Pain in Breastbone (Sternum)

QUESTION: I was diagnosed with stage IC breast cancer, had a lumpectomy and 11 lymph nodes out. All nodes were negative. Had three months of CMF chemo and now am at 10 of 25 radiation treatments. The doctor wants me to complete three more months of chemo and then start tamoxifen, but I don't want any more chemo due to hospitalizations for extreme pain in my sternum, which none of the drugs I was given helped. I can't imagine suffering like that again. It happened twice. Isn't there something else I can do? I am willing to look into all options.

ANSWER: First of all, you need consider the fact that you have attained some benefit already from the adjuvant treatments you have already received. Three cycles of CMF (cytoxan, methotrexate, fluorouracil) confers more benefit than none! However, we believe that CMF's optimal effectiveness is achieved with six cycles of treatment, maximizing dose-intensity. Sternal pain severe enough to require hospitalization is not typically a feature of adjuvant chemotherapy or adjuvant tamoxifen. The central portion of the chest contains many structures that can give rise to pain: blood cell production in the bone marrow, heart, lungs, esophagus, pleural membranes, bone, intercostal nerves, etc. I recommend addressing this symptom aggressively from a diagnostic/therapeutic standpoint with your doctor, before proceeding with your treatment plan. If the discomfort can be eliminated or controlled, perhaps an additional three cycles of therapy would be much better tolerated.

—Fran Fleegler, M.D.