oncotype--chemo or no chemo

Lola, That is such a hard decision to make. I think you need to know the oncotype results. An important thing is also your age, the younger you are the more the Dr's want to do chemo. In my case I am 57, my oncotype test came back 24 which is in the gray area. That gave me a 3% advantage doing chemo, my onc let me make the decision without trying to push me one way or the other.

If you check out peoples decisions on this site you will see many of us are getting conflicting opinions from our Dr's about chemo. Good luck with your decision.

Karen

Lola, like you I had two invasive tumors.  Normally treatment in multicentric/multifocal breast cancer is based on the largest tumor.  But that just doesn't make sense to me, so I asked to have oncotype scores done on both tumors and based my decision regarding chemo on both scores.  One tumor had a score of 16 and the other had a score of 8.   I figured out the statistical chance of either tumor recurring  based on these scores and the benefit from chemo.  I would have gotten little benefit over tamoxifen alone, so decided against it.  My oncologist agreed, although he originally recommended chemo.

You should talk with the oncologist who is recomending against chemo if  you have a low oncotype score about his recomendation considering you have two tumors.  Is he taking that into account or is he ignoring the smaller tumor.   In my case, the smaller tumor had the higher oncotype score and while it was low enough for me to be comfortable without chemo, I didn't want to ignore it.

If you are still conflicted after you get the results, I'd get a third opinion. 

My OncoType result was 18.  I was told as long as it was under 19, no chemo.  So, I am not doing chemo.  Wait and get your results.  Hopefully, the results will be low.  Hang in there....I know how hard to waiting is!  Hugs

if the onco score is low does that mean you girls are not doing meds either???

grannydukes, I think the use of meds is another thing. My onco score was 24 so i was in the gray zone. I checked online and by doing chemo it reduced my score by 3% which at my age isn't much. If you check your score for the meds it will also give you that info. some are using the meds and others are not. i will decide by how bad my SE are.

Granny,

I am going to be on tamoxiphen for a while.  I just read today that tamoxiphen taken with and Zometa keeps  the reoccurance lower and prevents bone mets.  I am going to ask for Zometa when I see the Onc tomorrow.

I just went to an information session about Breast Cancer Treatments at Gilda's club tonight.  They talked about about the onco test.  It seems that if you are in the low risk area, that chemo will be of little benefit, meaning not that the chemo isn't a benefit but that you don't NEED it as your recurrence risk is low and you can be treated with the estrogen blocking drugs.  If you are in the middle area, you should probably do chemo but there are women who opt not to.  If you are in the high area, you recurrence risk is high and you need chemo, even if you have a very smalll tumor.  In the past, ALL women got chemo which carries a lot unpleasant side effects.  Back then, they had no way of knowing which women with non lymph node invasion had more agressive tumors.  The oncotype test gives the doctors a better idea of which node negative women should get chemo and which node negative woman don't need chemo. If you have positive nodes, you get chemo.  If you are estrogen negative the test is useless, it only benefits estrogen positive women. So then if you are triple negative I would imagine you just get chemo.  I was estrogen and progesterone negative but Her2+.  I was told due to this I would need chemo even if the cancer had not spread to lymph nodes (which it did, which was a shock as the tumor was not very large, Her2+ can be more aggressive but now we have herceptin, it is a miracle drug and I feel very fortunate to have it).  I hope this helps. Personally, I would do chemo if my oncotype test was in the mid-range or high range.

I had one micromet and still said no to chemo. My onc agreed.

Grannydukes - the score you get with the oncotype test PRESUMES you will be taking Tamoxifen for 5 years. Your risk of recurrence will be higher if you do NOT take the Tamoxifen (or an AI). I am quoting from the pamphlet Genomic Health sent me:

"The Oncotype DX test is intended to help determine whether or not you are likely to benefit from chemotherapy in addition to your hormonal treatment."

Karen

Stage 2, did not spread to the lymp nodes. Had double mast. No chemo.

So I've read all the posts on this, and I know it's a personal decision, but do any of you have family history added in?   My oncotype came back as 17, also a family history with mother and aunt both not surviving breast cancer, I'm 45, ER/PR+, HER2-, found very early on screening mammo, just a smidge over 1 cm, no nodes.   I have 2nd opinion next week.   My oncologist is recommending chemo.   I'm assuming 2nd opinion will recommend it as well, but maybe he won't which will be worse if I have conflicting opinions because then the ball's in my court.

I had a micromet < .02mm in the sentinal node and the onc was fine with no chemo as he knew I would be doing rads.

Boo - do you know your BRCA status? My mother had BC but none of her sisters did and on my dad's side there aren't many women. My oncotype was 17 also and my onco didn't recommend chemo (though without the test he would have because of my age-39 at diagnosis) and I later found out that I'm BRCA negative, so that helped reinforce my decision.

i am 59 and was diagnosed on nov 23, 2010 with invasive ductal breast cancer, stage 1, grade 1, er +, her2 neg. my onco score was 22 correlating to 14%. i am definitely going to have radiation and arimidex. One oncologist suggested chemo- taxatere and cytoxin while the other onc. said no chemo. Any thoughts??

I think it really depends on age. I was under 40 at diagnosis, and the studies show that aggressive seems to be the best way to go with that group.  I had an oncotype of 12, which pends Tailor X findings as to whether I should have had chemo or not.  It was a grey area, but with the unpredictability of my age, I was strongly advised to do chemo.  Additionally, at my hospital, the oncologists feel that the Oncotype is not entirely predictive in the grade 3 environment (which is what I had). 

I think they'll know more soon for us ER+ gals, which is amazing.  And I'm afraid that what we'll find out is that I really didn't benefit from chemo.  But you work with what you have at the time, that's the moving target of cancer.