Walnut Creek Kaiser Opinion: No Further Treatment

On Wednesday I drove to the Kaiser Walnut Creek facility to meet with another oncologist, Dr. Huang.  She inquired about the reason for my visit (2nd opinion) and began the conversation by concurring with Dr. Jeske’s recommendation of no further treatment.  She said the data for small-sized, node-negative, Her2 positive breast cancer is limited because of its relative infrequency.  Since there are not many cases, there is less call for research and therefore very little data on outcomes with or without treatment.  She stated that her department’s oncology practice is literature-based:  published results -> treatment; no published results -> no treatment.  She said that if I do insist on pursuing adjuvant therapy, Kaiser would provide treatment, and she would recommend TCH (taxotere-carpoplatin-Herceptin).

In addition, I spoke with Dr. Moasser over the phone yesterday to clarify a few additional questions.  I asked whether I could email him the Kaiser study [1] so he could compare those more favorable statistics with the ones from studies which he cited on Wednesday.  He declined, upon realizing the data came from a mere conference poster versus a peer-reviewed journal paper.  Also, he said that research is still inconclusive about whether a higher IHC score (measures Her2 status; possible values are 0, 1+, 2+, and 3+; mine is the highest at 3+) correlates with better Herceptin response.  Finally, I asked about the discrepancy between the 15% recurrence rate he quoted from the MD Anderson study [2] and the 13.6% figure I actually found in that paper for risk of recurrence for both T1a and T1b, node-negative, Her2+ patients. He said 15% was his educated guess given I’m only T1a (improving the 13.6% figure) but also hormone receptor negative (worsening the 13.6%).  He planned to fax Dr. Jeske his patient notes (attempting to persuade her of his opinion) yesterday afternoon.


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