ONCOTYPE 35 - 66 YRS OLD

Hi Bienegn,

Your ID is hard to type!  My fingers did not  want to do that combination.

Are you Stage II based on size alone or did you have lymph node involvement?  I am 62 with an oncotype score of 26.  I was told by my 3 doctors not to consider chemo.  Makes me nervous but  glad to pass up the experience.  This is all so complicated, hard to know what is the right thing to do.   Is chemo after rads okay?  Usually it is the other way around.  

I guess in the end we have to trust our doctors, do our research and say a little prayer for guidance.

Welcome to Florida.  Sorry we are making it so hot for you!  It does cool off eventually.

Pam 

You might want to check the Chemotherapy discussion board.  There is an OncoDX and an Onctopye Roll call post where women report their scores and treatments.  I am 58, my oncotype was 26 and I did four rounds of adriamycin/cytoxan.  You could also post your question there.

Good luck with your decision.

Your situation is unusual, and your own discussion and choice with your personal oncologists is absolutely essential.

One way to pose your situation might be: "is it ever too late to receive chemotherapy in early breast cancer"? This is known as adjuvant chemotherapy to us. You mention a higher Oncotype Dx score which may suggest a higher likelihood of recurrence, perhaps based on the Ki-67 (cell proliferation index score) component. Your oncologists' probably reviewed actual numbers with you, and reminded you too that breast cancer recurrence scores are still a work in progress in interpretation and prognosis.The big question every patient and oncologist faces, especially in ER+/PR+ breast cancers, is "is chemotherapy advisable"?

When the benefit is decided upon as yes, adjuvant chemotherapy is usually given in a timely manner. There are a few abstracts which talk about outcome when given as late as 6 months out which I cite below. Apparently the risk of recurrence increases from time of diagnosis to receipt of chemotherapy in most studies. But you are a unique number of 1, which many of us have come to respect as solely empowering in our choices along this journey. Studies show us numbers, but our own outcome may lie outside of the average. 

Your tumor is ER+/PR+/HER-, which is typically ideal for anti breast cancer hormonal treatments. You've been taking Arimidex all these months, a very potent estrogen-maker inhibitor. These therapies help many. You don't say how strongly your tumor cells reflected ER and PR positivity. The presence of progesterone, which is made further down the road from estrogen, suggests that your body and tumor had a good amount of estrogen exposure and reaction, hence stimulated at least some progesterone receptors which Arimidex suppression will effect by minimizing total body estrogen and progesterone production. Aromatase inhibitors like Arimidex do differ in nature from chemotherapy in that chemotherapy causes death of the cancer cell (called apoptosis), whereas hormonal therapy holds the cell from division or in other manners of abeyance. Researchers are hoping to find a way to cause apoptosis with newer modified hormonals against breast cancer, an effect which many are hoping will also minimize breast cancer stem cell resurgence or growth.

One way to think about your question is the risk/benefit of chemo and buying you time. Will doing chemotherapy now, later than typical but still doing it, ultimately help buy you time with your journey with breast cancer? Time for currently in trial and newer therapies such as small molecule biologic/ gene therapy, angiogenesis (blood vessel forming) therapies, immunologic therapy (vaccines etc), new hormonal therapies and combinations, and for ER+ patients, time for finding a solution on hormone resistance development in our ER+ states.I doubt you'll be able to find a statistical answer to this question, but surely it is intuitive there should be a positive theoretical answer. Nevertheless, chemotherapy must be reviewed very carefully with your personal doctors in terms of it's risks vs benefit.

I can only offer these words, not an answer to your dilemma.Since your current oncologist raised the question, you need to make a decision. Seeking a second opinion from a comprehensive breast center is often very helpful, if there is one near you who might render an opinion in a timely manner.

I wish you the very best at a hard decision time, and hope too that you're tolerating the Arimidex well.

Tender

Delay of adjuvant chemotherapy initiation following breast cancer surgery among elderly women

 http://www.springerlink.com/content/m168pr723l57l613/

 Effect of timing of initiation of adjuvant chemotherapy on disease-free survival in breast cancer.

http://www.ncbi.nlm.nih.gov/pubmed/6897369?dopt=Abstract

 Does Timing of Adjuvant Chemotherapy for Early Breast Cancer Influence Survival?

http://jco.ascopubs.org/cgi/content/full/21/20/3792

 2009 Breast Cancer Estimate Numbers

"The American Cancer Society estimates that there will be 192,370 patients diagnosed with invasive breast cancer in the United States in 2009. Another 62,280 will be diagnosed with non-invasive breast cancer because it’s in its earliest stages"

I am 59; soon to be 60!  I also had a missed tumor on a mamm in 2004 and ended up with a 6 cm, stage IIIb in 2007.  I DID have Chemotherapy; ACT and radiation.  I now have mets in about 8 bones.  It's totally up to you about your treatment, but you probably have less chance of mets with Chemotherapy.  I would like to hear how it goes for you and I wish you the best.

Barb in Oregon

birenegn ~  How about getting a third opinion?  35 sounds like a rather high Oncotype-DX score to have skipped chemo, and yet the only research on how long we can wait and still be assured chemo will be effective says it's 3 mos.  So, it may not be worth the risks at this point.

http://www.ncbi.nlm.nih.gov/pubmed/17015884

If I was in your situation, I would probably go to an NCI-designated cancer center for their opinion.  My rationale for doing that is, because they see more cancer patients than other facilities, they probably will have experience with situations similar to yours, which is an unusual one:

http://www.ncbi.nlm.nih.gov/pubmed/17015884

Also, if you do end up doing chemo, I'd try to avoid Adriamycin, which is known to carry have a higher risk of heart damage, and ask about possibly having Taxotere & Cytoxin (TC) as an option.  There are many of us here who can elaborate more on that point if chemo turns out to be in your treatment plan afterall. 

So sorry that you've been blindsided by this news, but best to get to the bottom of it and make an informed decision, and hopefully we  can help you figure it out  ~   Deanna 

I am also in Orlando and go to MD Anderson. If it is within reasonable driving distance for you it may be worth going there to see what they recommend.Best wishes to you with whatever you decide.