A very good interview with Dr. Stefan Gluck, medical oncologist at the Braman Family Breast Cancer Institute at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.
We look at the size of the cancer, the number of lymph nodes involved and the surgery. Those issues drive whether a woman will need radiation. Then the pathologist measures estrogen receptor, progesterone receptor and human epidermal growth receptor, the HER-2. The first two are good prognostic markers, whereas the HER-2 is a bad prognostic marker. If both good ones are positive, then it tends to be a less aggressive cancer and patients tend to do better over the years with fewer recurrences. The patient who has ER, PR negative breast cancer has many more recurrences, particularly in the first three to five years. The HER-2 doubles the recurrence rate if it is positive. The good news is we can counterbalance it with treatment. If a patient has an HER-2 positive breast cancer, we treat her with Herceptin. Herceptin is an immunotherapy because it’s an antibody and you infuse it every three weeks for one year. It decreases the recurrences by half. Then you have the cancer that is negative for ER, PR and HER-2. We call it triple negative breast cancer. The only thing we can use is chemotherapy.