I'm at high risk of recurrence/mets? How can I calculate?

AnotherMichelle

Today at my post-radiation, pre-AI appointment, my MO told me that I was at "high risk" because there were still cancer cells in my one lymph node after neoadjuvant chemo (the frozen slide during surgery was negative but the final path was positive--no mass but cells spanning an area of 8 mm). I never got to do an OncoType because I knew I was doing chemo because the lymph node tested positive in biopsy. CancerMath and Predict don't take those things into account (still having cells even after chemo).

I already understood myself to be at high risk because of the size (2.1 cm) and the lymph node status (1 node), but I didn't know my risk could be heightened by chemo not having eradicated it completely during chemo. In fact, my surgeon told me before surgery that my cancer likely WOULDN'T go completely away (pCR) because ER+/PR+, grade 2, KI67-11% is not totally fast-growing and so probably wouldn't get rid of it all anyway. So I was a little taken aback by my MO telling me that I was high risk of recurrence/mets because of this residual cells in the node.

Is there a way to calculate my actual chance of recurrence like the Oncotype does without doing the Oncotype? Or am I just left with the more generic CancerMath and Predict?

Thanks,

Kelli

SpecialK

I am not sure that Cancermath and PREDICT do not take this into consideration because of the number of us who do adjuvant chemo and would never have the knowledge of residual cancer that is present to potentially increase our risk. Those models are based on statistics so your residual cancer after neoadjuvent would be the same as residual cancer after adjuvant systemic treatment, it is just that you know about it. What does your MO say about the benefit, or risk reduction, offered by anti-hormonals? In many cases with ER+ cancer the most bang for the buck will be the AI drugs.

Hopeful82014

You can still press for the Oncotype. You may find that having some of that info is helpful as encouragement to stick with AI treatment, for example.

Any one of your team can order the test - it doesn't necessarily have to be your MO. There might be issues of insurance reimbursement but those can usually be worked out, one way or another.

Do remember that RT will be tailored to address any remnants of cancer in your nodes as well as the breast. It can help to substantially reduce your risk of local/regional recurrence. You may want to go over that issue in detail with your RO when you meet.

AnotherMichelle

Thanks for this one, too, Hopeful! I'll try to find out what the Oncotype might cost because I'm sure insurance will not reimburse now that my treatment (except AIs) is over. Happy Monday!