Oncotype results

CNSTP, I hear what you're saying and I've noticed the same thing -  some grade 1 tumors with unusually high oncotype score.  But you need to keep in mind that just because they've been assigned a grade 1 status doesn't necessarily mean that they're all equal as a grade 1 and of course, the same holds true for a grade 2 or 3 as well.

Using a grading system like Nottingham, the entire breast cancer population is divided into just 3 categories - which is basically about as vague as taking the entire caucasian population and dividing them into designated groups as blonde, brunette or redhead but ignoring the wide and distinct variations of each shade. It gives you a general idea of what to expect, but it doesn't paint the entire picture. You can have a total score of  3, 4 or 5 as a  Nottingham grade 1 but someone with a score of 3 is surely not equal to someone with a score of 4 or 5.  I would expect that someone with a 4 or 5 would have a higher oncotype recurrence score than someone with a 3 because in order to get a score higher than 3, at least one of the three prognostic factors being examined in that grading system would have to be less than ideal.  So yes, you're going to see some people with grade 1 tumors get higher oncotype scores than others. And if a grade 1 has a Nottingham score of 5, then it's right on the borderline of being grade 2. 

And take for example, someone with lobular rather than ductal cancer. That person would almost always get a score of 3 for tubular formation because lobular gnerally doesn't have tubular formation - or if it does, it has very little. So a tubular score of 3 in ductal would indicate loss of tubular formation and a more aggressive tumor, but a tubular score of 3  in a lobular cancer would not necessarily have the same prognostic implications  In general, a lobular diagnosis would never be Nottingham grade 1 and have a total score of just 3 (1+1+1). You would expect a lobular grade 1 total score to be at least a 4 (2+1+1) and most usually a 5 (3+1+1) and in fact statistically, the vast majority of lobular cancers are given a grade 2. There's some controversy about even using Nottingham for grading lobular because of it's distinct differences in tubular formation.

Medical,

That's the nice thing about the Oncotype test. It can be done at any time. Your BS or Onc. would need to request it. At the time you had surgery you had a sample taken of your tumor, or maybe all of it, that I don't know. It was sent to the pathology department, that's where it is now, and will stay.

As far as should we be getting the Onco test? Lord only knows. The NCCN seems to be saying no for stage 1 grade 1. I know my Dr. said yes, and I got a 24 on it.

Medigal,

The OncoType DX test is a test that you can have done on a sample of the tissue that has been removed during surgery.  It is a test that can be a useful tool to help in deciding whether or not chemotherapy would be of benefit.  A low score would indicate that benefit of chemotherapy MAY not outweigh it's risks.

It is reserved for women who are ER positive and, it used to be you had to be node negative, but I think that has changed to less than 3 nodes positive.  Although I went to their website and it doesn't say it there so I could be wrong.

Lots more information can be found here http://www.oncotypedx.com/en/Breast.aspx and here http://www.breastcancer.org/symptoms/testing/types/oncotype_dx.jsp#who

Hope that helps.

Where do you see Ki67 on the Oncotype test report? I'm trying to understand what my Oncotype report means. I see that ER score 9.8, PR score >= 10.0 and HER2 score 9.5. Some of you mentioned ER receptivity above. Do those scores suggest ER, PR receptivities? My ER score is not that high. Does that mean I will not be very responsive to Tomaxifen, a good reason to opt out Tomaxifen? The PR score seems very high to me. Is there any where to lower the PR? My doctors don't have answers to those questions. Hope you can help me shed some light on the interpretation of the report. Thanks!

MarieKelly,

I couldn't have said it better myself.You are a wealth of information and I value your input.

2TZUS-The TailorRX study is not permitting patients with tumors < 1cm and grade 1with favorable characteristics to participate in the study,so we will not know how the results  will apply to these individuals.

Bostonlex,

If you look at the report sent to you by Genomic Health, you should see the section that includes the ER, PR, and HER2 Scores, with a graph to the right. I'm looking at mine right now, and the ER and PR scores you mentioned are both positive. So you WOULD be responsive to Tamoxifen, at least theoretically. I don't think the Ki67 is on the oncotype report (at least I don't see it anywhere on mine).

Thank you, 2tuzs, Karenlen and MarieKelly!

It looks like some pathologists do more than others. I don't have Ki67 on my path report. I'll ask if my doctor has a more detailed one (I doubt it). Some of you have estrogen receptivity reported. I don't have that either.It's interesting that there is no standard as what to test for pathologists.

Joining this thread late, but wanted to send a note of encouragement to anyone else mulling over this decision.  I was Stage I at dx, but Grade III (apparently the tumor was a fast-growing SOB!!).  My breast surgeon got my hopes up by saying that I might not need chemo since I was Stage I, depending on what the Onco test showed.

While awaiting the results, I agonized over what I should do if it came back low- or intermediate risk of recurrence.  I have 2 teens that I hope to be around to nag for many years, and worried that I would feel guilty if I didn't throw the "kitchen sink" at it and it ended up coming back.  In a bizzare kind of way, it was sort of  relief that the score came back high (33), because it made the chemo decision a no-brainer.  While I certainly have no desire to belly up to the chemo bar again, it wasn't as bad as I expected it to be.  Worst thing, IMHO, is the dang "chemo brain," which is still a bitch!!

Good luck to everyone awaiting Onco Dx results and trying to decide where to go next.