Barely ER+ means what?

Chirps

Newbie here; been lurking awhile though.

Had BMX on 8/10/10 for IDC, ER+/PR- HER2-, Grade 2, 1.3cm, node 0/3.  

The "Allred" score for the ER+ was 1+1 = 2 / 8. 

 Best I can tell, this is barely ER; the "proportion score" of 1 means it's up to 1% and the "intensity score" of 1 means "weak." 

Is this an artifact of the testing procedure or does it mean that "only up to 1%" of the cancer cells have estrogen receptors or does it mean something else?  From things I've read, I'm under the impression that Tamox wouldn't do as much for this (low Allred) as it would for a cancer with higher Allred score.  But a knowledgeable person told me it's treated the same, as in "you can't be a little bit pregnant."  (Hmmm... would the Allred score increase over time?)

 Also, is this a good candidate for the oncotype dx test?  Are there other tests I should be asking about?   Go to see onco in 2 days to discuss "where we go from here."  None of the receptor status info was available when we met before the BMX.  

 Also, I visited the Adjuvant online but I wonder how to tweak numbers for BMX (vs lumpectomy+rad or MX).

I read that newbies are limited in #posts (but how many??) so I'm not sure how much I need to cram into one post!

Thanks so much for any and all insight, links, etc!

tryn2staycalm

Chirps- First of all Welcome. I can't answer all your questions but be patient there are gals here that can.  One thing I can tell you is my ER+ is 30%.  My onco told me I would still be able to take hormone therapy.  She said higher would be better but we can still work with that.  As for posts I'm trying to remember.  Possibly 3 in 24 hours- until you reach 50.  I'm sure others will clarify that for you also.  There is so much to learn but this is a good place to start.  Good luck with your journey.

Cathy

Chirps

Thanks for your response, Cathy!  I appreciate your input.  I'm not familiar with all of the measures of ER, in addition to the Allred score, but I do see many who report just a percent.  I hope the hormone therapy works well for you and that you find it agreeable!  I see you're a July'10 dx like me...  I wish you good luck also!! 

snuz1

Good Evening Ladies...I have ER+ 95% and PR+ 95% and I am assuming that is very good for treatment perspective.  I never really understood the rationale of the different percentages.  Also I had the Ki-67 staining test with results of 15% which they called borderline.  Borderline what?  Anyway, so many tests but still clueless.

Take care of yourselves and hopes for a great recovery.

Chirps

Hi there snuz1,

I'm sorry but I have scant understanding of the Ki-67 test. I'm under the impression that "more quickly growing" cancers have a higher Ki-67. One place I read says for this test, greater than 20% is considered "high" ... making your 15% "borderline" to mean "borderline fast growing." Same source says that some studies suggest the hormone therapy is less effective on hormone-positive tumors with "high Ki-67"... so this is another "piece to the puzzle" in selecting effective treatments ("high Ki-67" may suggest adding chemo to recommended treatment). Personally I find it interesting that you have Grade 1 and "borderline" Ki-67 ... not that I have enough understanding to know if this is typical or not!

From all I've read, I think you're right on track in thinking your 95% positive is very good for treatment perspective... although if one's Ki-67 is "high" (NOT saying yours is!) then of course it's not so straightforward as I had thought!  I don't know the real rationale for why-the-% but I'm getting the impression that "the higher the ER %, the better the hormone therapy will work on that particular BC"---compared to other tumors with lower ER that are "otherwise equal." 

And in saying that, I should also mention that yesterday I learned from my MedOnco that my Allred score of 2 (out of possible 8 total) for ER is so "barely positive" that he thinks hormone therapy (such as Tamox) would be virtually useless for me!  So, my options are now "chemo" or "nothing" just like the "triple negative" folks. Next step is Oncotype DX to get more data to aid in decision process... I think I'll be getting the Ki-67 info as part of the Oncotype DX test...

Take care and best wishes to you!

snuz1

Thanks for the info Chirps.  The Stages have me baffled.  Their ranges sometimes don't make any sense to me.  I had a 2.3 cm tumor and ranges were <1  -  2 is Stage 1 and    >2- 5 is stage 2..go figure.  Again I am borderline....same with the grade...I could have gone either way with l or 2.  My onc mentioned chemo to me if I wanted to do that and then rads, but I told him and he agreed, that the 1% extra protection it gave isn't worth the health risks.  I read the info on the Ki-67 and  I feel like I am on a tightrope...I can either get across, no problem, or fall off.   I intend to talk to my onc next week and ask him to EXPLAIN in laymans terms, all these results.

One thing we have in our favor is there are so many more choices and it is OUR choice.  I wish you all the best.