Questions for your Breast Surgeon and Medical Oncologist:
- What is HER2-Positive breast cancer?
- Will I need Chemo and Targeted Therapy?
- What are the benefits of Neoadjuvant Chemo?
- Isn’t Neoadjuvant Chemo recommended more now?
- Should I consider a Clinical Trial?
What is “HER2-Positive” breast cancer?
“HER2-Positive” breast cancers are fast growing tumors that more frequently spread beyond the breast to other parts of the body. Because of this, they are a bigger threat to your life than most other types of cancers with different receptor patterns. These cancers are called “HER2-positive” because they have too many HER2 protein receptors on their surface. These tiny proteins act like “light switches” to turn cancer cell growth “on.” Chemotherapy, combined with new, “targeted” drugs, are very effective against HER2-positive breast cancer and are a leap forward in breast cancer care.
Your Breast Surgeon will know your “receptor pattern” within days after your initial breast biopsy. These results are often not communicated to you early on in your decision process. Although only 20% of breast cancers are “HER2-positive,” it is imperative that you specifically ask your surgeon immediately, and well before surgery, “What are my receptor results?” Take our lesson on “My Tumor Receptors” to learn more.
Treated with Chemo and “Targeted Therapy”
HER2 Receptor Positive (HER2+) tumors are incredibly responsive to chemotherapy when paired with new breakthrough drugs that target these cancers, such as Herceptin and Perjeta. The same holds true if a HER2+ tumor is also Estrogen Receptor positive (ER+). HER2+ tumors are more aggressive cancers, but we now can treat them more effectively, than in the past, with chemotherapy and “targeted immunotherapy” drugs that are designed to destroy them. Everyone with a HER2+ tumor larger than 5mm (1/4 inch) and in good health is considered for chemotherapy and targeted therapy.
Unfortunately, studies have shown that many patients are not offered these standard of care, life-saving “targeted drugs” along with chemotherapy. You will make better treatment choices when you are well informed about HER2 therapies before meeting with your medical oncologist. You must inquire about Herceptin, Perjeta, and other “anti-HER2 drugs” that may be of benefit to you.
Ask about the benefits of “Neoadjuvant Chemo”
What is often overlooked are the benefits of offering neoadjuvant chemotherapy for patients with HER2-Positive, “Early-Stage” (1 & 2) breast cancers. There are distinct advantages (listed below) to having chemotherapy before surgery instead of afterwards. The decision to consider neoadjuvant chemotherapy always begins with your breast surgeon. Breast surgeons choose the initial direction of your entire breast cancer treatment plan. You must address this “cutting edge” treatment option well before surgery to benefit from neoadjuvant chemotherapy. Do not be afraid to ask. This is a very important question. Learn more about “Neoadjuvant Chemotherapy“ by taking our video lesson on the topic.
The Potential Benefits of Neoadjuvant Chemo:
- Begin life-saving chemotherapy earlier
- Reduce the need for a mastectomy
- Improve lumpectomy cosmetic outcomes
- Reduce the need for an “Axillary Dissection”
- Allows more time for BRCA genetic testing
- More time to think about “lumpectomy vs. mastectomy”
- Shows your cancer team if the chemo is working
- Can possibly eliminate all cancer cells before surgery
- Reduces the need for radiation after a mastectomy
Ask if you might benefit from a Clinical Trial.
New therapies must be studied in clinical trials to make sure they are safe and effective at treating breast cancer. HER2-positive breast cancers are currently the focus of intense clinical research. New drug treatments are rapidly being developed for this aggressive cancer. Less than 5% of all patients with breast cancer participate in clinical trials. Patients with cancer willing to participate in clinical trials are essential for the advancement of breast cancer care. Ask your medical oncologist if they offer or recommend you participate in a clinical trial for your unique breast cancer situation. Learn more about “Clinicial Trials“ at the Breast Cancer School for Patients.
Patient-Friendly References:
This page (here) “HER2-Positive Breast Cancer” is a very good overview for patients. Living Beyond Breast Cancer is a non-profit organization dedicated to providing quality information about breast cancer to patients.
- 4HER HER2+ Patient Support App
This iphone app (here) is a resource specifically designed to help women who have been diagnosed with HER2-positive breast cancer. This link (here) is the online version. It is created by Genentech, Inc., maker of anti-HER2 treatments in conjunction with www.breastcancer.org.
This website (here) is the portal to a free program supporting patients receiving the anti-HER2 drug Herceptin. This site is created by Genentech, Inc., the maker of anti-HER2 treatments.
Their website page (here) “HER2-Positive Breast Cancer: Treatment Considerations” is a good overview of the topic. This site is created for patients by the American Society of Breast Surgeons.
These interactive web pages “Treatment Navigation: Neoadjuvant Chemotherapy” are excellent at outlining neoadjuvant chemotherapy. This page (here) covers “HER2-positive” tumors. The Susan G. Komen organization is a leading advocacy group dedicated to assisting patients, funding research, and ensuring quality breast cancer care.
Download this booklet (here) “Your Guide to the Breast Pathology Report” to learn about how to understand your pathology report. On page 45-46 of this booklet, there is a list of “Key Questions” and a “Checklist” of key items in your report. This non-profit organization provides excellent online and printable patient resources about breast cancer.
This website is a resource for learning about participating in clinical trials. BreastCancerTrials.org is a non-profit service that encourages individuals affected by breast cancer to consider participating in clinical trials.
More Detailed References:
Their journal article (here) “Performance and Practice Guidelines for the Use of Neoadjuvant Systemic Therapy in the Management of Breast Cancer” is an overview for physicians about the benefits of neoadjuvant chemotherapy. The document was written by the American Society of Breast Surgeons and published in the Annals of Surgical Oncology.
If you want to get deep into the details, this free 200-page pdf document (here) has guidelines to help clinicians to make treatment recommendations about nearly all aspects of breast cancer. You can easily register (here) as a non-professional to get access and more information about breast cancer. The National Comprehensive Cancer Network is the leading organization in developing clinical guidelines.
