Mixed Pathology Reports and ER Status Change After Oncotype Test

Warrior_Woman

Hi Everyone -

I am terribly confused and looking for others who have had this experience or knowledge of it.  My core needle biopsy showed I was ER+ (70%), PR +, HER2 -.  My post mastectomy path report showed I was ER+ (90%), PR +, HER2 -. My Oncotype test now reports ER- (5.4% with 6.5% needed to be positive), PR +, HER2 -..  What the heck!  Can anyone offer insight?  

ziggypop

Warrior Woman - I think you're going to need to ask your oncologist on that one, but it could be that it's measuring different things about the er status - the oncotype test is done on er+ cancers and assumes that you will use an AI or SERM. Since the idea is to predict the potential benefit of chemo maybe it uses a lowered er score based on the idea that that the AI of SER will effectively lower the amount of estrogen feeding the cell. For sure you would want to ask your onc, but it may just be that the two tests are measuring 2 different things about the er status. 

bdavis

Is it possible you have two different primary cancers?

Warrior_Woman

Ziggypop and BDavis - The consensus with the one million oncologists I've spoken with is that while this dramatic of a difference is highly unusual it won't change my treatment.  I had the theory of mixed cancers or a very heterogeneous tumor as well as many other theories.  I had a theory that I'm really an alien from outer space.  I was terrified by the possibility that no treatment on Earth would help me.  As it turns out, the measurements are done differently at Genomics.  The good news is that the research on Tamoxifen effectiveness measures ER the same way it was done with my two path reports showing I am highly ER positive.  I am meeting with an Oncotype "expert" oncologist this week who will give me his thoughts.  That will be opinion one million and one.  

I appreciate your replies.  Every time I think I know what is going on another surprise pops up.  I am doing the chemo. Cytoxan, Taxotere x 4 and later the Tamoxifen.  The oddity of this report helped me make the decision to definitely do chemo for the possible chance the Tamoxifen won't be as effective.  

BTW, BDavis - We're neighbors.  I live in Hunterdon County near the river - Frenchtown.  I took flying lessons at Princeton Airport.  I actually flew a plane one time.  It was awesome. Princeton is such a beautiful area.  

bdavis

Glad you have a plan neighbor... It does seem confusing though. I too did chemo TC 6tx and am now on Tamoxifen. Its all doable,

momand2kids

Something like this happened to me-- in the PR which was positive in pathology and slightly negative in the oncotype.. My onc said it would make no difference in treatment and they considered me PR+ via the pathology.... but the difference was slight.  I got the sense that this difference was not unusual with the oncotype.... 

There always seems to be "one more thing", but the truth is, eventually you do have all the info.... there is a stopping point and it sounds like you are close. Then you just get to execute your plan!

Good luck.

Warrior_Woman

I read a poem titled, "Clawing & Soaring" written by a woman with BC.  The title captures it all.