Oncotype score of 19; to do chemo or not?

Isis02

Hey everyone!

I just received my Oncotype score and it is 19. MO says that puts me in the low intermediate range. At this point chemo is my choice.

I know no one can tell me what l should do. I am just really torn inside. Has anyone ever had an intermediate score and chose chemo? And what was the reasons for your choice?

Thanks in advance for any help.

pupmom

It would help if you filled out your diagnosis section.

Isis02

Pupmom,

Thanks for pointing that out. I had updated my profile this morning and must have done something wrong. Hopefully it will show up now.

Isis02

Well, my dx are not showing up although l have edited and saved it.

Dx 3/13/17 ILC, 7cm, right breast estrogen and progesterone positive, Her2 negative.

Masectomy 3/2917; left, right. 1/3 nodes. Micro mets in positive node

Hope l provided all pertinent information.

lovepugs77

Isis02, have you gone into settings and made your dx public? They are set to private as default.

Isis02

lovepugs 77,

Thank you. I changed the settings.

keepthefaith

isis02, There are many factors to consider along with the onco-score. Since you are intermediate, you can ask your MO to do a mamma-print test also. It will give you a high or low recurrence score. Have you had the BRCA test? Any family history?

I had a 21 onco-score, was 58 when DX'd. I chose to do chemo. I do have a family history, but no BRCA mutation. I based my decision on feeling like I would be regretful if I had a recurrence and not done chemo. Of course, there is no guarantee either way. You have to do what you think is right for you. Get as much information as you can. You can always seek a second opinion. For what it's worth, chemo was not too bad for me. I didn't realize I would have to make so many decisions when DX'd. I guess I thought it would be more black and white...NOT!:) Best wishes moving forward.

Isis02

l just provided the blood sample today for the BRCA test. Thus far my only relative who has had breast cancer is an aunt. And she is a 16 year survivor. I am 48. I am leaning towards chemo because l don't want to have any regrets. But l am so afraid of the side effects.

BarredOwl

Hi Isis02:

With ILC, micromets in a lymph node, and a low intermediate Oncotype Recurrence Score, you may benefit from a second opinion at an independent institution, assuming you have some lead time.

Regarding the suggestion to ask for the MammaPrint test, I would instead recommend that you inquire whether such additional testing may or may not provide additional information that would clarify the situation for you. You can ask what the possible outcomes would be in light of your "Clinical Risk Classification" under MINDACT criteria. Unfortunately, in light of the recent results of the MINDACT trial, patients who do receive such secondary testing may or may not receive a clear signal.

For more background, see this post, and the section: MammaPrint: Is it black and white?

https://community.breastcancer.org/forum/108/topics/853465?page=1#post_4940692

Of course, patients should never hesitate to inquire with their medical oncologist about such additional testing.

BarredOwl

ChiSandy

Isis, are you premenopausal? Chemo would be more easily tolerated by a younger pre-or even peri-menopausal woman than by someone in her early “golden years." My Oncotype was 16, at the high end of “low risk," and some much younger women with my score opted to throw every weapon in the arsenal at their cancers. Had I been 44 (maybe even 54, as I wasn't fully menopausal till 55) rather than 64 when diagnosed, I might have done the same. Had my tumor been larger and node-positive, I might also have considered chemo. But at my age, IDC Luminal A tumors such as mine just grow more slowly than they would in a pre-menopausal woman. And I also wouldn't tolerate chemo well enough to make the very slight benefit (acc. to some online prediction tools, barely an extra year, maybe less of survival) worth it.

But taking into effect that ILC is a sneaky bastard compared to IDC, and the large size of your tumor, chemo is worth considering if your MO (and a confirming second opinion) believes that your tumor contained enough fast-growing cells to be vulnerable to chemo. A tumor that big, not to mention node-positive, would be likelier to have sent out micromets past the lymph nodes before it was removed, and therefore warrant systemic therapy beyond anti-hormonals.

A second opinion is definitely warranted. What does your hospital's tumor board say?

Gully

Hello Isis,

I chose to undergo chemo with an oncotype of 19. As you can see below I had bilateral cancer at age 45 Wanted to do all I could to kick it to the curb! Good luck with your decision.

Gully

pupmom

Isis02, I see your diagnosis now. Thanks for that. IDK, but if I were you, I would probably go with chemo. Stage 3, one positive node, and 6 cm tumor seems pretty serious. Also, you are on the young side, meaning your cancer might be more aggressive. Of course I don't have all the particulars of your case, so this is just my 2 cents. Best wishes!

Isis02

Thanks ladies for the replies

Barredowl l appreciate the link to the other thread. I glanced at it and looks like l will surely be getting a lot of good information.

Chisandy l am premenopausal. After my surgery and after my BS met with the Breast Alliance, which is similar to a tumor board, BS told me chemo and radiation was the recommendation.

The oncologist that l was referred to is basically leaving the decision in my hands. He feels that it iunlikely that the micromets metastasized beyond the sentinel node. He feels hormonal therapy is sufficient. He will do chemo if l so desire.

I now agree that a second opinion is warranted. Thanks for the idea. It is such a simple option but one l could not see.

Gully snd pupmom, thanks for your input,sharing , and support.

BarredOwl

Hi Isis02:

I cited the other thread primarily for the information about the MammaPrint test.

Please note that some of the studies linked in that thread did not include any patients with nodal micrometastases and would not appear to be informative for your decision-making. For example, TAILORx was a trial in node-negative (N0) patients and so far, results have been published for those with Recurrence Scores of 0 to 10 only.

In pursuing a second opinion, you may wish to inquire about the scope and strength of the clinical evidence behind the test in [patients with tumor size and lymph node status like me] [Text deleted] for those with standard Intermediate Recurrence Scores (18-30).

BarredOwl

[Strikeout formatting is not displaying, so I deleted text. The deleted text read: "in the setting of pN1mi disease"]

Isis02

What is pN1mi?

BarredOwl

Hi Isis02:

My apologies. I am not sure whether that designation applies to your situation or not.

From your reference to micromets, I had assumed pN1mi nodal status, possibly in error. Under the AJCC "TNM" Staging system (7th Edition), "pN1mi" is:

https://cancerstaging.org/references-tools/quickreferences/Documents/BreastMedium.pdf

"pN1mi Micrometastases (greater than 0.2 mm and/or more than 200 cells, but none greater than 2.0 mm)"

The lower case "p" stands for pathologic staging, which is the stage determined post-surgery, based on the combined results of all biopsies and surgeries.

Please seek expert medical advice regarding your lymph node status under AJCC staging. In the meantime, you can check your pathology report for staging information and the pathologist's assignment of nodal status (e.g., N1mi, N1 or N2).

BarredOwl

amanda6

well 3A is a serious cancer. I would definitely ask my oncologist for his/her opinion. And not to throw cold water on you at this stage of the game, but as a 7 year survivor, I can tell you that cancer treatments do come with some risk of long term after effects. I did taxotere & cyotoxin (6) & my hair didn't grow back- I've read the risk for that is about 6 °/°- and I am having open heart surgery in a few weeks for a damaged mitral valve repair ( from radiation on my left breast). And I've had heart arrhythmias - again docs think from chemo or radiation as I have no risk factors. On the other hand I was a 3 A too, & basically consider myself to be pretty healthy & I'm very active- run, bike & ski...I'm alive:). Just do your due diligence & decide based on your research & on your oncologists opinion.

Isis02

Thank you Amanda6 for the response. I spoke with my BS and he said that now that we have an Oncotype score he will present my case to the Breast Alliance again. But what if they say chemo and radiation again? I can still say no all l want until it's too late to do it. My heart and head say do chemo but my body says no. I really need to consider that stage III is serious but that most of all l have two teenagers that l need to survive for.

Therefore l am going with my head and heart and am going to do chemo. I appreciate everyone's responses. Thank you so much.

MameMe

Isis, Just another two cents, here: My oncotype was 16, done at mysecond occurrance of bc in 2012. I did not do chemo. Less than 2 years later, I became stage 4. Then I did weekly Taxol for five months. Hair loss was discouraging, but it came back as predicted. Taxol set up a solid stable state for me, and I was able to use Xeloda, an oral chemo, the next two years. Also effective. Just now I am starting Doxil on a monthly basis due to some progression.

I have wondered if using chemo earlier would have been helpful in delaying stage 4. If I had had the type and stage of cancer that you report, I would definitely have said yes to the drip. Best, Best of luck to you in deciding your course of action. These forums can help tons when you are going through stuff. Big hugs, Mame