Stage I Multi-focal Lobular Cancer

QUESTION: I am doing research for my wife, age 63, who was recently diagnosed with invasive lobular cancer. She had four small tumors—1 cm, 7 mm, 3 mm, and 3 mm—two clear sentinel nodes, estrogen- and progesterone-receptor-positive, grade 3, low proliferation rate, HER2/neu negative, treated by mastectomy with clear borders. Tamoxifen is planned. Is chemo required?

ANSWER: It sounds as if she was diagnosed with several early-stage lobular cancers in her one breast that have favorable features, including the absence of lymph node involvement, HER2/neu overexpression, and the presence of hormone receptors. Learn more about all of these factors. Given her post-menopausal status together with the features above, an anti-estrogen therapy, such as tamoxifen, would be considered to be an important part of her care moving forward. Chemotherapy may be able to offer some additional benefit. But given your wife's already favorable outlook, the ability of chemotherapy to make her prognosis even more favorable is limited to a few additional percentage points. To make the right decision and feel comfortable with her choice, a second opinion would be quite helpful.

—Marisa Weiss, M.D.