IDC 2b 2/9positive 47 pre meno -no chemo/rad Oncodype dx is low

Celkea

Just had a double masectomy on July 1, 2015 for multi centric IDC, 3 masses, largest 2.1cm, 1.2cm and 0.9cm. All in left breast. Just curious as to what determines radiation and has anyone avoided chemo who are pre menopausal with 2 lymph nodes positive and with no radiation. My oncologist seems to believe I can avoid chemo if I get a low Oncodype DX score. My internet researches are not supporting No chemo/no rad2/9 nodes positive (microscopic) . No mention of radiation my margins were clear. Closes to the margins was 1mm SITU.

Anyone with a similar diagnosis and treatment options - feedback would be greatly appreciated

cookiegal

we are seeing more and more women with nodes using oncotype to determine chemo decisions.

The sciences has stayed reliable, however the samples in the node positive study are smaller.

Yes it is a reasonable option and one that is becoming more common.

powerthruit

Not sure if this helps, but I am for the chemo "insurance policy" if nodes are involved. I was 2b and 0/13 nodes. I did a UMX Right side. I am doing four rounds of TC (once every 3 weeks). Going for my second 7/27. The choice is highly personal, but I did not have Oncotype test as an option. For me I broke it down like this. DX on May 1, surgery 6/4, and last chemo infusion Sept 9. DX and DONE in 4 months. If your margins were sufficiently clear, then radiation may not be necessary/or just a cosideration. I am in this boat and will likely not do rads. Back on chemo, tumor grade is important too (didn't see it mentioned above) Mine was actually low, Grade 1, but I had a huge/long unifocal tumor -- this gave me the 2 "B" I was hoping to do the Oncotype DX test, but it's not validated on larger tumors, hence chemo. It's really not that bad and I'm happy to have the insurance policy. I am premenopausal, but the whole thing will put me into menopause. No future cancer is what I'm focused on. Any nodes are too many for me and chemo is totally doable.

Celkea

Thank you for the feedback and the very best of luck with your treatment. I just realized my pathology info was not public..it now is. Thanks again.

powerthruit

FWIW you might want to scan the July Chemo group. Lots of folks there with a range of diagnoses and regimens. Crossing my fingers for the low Oncotype for you. 😃

Hopeful82014

In all of this discussion of whether to do chemotherapy or not, let's please remember that there are significant toxicities with any chemotherapy. Nor does chemotherapy convey any sort of guarantee. Many women simply will not benefit (either significantly or at all) from chemo. The Oncotype DX is a tool to help determine who those women are likely to be.

Some women will benefit significantly from chemo and should know that before they agree to undertake the risks of chemotherapy.

Oncologists tend to be a very conservative lot but more and more of them are beginning to approach treatment even of node positive disease in a more nuanced fashion. I personally this this is a very good thing and I suspect that ten years from now we'll be seeing much less chemotherapy for node positive situations.

I don't pretend that the decision I made would be the best one for anyone else. I am sometimes a bit put off by the fervour with which women espouse the value of undertaking one treatment or another. We all have our own value systems, our own tumor biology and our own tolerance of different risks. I think we all need to respect that.

Cowgirl13

When I was diagnosed I decided to throw the book at it because if I were to have a recurrence, I'd feel terrible and feel like I had caused the recurrence. This may not relate, but when I read about women who have been diagnosed and they have children, I think immediately about women who are Stage IV and hoping to live long enough to see their children graduate, get married, etc. Its a chance I couldn't take.

4pink101

Celkea-

I was just in your shoes a few months ago. I had an Oncotype DX done (18.. 12% chance of recurrence no change with chemo). My MO decided against chemo - he believes more can be done with strong hormonal therapy. I just started tamoxifen and will soon be going in for my monthly shots to suppress my ovaries (goserlin). I'm terrified hoping I've made all the right decisions... sending you strength....

mira845

i was given 2 options, one, with chemo, CMF or TC and tamoxifin, or two, with ovarian suppression and an AI.

Radiation either way.

Since I'm lobular my Onc told me chemo is found to be less effective than strong hormonal treatment. She recommends option 2.

I make my final decision prob tomorrow. I'm leaning heavily torward option 2, hormonal.

labelle

Because I had a lumpectomy I had RADS and they are pretty standard treatment with a lumpectomy, but despite a positive node, no chemo. Two different doctors at two different breast centers (UT and Vanderbilt) both agreed a low oncotype score (11) trumps a positive node and the risks of chemo would outweighed its potential benefits in my case.

I've been told there was a time, not too long ago, that even one node positive would land you in chemo land, but in the last few years the oncotype test is being used more and more to determine the need for chemo in those w 1-3 nodes positive.

Hopeful82014

That's pretty much my understanding as well, Labelle. In fact, two MOs told me that with any Oncotype (in this situation) up to 25 they would look at the potential benefit of chemo very much on a case by case basis. In my case, the benefit would have been roughly 1-3%, which hardly outweighs the long-term risks and toxicities of chemo in my mind.