Not certain what to do - DCIS and Low Oncotype Score

dody11

Very confused and anxious about further treatment. Diagnosed with DCIS in January low to intermediate grade Stage 0. Relayed I hoped to avoid radiation. Age 60 - very healthy and active

Surgery 4/3/18 Lumpectomy

Pathology DCIS .2 CM The margin less than .1cm in 3 of 16 tissue blocks.

Oncotype score 26 (low risk category for recurrence. )

second surgery 5/22/18 - DCIS in medial margin measuring 1MM from Margin (standard is now 2MM but I think some accept the 1MM if radiation route is taken)

BS has relayed since I don't want radiation another re-excision. I like my surgeon and he has a good track record but I am not feeling too optomistic about this last spot coming back with the necessary margins. With low oncotype score would love to take the wait and see approach but not feeling certain about this either. I meet with medical oncologist next week. Based on previous discussions, he likely will advise to do radiation vs another surgery.

Please share any thoughts, especially based on the low oncotype score and clear margins.

Oncotype report (low score) favorable which helped me feel good about not taking the radiation route prior to my re-excision (2nd surgery) and still one spot with a 1 MM margin. My uncertainty is whether to do a 3rd surgery or do radiation (or wait and see with my thinking a 1 MM margin was the standard at one time). Not one to over treat

CindyNY

Please take a look at the TAILORx study. Its link is posted on the main site and the community site. It may help you with discussions with your MO.

Best of luck.

Ingerp

In hindsight, I wish I could have had both breasts irradiated back in 2016.

Anyway—what helped me back then (because I am not one to over-treat) was hearing that rads would cut my probability of recurrence in half. At that point it was an easy decision I haven’t looked back on. You might ask what your probabilities are going forward with and without rads.

Moderators

Hi dody, and welcome to Breastcancer.org! We're sorry for what you have to be here, but so glad you've joined our Community!

Here is our Research News article regarding the findings: Women with mid-range Oncotype DX scores can skip chemo, NEJM and 2018 ASCO Annual Meeting, June 4, 2018

https://www.breastcancer.org/research-news/oncotypedx-intermediate-results-skip-chemo

Hope this helps! Let us know how you're doing.

The Mods

MelissaDallas

Mods, I think she is talking about the special oncotype test for DCIS only to see if she needs radiation, etc. TailorX and chemo are not applicable to her situation

dody11

Thanks to all for taking time to reply to my post. So nice to have this site.

Melissa is correct. Oncotype report (low score) favorable which helped me feel good about not taking the radiation route prior to my re-excision (2nd surgery) and still one spot with a 1 MM margin. My uncertainty is whether to do a 3rd surgery or do radiation (or wait and see with my thinking a 1 MM margin was the standard at one time).

kittenknit

I'm about the same age as you and choosing wait and see even without surgery, fwiw. I don't think the risks of radiation is worth the benefit; my surgeons think my choice is reasonable. I'd say make sure you know all the possible effects of rads before deciding.

dody11

Thank you for sharing Kittenknit. I meet with the RO tomorrow. I initially with the RO in March prior to having my lumpectomy and I stated I did not want to have radiation (my thinking too was that is not worth the benefit). My RO made me feel okay about my choice. Now after the second re-excision I met with the MO and because the DCIS margin in pathology report is in a new area, he relayed the option of a mastectomy. I never imagined I would hear this so I feel I'm somewhat in denial but now even a bit more uncertain about the wait and see approach. I'd love to know if you've had repeat mammograms. How often are you being evaluated? I'd also like to know if you based your decision on any studies that you read (if yes, please share study). I have read several articles and a few studies and I'm still on the fence. Really feeling I need to wait and see but I believe that future mammogram would show residual DCIS.

nonomimi5

Dody11, when I was first diagnosed in March, all I wanted to do is the least abrasive treatment and finish everything by summer. I am blessed and my Oncotyoe came back 17 and I could skip chemo and do the accelerated 16 radiation. Tmrw is my last. Now that my treatment is almost over and I know more, I want to do whatever I can to prevent recurrence. Even with my Oncotype 17, my recurrence in 10 year after 5 years of Tam is 11%. I will take AI so recurrence will go down a little more. That to me is still too high and I will take AI 10 years if it helps. Mammo can't detect BC accurately all the time. Why was mastectomy brought up?What is your recurrence % according to Oncotype? Your score is higher than mine so I am curious.

Lula73

dody- have you had an mri? MRI is much more sensitive than mammo and u/s and should be able to tell you how extensive the DCIS is

MILO2018

my score was 27. My dr suggested starting radiation prior to June TAILORx study. Met we her last week and we decided on chemo 8 rounds and than hormone meds. Stage 2b 2 cm tumor grade 3

Mackadoo

I think a few posters with Oncotype scores are talking about the Oncotype test for cancer other than DCIS. There is a fairly new Oncotype DX that is used specifically for DCIS. So the scoring of the two different tests is not the same. That is why the question of a higher or lower score means different treatment. From what I understand, chemo is not used in pure DCIS. So the Oncotype for DCIS is for determining only whether or not to have radiation, not chemo.

Mackadoo

By the way Dodi my Oncotype dcis test came back with high score, so I opted to have hypofractionated radiation. I had no side effects except very slight rash in very small area. It cleared up quickly. So if you decide to have it, check into the 3 week course. I understand it is now the recommended protocol instead of the 5 or 6 week course. You will get through it, and it may be easier than a third surgery in the end. It lowered my risk from 18 percent down to 9. Worth it to me, and I was pleasantly surprised that it was easier than I imagined it would be. Take care.