Considering chemo

What are the factors to consider when treating a woman with early stage breast cancer?

Val, a healthy 66-year-old retired nurse, found a left breast lump two months ahead of her regular screening mammogram.

She has not smoked for 40 years, maintains a healthy weight and exercises regularly.

She took combined HRT for three years from age 50 but takes no regular medication now. Val’s mother was treated for breast cancer aged 80, then died five years later of unrelated causes.

Val underwent conservative surgery for a 22mm, Grade 3, infiltrating ductal carcinoma with clear margins, with perineural but no lymphovascular invasion.

Two sentinel lymph nodes were uninvolved. The tumour was oestrogen receptor (ER) positive and progesterone receptor (PgR) negative.

Human epidermal growth factor receptor-2 (HER-2) staining was negative.

Val’s oncologist recommended post-operative radiotherapy and long-term endocrine therapy, and offered