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Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 45940
Experience:  Board Certified Oncologist
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Dr i am 39 premenauposal woman bc idc 1.3 cm er+ pr+

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Hello dr i am 39 premenauposal woman bc idc 1.3 cm er+ pr+ her 2 neg did the pam50 came back low risk luminal A score 23 4% distant recurrence in 10 years but an onco here told me pam50 is only for post menauposal woman my question can i take for sure according to pam50 that i am luminal A?
Submitted: 1 year ago.
Category: Oncology
Expert:  Dr. David replied 1 year ago.
This is Dr. Davidluminal A? I'm not sure what you mean by this?did your doctor recommend adjuvant chemotherapy for you and radiation after a lumpectomy?
Customer: replied 1 year ago.
I already did a bilateral mastectomy and did the pam50 test my ki67 is 10% luminal A and b are subtypes by the pam50 my onco recomended no chemo because my pam50 is low but another onco said pam50 is for post menauposal
Customer: replied 1 year ago.
I will have also zoladez for ovarian function suppression and tamoxifene
Expert:  Dr. David replied 1 year ago.
http://bmcmedgenomics.biomedcentral.com/articles/10.1186/1755-8794-5-44the pam50 study used patients from age 25-76.the oncotype DX study was done first on patients who were post menopausal.what was your distant recurrence score at 10 years? 23.4?
Customer: replied 1 year ago.
ror score 23 which corresponds to 4% it is a low risk
Customer: replied 1 year ago.
Do you think i can rely on pam50? My onco said i can skip chemo bec it is low risk he proposed zoladex for ovarian function suppression and tamixifen or exemestase do u think it is a safe approach?
Customer: replied 1 year ago.
Dr david ????
Customer: replied 1 year ago.
Are u still here dr?
Expert:  Dr. David replied 1 year ago.
we know women who get breast cancer before age 50 tend to get more aggressive breast cancers.I take it your sentinel lymph node dissection was negative for lymph node spread.before these genetic tests, women under age 50 who had breast cancers 0.5 or 1cm in size all received adjuvant chemotherapy and then tamoxifen therapy.there are no guarantees in adjuvant therapy and no one can predict the future.if you want your lowest possible chances of breast cancer recurrence in the future, I would undergo adjuvant chemotherapy and then ovarian ablation and tamoxifen therapy.
Customer: replied 1 year ago.
Thank u for ur response but is pam50 a reliable test for the intrinsic subtypes ? I heard luminal A didn't benefit from chemo and pam50 said i am luminal A so i am afraid of going through chemo for nothing
Expert:  Dr. David replied 1 year ago.
pam50 is a new tests with limited follow up and no long term data.http://ww5.komen.org/BreastCancer/SubtypesofBreastCancer.htmlluminal A breast cancers doesn't mean your cancer is not aggressiveor that it will not benefit from chemotherapy.it is not the pam50 test which is telling it is luminal Aluminal A is onlyER-positive and/or PR-positive HER2-negative Low Ki67you would not be going through chemotherapy for nothing.chemotherapy would further reduce your risks for systemic recurrence of your breast cancer. along with tamoxifen therapy and hormone ablation.
Customer: replied 1 year ago.
Even with a 4% distant recurrence score at 10 years you advise to go for chemo ?
Expert:  Dr. David replied 1 year ago.
it sounds like you found another doctor who also advised you for chemotherapy as wellso I am not the only doctor recommending this.if it were me, I would get the chemo.PAM50 testing is still new.you are very young at 39. we know breast cancers are much more aggressive in younger patients.that 4% recurrence rate may or may not be 100% accurate.
Expert:  Dr. David replied 1 year ago.
let me know if you have other questions.if done for now, please leave positive rating of 3-5 stars so I can get credit for helping you todaywe only get credit for helping clients after positive feedbackyou can always reach me directly with "a question for Dr. David" in the medicine or oncology categories if you have other questionshere is my website if you need to reach me:http://www.justanswer.com/medical/expert-dr-david/Thanks for using JustAnswers.com
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