Oncotype and HER2

No, my onc (the "second best onc in the area", as you know ) doesn't do it for Her2 patients. It didn't even come up. He also didn't do it for my friend who is ER+ Her2- since she had one positive node. I guess if he knows someone is going to need chemo anyway, he doesn't bother.

(By the way, I got my port out two weeks ago - what a great feeling! I can wear a seat belt again!)

Have a great weekend,

Sue

Hi mmm5,

I would also think that it is the difference in grade (1 vs 3) that must make a difference in the score. Maybe you also had a higher Ki67? - though I am not sure if that is somehow counted in the Oncotype score. I will never know my score but it is probably very high. Part of me wants to know and part of me doesn't.

How are you doing lately? Hope you are very well. Have you gotten the hormonal treatments (tamoxifen vs AI) sorted out?

Best regards,

Helena.

Hi mmm5 - I'm glad you started this thread - you always ask interesting questions!

I DID get the Oncotype DX test done - but it was done in error. My onc ordered it before he received the results of my FISH report. My Her2 status originally was "equivacal" and in tiny print at the bottom of the path report, it said the tumor was sent out for a FISH test. My breast surgeon and his office dropped the ball on this one - while I was so sick in the hospital with the MRSA - and while my brast surgeon was moving from his old dusty office into a brand-new shiny more expensive place -  no one bothered to follow-up on receiving this report - not even me, because I had no clue what was going on.   Once I was released from the hospital (3 weeks after my original surgery date) and finally saw my onc in his office, he said the results of my Oncotype DX were "low" and I wouldn't need chemo - I could just go home with a prescription for Arimidex..........but "oh wait a minute, what's this? Your FISH report was never received. Wait here just 5 minutes while I have them fax it over, then you can leave."...............well, 5 minutes later he opens the door with this really serious expression on his face and says, "Come back inside and let's talk about your FISH report." My heart dropped.........almost as much as when I was first dx'd with bc. My onc proceeds to tell me that my FISH report shows the tumor was Her2+++ and I would definitely need chemo with Herceptin and probably a port. Later (after researching info here at bc.org and getting MUCH smarter) I asked him what my actual Onctotype DX score was - and he said 22. Well - duh - 22 is NOT a "low" score - but "intermediate" with a 14% chance of recurrence! I was flabbergasted! I was led to believe by my breast surgeon that by getting a mastectomy instead of a lump with rads, I had decreased my chance for recurrence to near 0% - so much for believing numbers from a surgeon..........stupid me, I should have seen a medical onc before making any surgery decisions. My onc was so shocked at my Her2 status, he sent the tumor out to a second lab for a second FISH test - and it came back even higher - Her2++++. He said it's very unusual to see Stage 1 Grade 1 tumors showing up so highly Her2+..........I just mentally keep thanking the radiologist who first saw the nodule in my mammogram!

Sorry for being chatty-Kathy (my nickname since kindergarten!) Even though your score was very high mmm5 - it was good your onc got the Oncotype DX test done, sounds like he was being very thorough, especially considering your Grade 3.  There are a lot of genes they examine to determine your recurrence rate.........and I for one like to KNOW all about the good, the bad and the ugly with this horrible Beast! 

Edited to add:  A new study reported here at bc.org shows that many women are not getting the proper testing done prior to being treated with Herceptin - I would have fallen into that category if my onc hadn't noticed my missing FISH report!

http://www.breastcancer.org/symptoms/new_research/20090914.jsp

Thanks mm5 - my tumor had no evidence of LVI - did yours? And you are right - no one test alone is enough for an onc to determine the course of an individual's treatment........that's why one onc told me, "it's an art, not just a science". Actually - I never saw any mention of a Ki67 level on any of my path reports..........just that the tumor was "well differentiated" and had a low Bloom-richardson score (I think 3/9). I know other women who never had a Ki67 test done........again, I suppose it all depends on the onc and his "art". Have a nice weekend - the sun is shining here - and I'm finally getting off the computer and to the pool to help my hip!

Hi amyoboe -

I know this is all scary, especially since it is so new.  But try to relax a little.  With only a microinvasion and grade 2, its very unlikely you have any cancer cells still lurking around so you have time to gather information.  If I were where you are now, I would hear what your onc suggests, that will give you direction for future research.  You absolutely do not have to make any treatment decision immediately.  You can always make an additional appointment with your onc to discuss further once you've had time to digest it and come up with more questions.  Or just call him - most are good about calling back. They are  very used to phone calls and additional questions. 

Some questions to start with: 

Do I need chemo - why or why not?  I would guess not for only a micro invasion.

You will likely be offered hormonal treatment.  Ask him the pluses and minuses of all of them so you get a better understanding of your options.  Ovarian suppression, tamoxifen, oophorectomy + A!.

Just know that you have a great prognosis.  And you have time to conduct more research or get a second opinion, if that makes you more comfortable.

Good luck on Monday - let us know how it goes.

I have yet to seen my onc yet (next week) but am really confused with what different treatments people are getting.  Like amyobe, only being put on Tamoxifen?  WHat aabout the Herceptin???  I thought Herceptin was suppose to be the wonder drug for Her2+ ?  I realized there are many factors in how you are treated but still very confusing.  I surely don't want to be overtreated but don't want any regrets either.  Is chemo almost always in the cards for Her2+?

Lisa

Dear Mommymac,

 I am still unsure of what I am going to do.  I started a thread called "help with treatment options after bilateral mastectomies" and have posted most of my worries there.  I know just how you feel.    Maybe we can help each other get through this.        

Amy here's a link right from Breastcancer.org on lvi

http://www.breastcancer.org/pictures/types/vascular_lymphatic_invasion.jsp. 

You may have to copy and paste into your address bar. I hope that it helps to answer your question on LVI.