Is it worth it to go for Oncotype DX test in this case?

Elijah

Hello. Just had a breast conservative surgery getting the following results:

-Invasive ductal carcicoma, grade II/III, size=1.2cm

-ER = positive 100%

-PR = positive 100%

-HER-2 = negative

-Ki-67 =55% of nuclear proliferation rate.

-Lymph node biopsy = no metastasis.

Doctor says this is stage 1 cancer. In this stage and with no metastasis on lymph node, I could go for the Oncotype DX test.

The part that I am worried about is that this the tumor is grade II/III and the Ki-67 is 55%. I don't know if this marks are already so relevant to go for quemo already or we should actually go for the Oncotype test and see what it says.

I really do appreciate your attention and help.

Thank you so much.

123JustMe

Hi Elijah,

I am not sure how others will respond but I had the Oncotype Dx test done for my own peace of mind. You may want to check with you insurance carrier to see if it's covered and what your co-pay might be. Take care

doxie

I too advise getting the Oncotype DX test done. It gives you valuable information. I see it as a double check on your pathology, so if anything seems out of alignment, you catch it. Ki-67 and grade are not totally reliable. There can be reasons you KI-67 is high that aren't related specifically to the cancer. Grade is somewhat subjective. There is also strongly and weakly stained qualifiers for ER, PR, and HER2.

Waiting a little longer 2-3 weeks to start rads or chemo shouldn't be a problem.

labelle

I too advise getting the Oncotype test. This test has been proven to be very valuable and more accurate than staging in determining if chemo might be beneficial. My own doctors said they would not even make a recommendation about chemo without the results of the Oncotype DX. These results can and do change treatment plans and no one wants to go through chemo that will not in all likelihood be effective, nor do you want to skip chemo if you have a reasonable chance of benefiting from it. The Oncotype DX is the best tool they have in helping to decide the chemo or no chemo question for those with small ER+ tumors.

Elijah

Thank you all for your kind responses.

I forgot to mention, my age is 34 years old. It has been 2 weeks since my operation until I got the results yesterday. If I decide to go for the test, I have been told that it can take 2 to 4 weeks to get the results. Is it ok or is it too much to be waiting this long?

123JustMe

Hi,

2-4 weeks should not be a problem. The Oncotype DX results will help to define your treatment plan.

Good luck to you

Anonymous

I second some of the opinions here. I even had one positive lymph node and I still pushed for the oncotype (my score was 15). I also had a high ki-67 of 25%. But low mitotic index on the pathology. Ki-67 is tested as part of the oncotype. Grade and oncotype don't always match up. If your cells are rapidly dividing (let's say mitotic index of 3), then chemo would be more recommended regardless of oncotype. Wishing you the best going forward with a low-risk score!

mustlovepoodles

Another vote for the Oncotype DX. I think we need every tool available that might help direct out treatment. Oncotype DX helped my MO determine thst i needed chemo, rather than just radiation.

Moderators

Elijah, what has your treatment team suggested? Getting this score could help guide your treatment decisions, but we would strongly recommend you take the advice of your team. We're all here for you!

Marco516

Hi Everyone,

I also just had a lumpectomy, with the following results:

Invasive Ductal Carcinoma - 1 cm, Grade T1b, left side plus LCIS in another location in same breast

ER positive

PR positive

HER2 - negative

No lymph node involvement

Oncotype DX Reoccurrence score - 21

I don't see anything that indicates my Ki-67 score

One oncologist indicated that no chemo was necessary, just the radiation. I went for a second opinion which turns out to be just the opposite and they would suggest chemo since they indicate it is the standard of care for my indication. Suggesting eight CMF treatments over a 16 or 24 week period. However, I think the data are not clear that chemo is a benefit in the intermediate group and I am at the lower end of the intermediate group. This is now a very difficult decision.

keepthefaith

I had a 21 score also. A hard decision. Will you be having radiation and HT? Have you had genetic testing? IMHO, it boils down to, if you have any other health issues and what you might feel like, should you have a recurrence....at least, that was what swayed my decision to go forward with chemo. Sometimes it feels like a crap shoot, but you have to make the decision that is best for you. Good luck ladies!

Marco516

Yes. I will have radiation and HT as well. I am 53 years old and pre-menopausal and the doctor that recommended the chemo says I am young enough to tolerate it well and it will reduce my chance of reocurrence from 13% with Taxo to about 7% with Tam/radiation/chemo. I am just afraid of long term health issues with chemo.

Thanks.

Logang

I think the oncotype is a great tool that can help with decision-making! I think more oncologists are realizing that all cancers are different as well as all patients.

ChiSandy

Mine was 16, which is (was?) considered at the high end of “low” but still low enough for chemo to do more harm than good at my age (64 at the time) and with my comorbidities (asthma and allergies to three major antibiotic groups). My MO said she wouldn’t have taken chemo were she in my situation. (According to calculators, chemo would have added only 6 mos. to my lifespan--and who knows what those 6 months would have been like)? I opted for endocrine (AI) therapy after my lumpectomy & radiation. Now there there was a post from a patient whose doc said that based on the first reported part of the TailoRx study, the classification of “low” is about to be lowered to 10 or below. (I still haven’t heard of any specific links, except a recent one that found that one-or-two-nodes-positive and even some Grade 3 Luminal A postmenopausal patients with scores of 11 or below could safely skip chemo. No data yet that says 16 is not “low” for a postmenopausal, node-negative grade 1 or 2 Luminal A patient--the explanation is that there haven’t been enough recurrences in the 11-17 score cohort to draw any conclusions). Nonetheless, I am not second-guessing my MO’s and my decision to skip chemo, nor am I willing to seek out another MO and ask if I should undergo it. But were I 44 or even 54 at diagnosis? I might have considered it if I thought I was healthy enough to tolerate it.

keepthefaith

You can ask your MO to order a mammaprint test if you are in the onco intermediate range, also. I didn't do that, bc I didn't want to wait any longer to start my TX.

I know everyone is different and I am only 2 yrs post-chemo, but tolerated it well and so far so good, with no signs of long-term SE's.

Elijah

Thank you everybody for all your replies. Where I live it is not covered so it will be very very costly. Tomorrow I will have to make a decision whether I will go for the test or not.

An idea that just come to my mind is to start the quemo and ask for the test anyway and if after 1 month when I get the report it shows that quemo doesnt help, I just stop.

Any opinions about this? I am really sorry to ask so many things, I am just so confused, I am the very first one in my surroundings with this issue.

Thanks a lot for your support.

doxie

Elijah,

One less expensive option it to get your tumor tissue retested at another lab, unaffiliated with the first. If the results are the same, especially the grade and Ki67, this gives may back up getting chemo. If not that could change your mind.

If I were you, I'd not start chemo, then stop it if an Oncotype DX arrives with different info. I'd commit to waiting for all the information first or just do the chemo and not look back.

Paxton29

I didn't bother with the Oncotype and went straight to chemo. My MO felt that my Ki 67 of 25 on my left tumor, plus the facts I was 45 at diagnosis and had IDC in both breasts (right tumor had Ki 67 of 4), that was enough to think chemo would help. She would have ordered it had I wanted it, but I didn't want to delay treatment further. The study kayb linked was some confirmation to me that my likelihood of at best an intermediate score was high. My MO also told me if I were 20 or 30 years older she probably wouldn't have recommended chemo

Moondust

I think Genomic Health might offer some financial help in some cases. It's worth looking into. With a score of 26 I initially decided against chemo, and my MO was fine with that. I continued on to my radiation treatments (now a third done) but made a decision to have the chemo after all. I will have it after radiation. There is no clear path for women with an intermediate score, but with a low PR+ percentage and a high Ki67 I decided it was my best option. Once someone gets that distant recurrence, whether it be in 3 years or 13 years, life will never be the same and I'm a very active person. Chemo gives no guarantees, but it gives me better odds. It took me a few weeks to wrestle around with it in my head. It's very hard to be presented with a score and make an instant decision if you are in the gray area as so many are.

cookiegal

Geonomic is very generous with assistance.

I say go for the oncotype. It is information.

I was a 22 with a node and opted not to do chemo.

In 2009, when I was an outlier.

Still here.

doxie

Elijah,

As a comparison, my tumor was 95% ER+, 5% PR+, HER2- (1) with Ki67 40%. My Oncotype score was 30. At the least, the very low PR and little bit of HER2 caused a higher score. I assume that the Ki 67 was somewhat accurate and did so also.

With your 100% ER and PR and HER2-, high Ki67 is the outlier, as well as grade.

Ki 67 is an unreliable test, and grade is somewhat subjective. I was a high grade 2. Someone else doing the pathology may have put me at 3.

That's why I think you should send out for a second opinion on yourtissue, before spending the money for the Onco DX with such high ER and PR.

Anti-hormonals will very likely be your best defense against a recurrence. Even with chemo, the AIs are still the most important part of my treatment after surgery and rads.

Anonymous

Cookiegal, I feel like an outlier by going against "standard recommendation" with a score of 15! But thanks for sharing, it gives me hope.

cookiegal

Loving is living, the standards keep changing, and are different from the USA to Europe. Back in the day if you were node negative, 1CM was the border for chemo in the us, 2 cm in Europe. Now I have seen women with larger tumors opt out. My oncologist says biology trumps staging!