average wait time for oncotype results

JuniperCat

Hello! I am wondering if anyone can shed some light on this. I had lumpectomy surgery for IDC 1.5 cm tumor on Nov 11. It was Er+PR+. When I saw my surgeon last week (Dec. 8) I asked her about the oncotype text. She said it hasn't come in yet. Is it normal to take this long? I also had high grade DCIS that required another excision. Do they test that as well? Many,many thanks!

doxie

This seems a little long. When this happen to me, it turned out that someone dropped the ball and didn't send my tissue. My MO was new to the teaching hospital and he or his nurse or the lab didn't send out my tissue. I finally called Genomics and found out that they'd not received it. Then the turnaround was less than two weeks.

Not sure about checking the DCIS. I think the question there is whether or not you should have radiation. With a lumpectomy for IDC, that is a moot question. Rads are a given.

JuniperCat

Hi, Doxie, it turns out that they had forgotten to have it sent. The results should be in next week. I'm not looking forward to radiation...I'm worried about breast shrinkage and burns

Brimton

Hi
I too have been waiting for onco typing. I see the oncologist 1/5 and radiology 1/6. I am hoping it is back by then. I have read they take about ten days. I have been feeling a bit down about chemo... I had my head all wrapped around radiation and now with grade 3 I'm thinking chemo too... I'm trying to live day to day but just keep thinking that no one really understands in my family because it's not happening to them.

JuniperCat

Hang in there Brimton! Waiting for all of the test results is so difficult. I just found out that my Oncotype score is 22...I haven't spoken with any of the doctors yet, so I'm not quite sure how to interpret the result

mustlovepoodles

Glad you got your result, but I know it's maddening when you don't know what it means for you. Oncotype of 24 is mid-intermediate range. With your small ER+/PR+ HER- tumor, you may be able to get away with just lumpectomy and radiation. Of course, you will also have to take some kind of hormone suppression for the next 5-10 years, depending on your oncologist (standard of care is now 10 years.)

In my case, my Oncotype was 23. However, my family history is rife with breast, colon, and lung cancers, among others. There are 32 cases of cancer just in my 1st & 2nd gen relatives, including 5 just in my own family of origin (and one was breast, the other uterine.) I had a full genetics workup, which revealed that although I am BRCA negative, I have two rather rare but dangerous gene mutations which probably caused my breast cancer, PALB2 and Chek2. They estimated my risk at 45%+. Yikes.

So, my entire treatment plan has been upended. As my MO said, "Your breasts are going to try to kill you. If this comes back, I cannot cure you." I'm completing chemo now. My MO has strongly recommended that I have a BMX, plus oophorectomy (ovary removal) and possibly a full hysterectomy.

I wish you the best. Waiting for answers is the hardest. I found that once I had a firm plan in place, from a doctor that I liked and really clicked with, it has almost been a relief. Even though it made my treatment a lot more aggressive than I first thought, it's still a plan I can live with and feel comfortable that I am doing everything I can to limit my risk for future breast cancers.

Brimton

JuniperCat
We have close to the same stats. I don't know how to put them on my reply. I'm dc E+P+ HER2 Grade3 T1 n0. I'm nervous about chemo... Thinking with grade 3 I will have to have it. Just feeling nervous the waiting is a trial. Maybe that's what I'm supposed to learn from this patience.

JuniperCat

Hi, Brimton! I also had a bit of difficulty figuring out how to post the stats. Go to the "My Profile" button and fill in the info in the "My Treatments" and "My Diagnosis" sections and save. Then go to "Settings" and scroll down to see where your stats appear...this is where you can select which is private or which is public. Selecting public will allow others to see your stats. BTW: did you get the Oncotype test done?

JuniperCat

Dear Mustlovepoodles
Hello! Thank you so much for your reply to my post! I'm wondering: did the Oncotype test reveal that you have the PALB2 and Chek2 gene mutations?

JuniperCat

Brimton: One other thing: ChiSandy told me how to do this: if you want to add your age at diagnosis or your oncocyte score or any other info that you'd like to include, then use the "signature" area in settings and designate it "public."

BarredOwl

Hi JuniperCat:

Mustlovepoodles will eventually reply that no, the OncotypeDX test did not reveal the mutations in PALB2 or CHEK2. She would have had to have separate genetic testing done to determine mutation status. OncotypeDX does not test those genes.

OncotypeDX looks at 16 cancer-related test genes (and 5 reference genes) and determines the level of "gene expression", meaning how much are the genes being used by the tumor cells. Based on what is known about patterns of gene expression of these genes in tumor cells, and how such patterns correlate with low, intermediate or high risk, the test provides guidance about chemotherapy decisions.

It is important to understand that the OncotypeDX test is NOT a genetic test in that it does not provide any information about the presence or absence of genetic mutations in the test genes (or any other genes). If one is concerned about having a genetic predisposition to cancer based on factors like family history of breast cancer or other cancers, personal history of breast cancer, early age at presentation, etc., please request a referral to Genetic Counselor who can advise you if you are a candidate for genetic testing.

Here is an explanation of the two kinds of tests, highlighting some ways that they differ:

"Genetic testing" is performed on a sample containing normal cells (e.g., blood) to determine if you carry a mutation in your DNA that confers a genetic pre-disposition to cancer. By using normal cells, the implication is that all your cells, including germ cells (oocytes (F) or sperm (M)), also contain the mutation and the mutation is heritable. The methodology used entails extensive genomic DNA sequencing and may also include an assessment of certain gene rearrangements.

In contrast, Oncotype DX for "invasive" disease is performed on a sample of tumor cells and assesses the levels of gene expression (not the DNA sequence) from 16 cancer-related genes and five reference genes, meaning it looks at how much the genes are being used in the tumor cell. The methodology used is quantitative "RT-PCR" (reverse-transcriptase polymerase chain reaction) which looks at transcription (how much mRNA is being produced from each test gene).

If you are interested in the particular genes tested for expression, a list can be found here:

http://breast-cancer.oncotypedx.com/en-US/Professi...

BarredOwl

JuniperCat

BarredOwl: Thank you SO much for proving this comprehensive overview! I'm in the mid-range of the Oncotype, which seems to be a grey area. I'd like to know how you feel about the MammaPrint test for someone in my situation. Many thanks

BarredOwl

Hi JuniperCat:

While I understand what the tests are and how they are done (because I have some biology background), the clinical implications, particularly in the intermediate range, are a harder question! Hopefully, once you have a chance to discuss your Oncotype score with your MO, you will have a clearer picture of what your score means, and the weight of any other relevant pathological findings and presentation (e.g., age).

By the way, please make sure you get a copy of the original Oncotype report for your records if you do not already have one. You may want to ask your MO to review the report content with you, so you understand all of the information provided.

The following is some information about the MammaPrint test. Be sure to obtain current professional advice from your medical oncologist and confirm any information below.

Here is some information from the National Comprehensive Cancer Network (NCCN) guidelines for breast cancer (Professional Version, 1.2016) about MammaPrint (emphasis added by me):

"MammaPrint assay uses microarray technology to analyze a 70-gene expression profile from breast tumor tissue (formalin-fixed, paraffin-embedded fresh or frozen breast tumor tissue) to help identify patients with early-stage breast cancer likely to develop distant metastases.(242-248) MammaPrint is approved by the FDA to assist in assignment of women with ER-positive or ER-negative breast cancer into a high versus low risk for recurrence, but not for predicting benefit from adjuvant systemic therapy. MammaPrint is approved by the FDA and assigns women of all ages with ER-positive or ER-negative breast cancer as having high versus low risk for recurrence. The prospective RASTER study reported that breast cancer patients classified by MammaPrint as low risk (of whom 85% did not receive adjuvant chemotherapy) had an overall 97% distant recurrence-free interval at five years.(249)" [Note: 15% received chemo]

The MammaPrint test has not been incorporated into the NCCN treatment guidelines, although they do discuss its use. That may simply reflect that the Oncotype test is better validated, and can provide more information in a single test. In particular, the NCCN guidelines indicate:

"[B]ased on the currently available data, the panel believes that the 21-gene assay [OncotypeDX for invasive disease] has been best-validated for its use as a prognostic test as well as in predicting who is most likely to respond to systemic chemotherapy."

It seems like in the NCCN view, the MammaPrint test can currently be used to assess risk of distant recurrence.

My understanding is that patients are classified as "high risk" or "low risk". However, the MammaPrint results do not provide individualized risk, but only provide the average risk associated with the high risk cohort or the average risk associated with the low risk cohort.

"The MammaPrint® FFPE result is indicated for use by physicians as a prognostic marker only, along with other clinico-pathological factors." In other words, MammaPrint is not recommended as a stand-alone (does not dictate decisions), but is used in conjunction with other factors.

In some cases, this type of information might help inform or supplement the risk/benefit analysis. In fact, some members here, including Stage I, node negative patients, have received the MammaPrint test after they got an intermediate score by OncotypeDX. So, please do not hesitate to ask your MO about the MammaPrint test, what kind of information it can provide, and whether the information may be useful in your case.

More information can be found at Agendia's web site:

http://www.agendia.com/patient/breast/

All the best as you work to come to a decision that is right for you.

BarredOwl

JuniperCat

Dear BarredOwl: you are truly wonderful! Thank you so much for taking the time not just to provide all of this important information but to actually explain it in layman' terms. I can't even begin to thank you! I will call my MO next week (next year...yikes) and ask to see him again and go over the report. I will see my BS on Monday and ask her for the actual report since she was the one who ordered it. The MammaPrint sounds intriguing and I will inquire about that as well. Many, many thanks for this bounty of information that you've provided!

mustlovepoodles

Major thanks to Barred Owl for her accurate description of both the Oncotype DX test and genetic testing. Due to my family history of lung, colon, breast, and pancreatic cancer, my genetics counselor recommended that I have the 32-gene assay test, rather than just testing for the BRCA genes. So glad I did, because the simpler test would not have revealed the two much rarer genes.

JuniperCat

Mustlovepoodles, did your MO suggest chemo for you because of the genetic mutations or because of your Oncotype score? Or, I'm guessing, because of both? Many thanks! The folks posting on this website have been tremendously helpful. I'm still navigating through so many different waters: go ahead with radiation or to skip it...etc.

mustlovepoodles

My MO recommended chemo for 3 reasons: Oncotype 23, gene mutations, and PR- status. She also advised BMX, which will happen later in Jan, and ovary removal or total hysterectomy.

JuniperCat

Thank you Mustlovepoodles! Good luck with your procedure!!