physician modeling vs. cancermath.net

bcisnofun

Hi all,

Looking to all of you smart people out there to help me think through something.  I was dx with 1.5 cm ductal invasive in one breast and DCIS in the other.  Stage 1, grade 1, er/pr+ (>95%), her2/neu-.  I did a double mastectomy and reconstruction and am very pleased with the decision and results on that part.  Oncotype score came back 12, which is an 8% chance of distant recurrence/metastasis on tamoxofen. Per another modeling the physician used, I have a 13% chance of recurrence with tamoxofen and that reduces to 9% with chemo (A/C 4 treatments).  Cancermath.net shows only a 1.1% increase in prognosis by using chemo.  Seems like splitting hairs perhaps, but 4% and 1.1% are big differences to me in deciding whether or not to do chemo.  On one hand, I want to do everything I possibly can (I am 45 with a 7 year old).  On the other, I know there are potential negative effects from chemo.  I am eating healthy, exercising, trying to do all the right things.  Can anyone help me understand the differences in these methods to model potential outcomes?  Thank you

vlnrph

I'm no expert on these models but you are young and that should be a consideration. Your nodes were probably negative which is good and the tumor was small, also favorable. Four treatments is not very many in the big scheme of things. Why Adriamycin instead of Taxotere?

coraleliz

My MO uses adjuvant!, it's an online tool for healthcare professionals. The 1st time I met with him he told me, Tamoxifen would cut my reoccurence by 10% & adding chemo another 5%. I pushed to get my oncotype score run & it came back 4. He called me in for more discussion. This time when he ran my numbers again, Tamoxifen cut my reoccurence by 9% & adding chemo another 8%. I experimented with the program at home & was able to get the 2nd set of figures but I don't know how he got the first. Perhaps the data bank was updated. My MO cautions me about my low onco score because I am node positive. I don't think he did anything intentional. I played around in cancermath & got similar but not exact results. I wasn't going to do chemo for the additional 5% unless my oncoscore was high. Now I have 8% to ponder. There is a study taking place for node positve women with low to intermediate onco scores & randomly assigning them to chemo or no chemo groups. My MO says the current studies, the largest being 367women are to small.

Also, cancermath defaults to 15yr and adjuvent defaults to 10yr. It's easiest for me to view cancermath as a bargraph & change the years to 10  for comparison. Although doing all this really hasn't added clarity for me. It is a very hard decison.

coraleliz

Another thing I find interesting is that neither cancermath or ajuvant take into consideration surgery or radiation. So I guess these things are assumed

bcisnofun

• Hi Coraleliz and vinrph - I PM'd you and hope that's okay.  Thanks for your answers. 

mdg

I have somewhat similar stats..I am age 45 with a 4 year old son.  My oncotype was 17 which is the highest number in the low/no chemo recommended group.  Some of the things that made me feel uneasy was that I had angiolymphatic invasion on my pathology report listed as present meaning the cells had an established pathway to travel by blood.  I also was upgraded to grade 2 after my surgery from grade 1 which is intermediate.  I decided to go aggressive with surgery and do a BLMX.  I did not need rads.  I had two med onc opinions and one said no to chemo based on oncotype despite the angiolymphatic invasion.  She said tamoxifen would be the best way to battle that.  The other reviewed it and asked tumor board and 3 of 4 med onc's there said they felt I would benefit from chemo.  My recurrence rate from oncotype was at 11% but my med onc seemed to think it would be lower from doing chemo.  I now had to make the choice.  For me the angiolymhatic invasion scared me horribly and the fact that I have a very young child weighed heavily.  Besides BC I am in excellent health and workout daily.  My doc thought I would handle chemo well and recommended TCx4.  I chose the chemo and completed it o 5/4.  My compromise was doing cold caps to keep my hair.  I still have my hair and did chemo.  Chemo was not fun, but it was tolerable.  I was able to exercise daily - didn't miss one workout.  I was still able to get up and get my son off to preschool every morning and cook dinner every night just like normal.  I am glad I did the chemo.  I can look back and know I did everything possible to fight this.  I am now on tamoxifen.   Making the chemo decision was the hardest decision I had to make in all of this.....I know how hard it is to decide.  Good luck!  PM if I can help answer any questions since our stats are similar.  Hugs!