To:不知如何时好

太太(60岁)在一个月前诊断出乳腺癌 invasive mammary carcinoma ,半个月前做的根除手术.肿瘤大小为15MM X 15MM X 11 MM, ER Positive at 100%, PR Negative at 0%, HER2- Negative for overexpression at 1+, , 腋下淋巴切除了三个，未发现转移. 12/5在一个医院Biopsy 的pathology report说是 7-8 of 9， GRADE 3， 动手术的医院手术Surgical Pathology final report 说是grade 2 。Modified Bloom Richardson score: 6-7/9.
Nuclear score is 2-3/3
Tubular score is 3/3
Mitotic score is 1/3
AJCC Pahologic Tumor Stage: pT1c PNO(sn)pMX
手术前做了MRI 和X ray 胸透视。医生说未发现转移。是STAGE I, GRADE 2 or GRADE 3? 需作Hormonal Therapy.

请问：
1)现在需要做周身骨扫描和周身CT.吗？医生说考虑到副作用，不需要做周身骨扫描和周身CT。
2)医生解释了adjuvant on line Decision making tools for Breast Cancer. 说了做化疗和不做化疗的利弊。听起来似乎做不做区别不大。让我们做决定。请问做不做化疗哪？
3)医生要做DNA检查，以进一步确定，但需14天，如做化疗会不会晚？

1．  骨扫描意义不大，因为很早期。其实骨扫描副作用不大。

2．   化疗的对生存率可能提高2-3%左右，这是过去的说法。有的人愿意接受，有的人不愿意。现在要根据Oncotype DX的recurrence score决定是否化疗。这可能就是#3 DNA检查。

3．   不会。

4．   诊断以最后切除的为准，是GRADE 2。

[不知如何时好]

Thanks! We will do chemo. My wife's doctor asks her to decide whether to do Chemo or not. What she is worry about is that she got 原发性血小板减少症 when she was youn. She is alright now.We already told her doctor about that.

[郝大夫]

回复不知如何时好的评论:

This score is in the area where the benefit of chemotherapy is uncertain. There is a clinical trial open right now for this group of patients. I am not sure whether your wife is seen in an institution where the trial is open. Otherwise, I would favor chemo because of high grade and recurrence score of 26 which is more toward 33 (chemo recommended) than 17 (chemo not recommended) although benefit is uncertain and is small if there is any. Take care.

[不知如何时好]

郝大夫：The Oncotype DX的recurrence score 出来了：26。做不做化疗哪？