75 Year Old Mother - Triple Negative (Lumpectomy - but REFUSED treatment)

Have you seen this site,  which oncologist use as a rough guide? https://breast.predict.nhs.uk/

Really interesting post, especially the response from the NHS to repeatedly offer different treatments!  Have you seen the BBC Hannah Fry documentary on weighing up the potential gains from treatment using statistics?  It's here https://www.bbc.co.uk/programmes/m0017wzq.   Also there is a school of thought whether anyone can be regarded as "cured" from cancer.   Anyway, total respect to your mum.  

Yes I’ve visited that site and there was hardly any difference at all with treatment or no treatment which is part of the reason I did not push her harder. It was something like 64% cancer free in 5 years with treatment compared to 59% or something like that without treatment. And I even pointed that out to the oncologist and he said “oh that doesn’t count for triple negative - and I showed him - “yes it does!” And then he said “oh it doesn’t take into account any lymph node involvement “ and again I said “yes it does!” So he said “Yeah so that’s about right - it boils down to almost 50/50 with or without …” 

Really made me think HARD about how much pain and agony I wanted to see my mom go through especially if mentally she was NOT willing to “FIGHT.” 

I tried to click on that but I can’t watch it because I’m not in the UK. But I’d love to see that ! 

Oh!  Quick summary;  Hannah Fry had BC, she's a mathematician.  She read up on the medical approaches to BC, immersed herself in research.  She analysed the success rate of treatments and interviewed people after consultants offered them chemo.  She articulated that many common treatments would only benefit (for example) 10 in 100 people.  There was a higher probability that people would have treatment needlessly and suffer the side effects than it bringing benefit.  Even when she explained this to some patients they couldn't get on the same page.  They were all of the mindset "I have to have it, it's my only chance".  They didn't or couldn't appreciate that of 100 patients, they could be one of the 90/100 for whom it would make zero change in outcome.  There's a long history of over treatment for cancer - my oncologist (different cancer) is involved in some research on it.   

Oh and HF had good outcomes from the treatment but ended up with swollen legs, or fluid retention or similar as a result.  No cure.  

Hannah Fry had cervical cancer, not breast.  Hence swollen legs from treatment.

I've actually re-ran this via the 'breast predict' (and it's the same as when I ran it before). For everything pertaining to my mom - and with her being "74" at the time of diagnosis I know that general elderly age has to play a part in their statistics - it shows this: 

66% overall survival with surgery ONLY and NO treatment for 5 years. 

71% overall survival with 2nd generation chemo drugs (*and this predictor does not even mention radiation which we did not do regardless) for 5 years. 

74% overall survival with 3rd generation chemo drugs (*which I believe would include AC (red devil) and that was always off the table) for 5 years. 

So in my opinion - looking at "66% v. 71%" - I honestly cannot justify putting her through the horrors of chemo at her age and fraility - it just wouldn't make sense - that is of course UNLESS she had a 100% fighter attitude that she was going to throw EVERYTHING at this - which she does NOT have that mindset.  I could see her potentially doing one or two rounds and then saying "I'm not doing this anymore" - which from what I understand from oncologists - you cannot mess around with chemo - you either USE it until EVERYTHING is killed - or you DO NOT bother with it because it will just entice the cancer to come back stronger and harder. 

Very tough decisions us women must face.  Of course there is a difference being 30 years old as opposed to 74 - that has weighed heavily in our decision as well. 

I have TNBC, diagnosed in my mid 60s. I went through more or less the same logic, concluding that the with and without chemo data also implied chemo was fairly ineffective on TNBC. I dd have chemo, but unfortunately wasn’t cured. With hindsight I was probably metastatic de novo, despite no lymph node involvement. Pembrolizumab (Keytruda) is very different to chemo and can be very effective for some people - I had it once I found out I had metastasis and it worked very well for me. For TNBC it is initially given with a taxane, even if you already had one in the primary setting (as I did). That’s the case in the UK anyway, although I am wondering if you are from the US given the reference to Keytruda and to AC (the UK usually uses epirubicin rather than Adriamycin)?  It can have very serious negative consequences too, as I also found out. I am fairly sure if I had been 10 years older, I would have turned down chemo. 

Hello Coddfish and thank you for replying.  I hope you are thriving and doing well!  So if you can tell me - how long have you been battling this?  What all have you done and what staging are you at?

We are in the US - so they have requirements that you must do the immunotherapy (Keytruda) alongside the chemo - BUT the oncologist was willing to try and "waive" that - (but my mother still declined).  

Yes the AC I refer to is the Adriamycin (red devil) - I'm sort of thinking it is very similar to Epirubicn but not sure?  They did NOT want to offer my mother that due to her age (mostly due to the negative consequences). 

As far as we know she is not metastatic yet - (6 month mammo was fine) - but we've been told TNBC likes to come back "2 - 3 years after diagnosis" - so there is still time there - but we are hopeful that it will NOT return.  

I feel that since it had already made it to a sentinel lymph node it does not intend on "playing nice" - although with the lymph node removed and "hoping" that any and all microscopic cells had been removed we are hopeful my mother will live many more years.  

I guess it is truly a crap shoot with cancer - but again at 74 I think we've made the right choice with "quality" of life over "quantity" ... but time will tell!

I certainly hope you have many MANY more years left and are doing well!  

Hello,  fellow USA woman from Florida.  Has your Mom been offered the Signatera test.  It is a liquid biopsy that can pick up cancerous cells from solid tumor up to 9 months earlier than scans.  Here is a link to it.  Very difficult as you get older to make these decisions.  Hope all works out.

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