Chemo for High Ki 67, low oncotype score ?

sweetpotato12

The huge outlier on my pathology reports is a high ki 67 score (40%... initial biopsy showed 20%).  My oncotype score is a 12. I have split oncologists who say definitely chemo because of my age (38) and this ki 67... while those who say radiation and tamoxifen only say the oncotype overrules, is subjective, and is not even tested by Sloan anymore.  I live in NYC and did not go to Sloan for my second opinion, as an oncologist friend said he knows they would say no chemo based on oncotype. 

I want to make sure I don't regret not doing chemo and am torn.  I think I will start radiation first to give me some more time for another pathology to be run, but would appreciate advice in how to navigate. 

lala1

My ki67 score was 45% with an oncotype score of 15. All of my docs recommended against chemo. I was 49 when diagnosed a year and a half ago. I had no chemo or rads. My BS is considered one of the best in the south and he said he doesn't pay much attention to ki67 numbers. I was ER/PR+ and HER-, stage 2, grade 3 and he and my MO both said these numbers plus oncotype are the numbers that count. I am currently on Tamoxifen and will stay on something for 10 years. I have complete faith in their opinions so that helps!

keepthefaith

Maybe you are a candidate for the mammaprint test...

sweetpotato12

thank you... The mammoprint is apparently only run if I had scored intermediate on the oncotype, ie insurance won't send it. My MO had me send my slides to Sloan to see what they say, but I had another mo at nypreb cornell advise ovarian shutdown or chemo bc of the age and high ki67. Apparently Sloan doesn't even do the ki67 anymore.  Every doctor has said if I was even 5 years older this would be a no chemo situation, case closed.  

I've done a lot of reading and I'm not as concerned about the high ki67/ low oncotype situation anymore. I'm just so scared to make the wrong choice and feel like there are risks of going into menopause too early too. I was also advised of the study coming out in nov/ dec that will show tamoxifen v ovarian shutdown benefits. 

Nan54

My situation is very similar to yours, so I wanted to share my experience in case it is helpful to you. My ki67 was not tested by the Cleveland Clinic (they do not use this anymore as Oncotype trumps it) and my oncotype was a 13.  I was 37 at diagnosis. I got a 2nd opinion regarding treatment from Sloan Kettering (a top oncologist there) and he agreed no chemo. All 3 of my opinions suggested ovarian suppression plus tamoxifen instead of chemo. I have been doing this for over a year now, waiting on the SOFT and TEXT trial data to decide what is next in terms of ovarian suppression (continuing suppression therapy, removing my ovaries, or discontinuing suppression after 2 more years).

Please feel free to PM me with any questions... Overall, this treatment has been very tolerable for me personally. I do second guess not doing chemo all the time, but I have to put faith in the opinions of the experienced medical professionals... Good luck to you with your decisions and therapy!