Oncotype Score of 21 - Not Sure About Chemo?

mje123,

I am supprised at your age the onc is not making a recommendation. You can see my stats, and my onc gave me the choice but did say if I was 50 or younger she would recommend chemo. I am 57. I decided to do the chemo.

It was a very hard decision to make, but I felt if it came back I would always second guess myself.

My score was exactly as yours, it is a very tough decision that we are forced to make....I found some very interesting information on a website...www.oncotypedx.com...........At top click on "Managed Care Organizations", and then from drop, click on "Unmet need in early breast cancer"...May confuse you even more but it does have some eye-opening statistics on Chemotherapy-related adverse events.....To me no matter what we choose, we will have a recurrence or not..... Whatever you decide, the very best to you.

mje123 -

As everyone says, it's a very personal decision.  I think my score was either a 21 or 22 and my onc said anything over 18 would mean chemo.

From my perspective, 3% doesn't seem that high unless you're on the wrong side of the statistic.  So to me, that was a big enough difference.  Somebody has to be in that 3% and I wanted to do everything I could to try and not be.  It's true, you can have chemo and still have a recurrence; but I knew I couldn't live with the "what if" if it happened to me. 

I hope this helps.

Sherrie

Hi-

It is such a personal decision. I was 41 when diagonosed-stage 2A, no node involvement ER+her2-.  I couldn't decide if I should do chemo, either. My onc originally suggested I do it because of my age. When I was hesitant, we did the oncotype score and it came back in the grey area too-25. I was given a possible 3%, but also a possible negative outcome of 5%, as well. They just do not know what is right for those of us in the grey area. At the end of the day it's your deciscion to make. With my oncologist's OK/agreement I decided not to do chemo. I did 33 rounds of rads after surgery (clear margins) and Tamoxifen. Dec will be my 2 year 'anniversary' since diagnosis. Once I made the decision, I havent regretted it, because what's the point? If it does come back, at least I can still go the chemo route then, but I'm hoping it doesn't, as we all do! Good luck to you. I know everyone is different and it's a very personal, and sometimes agonizing decision to make.

Deborah

Deborah,

In your case your oncologist talked about the negative 5%. I just wish my Dr. had discussed that side with me. I think we all should be given all the info, good and bad before we are asked to make such a life changing decision. I know in my case I was given a sheet which listed the usual side effects, which I was more than happy to deal with.

Karen

I just found out my score is 27 so I have been reading message boards to try to determine what my oncologist is going to recommend. I see her tomorrow but from what I have read it appears chemo will be part of the plan. I just turned 40 so I prefer to do everything I can to make sure I don't go through this again. I will post tomorrow after I find out!

I met with my onc today and even though I had a score of 27 she doesn't feel chemo would give me any real added benefit above the Tamoxifen that I will be taking since my tumor was only 1/2 cm. I see this as great news and am glad to move on with the rest of my reconstruction! Hope this helps anyone else looking for some input. I am being treated at one of the best centers in the country (Duke) so I am relying on their expertise.

mje123

Have you met in person with the pathologist who wrote your report?  I wish I had done that  in the first place, as i think I would have gained much more clarity as to exactly what I'm dealing with.

Also, since your oncologist now seems indecisive as to whether you should have chemo, have you considered consulting with another oncologist?  When faced with such uncertainty, you need someone  to direct and take charge, and it should not be left up to you alone to make the decisions.

Like yours, my Oncotype score is 21. In my case, my oncologist told me she was comfortable with my not having chemo if I chose not to.  So I chose not to. I will have radiation and take Arimidex instead.  HOWEVER, I am considerably older than you, and I'm sure your young age will be an important factor in whatever treatment decisions are made.

Best of luck to you, and take care . . .

 

I was in a different position than you are, as clearly needed heavy artillary.  I did SIX DD AC, followed by SIX DD Taxol and got through just fine.  I am part of the SWOG 0221 study, so why the extra chemo.

The fact that two oncologists recommend AC tells me that they are very concerned about possible cells migrating elsewhere in your system.  At the very least, your cancer cells were "questionable", and certainly not Grade 1.

Something else to think about is your general health.  I was extremely healthy otherwise going in, and a year later, still am extremely healthy.  So I was able to take the hammering.  I had enough energy to cycle throughout my treatment and did a major cycling event within six weeks of finishing radiation (Seattle-to-Portland....200 miles over two days). 

I suspect though, that you won't need radiation.  I had a lumpectomy with node involvement, so I definitely needed it.

mje123-  Read this study regarding the OncotypeDX score and specifically, look at Table 5.  It examines the discordant "numbers" between the various grades and the Recurrence Scores.

http://www.nature.com/modpathol/journal/v21/n10/full/modpathol200854a.html

My impression is that women in the "gray" area have the hardest time making a decision. Making the decision even harder I  think there is a true dilemma when a woman has a discordant score, that is, a grade 3 tumor with a fairly low Intermediate OncotypeDX score.

I think the takeaway message is that, as good as the test is, a good medical oncologist should be able to put ALL of the prognostics together and help you come up with a treatment plan.  Furthermore, at the end of the day, there are some women who will want to take more risks to get a 1% benefit of chemo, while others might want more benefit before agreeing to chemo.

I ended up getting THREE opinions.  I saw two oncologists who were highly recommended and I also was lucky enough to have the opinion of a niece who is an oncologist as well.  I was very lucky that all three agreed with the plan.  Would someone else in my shoes, with my scores and prognostics done the same?  I have NO idea.  If you have any doubts about your treatment plan, then by all means, get a second or even a third opinion, make your decision and move on.  I'm a few months away from my active treatment and now beginning to be "comfortable" with my decision.  Only time will tell if I made the right decision.

Good luck to you and all of my breast cancer sisters!