Understanding Neoadjuvant & Adjuvant Chemotherapy for Breast Cancer

Question
Dear Dr Nordquist,

I have been given 2 different opinions for the chemotherapy treatment portion of my breast cancer.
I am 48 years old, my tumor is approximately 3.5 cm is an invasive duct carcinoma that has reached the axilla lymph node.
Both doctors agree that we should use neoadjuvant chemotherapy to attempt to shrink my tumor to make a lumpectomy possible.

One doctor proposes dose dense AC followed by dose dense Taxol - ALL prior to surgery.

The other doctor proposes dose dense AC followed by surgery followed by  dose dense Taxol AFTER surgery.

Which direction do you think I shold go? Are there survival benefits either way?

Thank you so much,
CD

Answer
This was difficult! I'll just complicate your situation even more by having a third opinion - or rather a mixture of both - since I happen to believe that chemotherapy (or perhaps radiation therapy) is necessary to shrink your tumor before surgery (hopefully a lumpectomy) but ALSO after surgery to increase your chances of a cure. I have not considered it fully yet but think - at the moment - that I see no reason to make the chemotherapy before and after any different so in that case both AC & Taxol would be used one way or another both before and after. I'm sorry for the complication I cause!



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