the latest diagnostic and treatment options for breast cancer.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Generosa Grana, M.D., F.A.C.PGenerosa Grana, M.D., F.A.C.P. is the director of the Cooper Cancer Institute and heads the division of hematology/medical oncology at Cooper University Hospital.

Marisa Weiss, M.D. is a radiation oncologist specializing in breast cancer and the founder, president, and guiding force behind Breastcancer.org.

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