Question: You had answered my few queries for my aunt breast carcinoma questions and this is a follow up question.

She got operated(quadrantectomy) for T2N0M0 invasive breast carcinoma in the first week of XXXXXXX 2017. Her tumor size was 3cm with no nodes affected but the complete axillary node dissection is done with 17 lymph nodes removed. It was ER+, PR+, HER2-

We had confusion on chemotherapy and finally opted for Endopredict test which came back as high risk with 21% of 10 years distance metastasis possibility with only 5 years of Endocrine(Hormone) treatment.

We took 3 opinions from different medical oncologist and couple of them suggested aggressive chemo with 6 cycles of FAC, FEC. But one of the famous medicalv oncologist suggested to go with 4 cycles of TC chemo regime and he dont wanted to give her Adriamycin as it might cause heart problems. But he suggested to go with 10 years of hormone treatment instead of 5.

We have given her 4 TC chemo, radiation to the entire right breast(21 cycles) and started her with Femara(Novartis) a month back.

I just wanted to check if we are going on the right track with her treatment.
Below is the plan given by our medical oncologist.
1. Femara daily one tablet
2. Dexa scan next month and follow up with the report.
3. Annual mammogram on both breast and pap smear.
4. 10 yearly once colonoscopy
5. Flu shots every year and pneumonia vaccination once in 5 years.

I also discussed about Vitamin D and calcium supplements for her and as she has grade 1 L4, L5 spondylosis and doctor told that the decision will taken after Dexa scan report.

Questions:
1. Are we at right path with the treatment plan?
2. I have read that Vitamin D and blood inflammation are linked with breast carcinoma and also recurrence. Is it better she takes these supplement everyday to avoid it. Her Vitamin D levels were low.
3. I read that Bisphosphonate can avoid metastasis. Is it recommended to take for my aunt's condition?
4. Since the Endopredict report came high we are bit worried about the recurrence and should we take any extra precaution?
5. How long it takes for her surgery pain to subside. She is still complaining about the pain and taking PENTANERVE NT 400/10 tablet daily.
6. Her left breast had BIRAD 3 when she was diagnosed carcinoma in right breast but our oncologist is not worried much on that and he is saying that this year December Mammogram is enough and no need of Biopsy and early Mammogram.

Question is little big and thanks for your patience in reading this and please give me your valuable feedback.

Thanks for your response.

Please see my comments below for your answers to my questions.

1. Do you also think that she should take the Femara for 10 years?

2. Please advise the name and dose of the vitamin D and calcium supplements. Also, suggest if there is any other supplement she should take. Our doctor just told to do the Dexascan before deciding on this. I will check with him during my next visit.

3. Please advise the name and dosage of bisphosphonates and how long it is advised to take? Is the dosage decided based on Dexascan? Since she has L4/L5 Grade 1 Spondylosis, I believe this should be advised for her. Please suggest.

4. Do you think TC chemo regime is enough for her condition?

5. ok. How long do you think she should continue taking PENTANERVE NT 400/10?

6. Do you mean the mammogram films or the report? I can upload the report. Somehow our doctor feels it is a benign one and not advising the mammogram/biopsy till this December. I had requested the radiation oncologist to have a close look at it when they gave her radiation last month and they told me there is a dense area but nothing concerning. Do you still think I should get left breast only mammogram done?

Couple of more question please.

7. Is there anything we are still missing or can be advised to further reduce the recurrence risk? I know she should reduce her weight as her BMI was over 30 when she was diagnosed. Now she is reduced approx 10 kg with BMI 28.
Height:151 cm and was around 74 kgs when diagnosed and now she is 64 kgs.

8. She is doing morning and evening walking daily and getting exposed to early and late evening sun to get Vitamin D. Will the walking is sufficient or should she start doing other exercises and yoga?

Please help us with your inputs.

Thanks again for your detailed answer. Please see couple of follow up questions.

2. Should I also check the Vitamin D levels along with the Dexascan to decide the dosage of Vitamin D? She was advised to take D3 MUST 60K when started with chemo 4 months back for 12 weeks which is now stopped. Also, SUPRADYN 1 tablet daily for 12 week during chemo. Generally the Vitamin D is given weekly once and for her can we give this everyday with what dosage?

5. Please see the report attached for your reference. I have attached both Mammogram and CT scan reports for your kind reference.

Thanks alot for taking time to review and answer my questions.