Oncotype Score 18

dcoffey:

I am 59 (58 at dx) and had ES/PR+ HER- 0/2 nodes, grade 2 and my oncotype was 19 (actually about a 18 1/2 according to oncologist). I did not need chemo or rads. I had DMX on 9/20 with immediate reconstruction. I take tamoxifen.

0-18 is considered low risk I believe.(not sure on this # though) Your oncologist should be able to give you recurrence %'s based on your path report.

Since your oncologist is not giving any recommendations I would definitetly get a 2nd opinion.

Good luck and keep us posted!

Jan

dcoffey: I also had the mammaprint and that came back as 'low risk'.

Get the 2nd opinion and like mari said the grade 3 may be of concern or the deciding factor.

My recurrence is 12% also but there was not reduction or very very little with chemo.

Tamxoifen seems to be the med of choice for me.

Just remember, everyone's cancer is unique and what may be right for one person won't be for someone else.

Jan

Dawn, there's a lengthy thread here called Oncotype-DX Rollcall.  You can find it by using the search box to upper right.  On it many women tell their Oncotype scores and what they decided about chemo.

Also, just a heads up ... When you first join BCO, you're limited to 5 posts per 24-hr period, which is done to prevent scamming.  It can be very frustrating though when you get shut out for 24 hrs.  If that happens, you can continue to chat with anyone here by clicking on their avatar or screen name, which will take you to a page with a Private Message (PM) feature.  Just thought you'd like to know...   Deanna

dcoffey I just turned 43 when diagnosed last year. My oncotype dx score was 17..low but the highest end of low which is now the new intermediate 9as they are changing the scale that above 12 is in the grey area) Anyhow, initally I was like OK 11% chance of recurrence ...thank you very much! I will be on Tamoxifen...have a nice day dr see ya in 6 months. Then I met with the Oncologist my BS referred me to. He said he doesn't recommend chemo unless it gives you a 4% benefit. I was at 3% absolute benefit WHICH could be higher as much as 5%. So I was like thank you very much as I certainly did NOT want to do chemo...had scheduled a second appt for another oncologist (didnt like personality of BS referral) just when I was about to get on with my life..my BS called me into his office. He was upset that I was not doing chemo..he said the final pathology on my mx found a 1mm tumor that was poorly differentiated which suggested that the cancer was becoming more aggressive as it hopped from duct to duct (I had 4 tumors in total biggest one 9.25mm smallest 1mm) He said he thought of me as a sister and wanted me to do all I could do to battle this cancer. He did a "mortality" model using all my histology and biology from my path reports and it was a little scary. I then met with my second Onc and he said the same thing, that if I was his friend or family member he would want me to do chemo. I thought of my nieces and how I wanted to ensure I was around for them and that I fought this hard. I said to my onc I just can't imagine if I did chemo and still had a recurrence...he said imagine how you would feel if you had a recurrence and didnt do chemo.

I did 4 rounds of Taxotere and Cytoxan. I will say if I didn't lose my hair I would have absolutely no regrets to doing it. It was tough but I weathered it pretty well with no real problems or side effects. I am glad I did it as I know I did all I could to prevent recurrence. My hair is growing back and I am getting back to my normal life.   Its not easy and you will sacrifice some time now so you will have more time later. It has truly given me a peace of mind to move forward.

Good luck with your decision. PM me anytime if you have any questions.

Stay strong!

Diane

This is a very personal decision. I too have an 18 Oncotype score. I struggled to decide whether to go with chemo or not. My Oncologist left the decision up to me on chemotherapy. He said he would support me no matter what decision I made.

I came to the decision on chemo by doing resaerch and thinking about my age (31), although my cancer was slow growing I had multiple small tumors and more than one BC cancer types, I also thought about how I would feel if the cancer returned and I had not gone thru with chemo. I also thought about what I would feel if I had serious side effects from the chemo but no recurrence.

I finally decided that I am young and hopefully have many more years to come. Only 3% of people at my age get BC anyways...so what does that say about Stats? I could be that 11% that has a recurrence or I could not..no one knows. Ultimtely, I would likely be unhappy later in life if the cancer came back and I had not taken all the treatment options presented to me. I also considered that my oncologist said I was young, healthy and atheletic so the risk of side effects from chemo were very low.

Such a tough decision but definitely one you need to go with your gut on and make sure you are the one that feels confident in whatever you decide. Chemo sucked but it was doable..if I can do it anyone can.

Just checked genomic health's site. Recurrence scores still as follows: •Cut-off points for Recurrence Score risk groups are defined: - A low-risk group with an RS of <18 - An intermediate-risk group with an RS between 18 and 30 - A high-risk group with an RS of ³31

I just checked my copy of my report and it says intermediate risk group for score of 18.

Hi,

My Onco Score was 18 and my Onc said that it would do me more harm than help!!!  Now on Femera and having a terrible time with pain!!!!! Not fun. Looking for a Natural Estrogen Blocker. I am on a mission so other women do not have to have this pain. I am 61 and otherwise in great health.

Hi there. I have an Onco score of 21, which is low intermediate, but the onc is recommending chemo due to the fact that I have lymphvascular invasion. She has also told me that chemo will improve my recurrence probability by 3-5%. Pretty negligible in my eyes, especially since chemo only works on cells that are actively dividing at the time of infusion. I am Stage 1, Grade 1, so it is not an aggressive cancer and maybe they are not actively doing anything. The problem is that it has also been three months since my lumpectomy and time is fleeting - who knows if any of these cells in the lymph vessels have travelled. My onc is recommending TCx4 - I really don't want to have chemo - feel risks out weigh benefits for me, but am frightened if I don't. Sooo confused

dcoffey ~ I have very similiar stats to you.  I was diagnosed last Oct at age 43.  My tumor was initially a Grade 3 from biopsy.. but the final pathology after surgery put it at a Grade 2.  My oncotype score was 15 = 10% risk.  

I agree with getting several opinions, do your own research and in the end.. YOU have to be comfortable with your decision.

Here's a simplified version of how I decided in my situation:

Things that would lean me towards chemo:

My "young" age, higher grade tumor, possible peace of mind?

Things that deterred me from chemo:

Clear margins, no nodes, no lymphvascular invasion, Onc recommended "no", wanted to avoid "possible" long term side effects from chemo, my tumor was HIGHLY ER+ so knew Tamoxifen was going to be most effective weapon of choice, I was already being pretty "agressive" by having a BMX, and I have made peace with the fact that nothing is certain ~ it may reoccur, it may not.  I will not/do not regret the choice I made with the information I had at the time.

I wish you good luck, strength and most of all ~ PEACE~ with your decision.  

ch08567, you might want to get another opinion about the rad oncs figures.  The reoccurence score provided when you get an oncotype test presumes you will be taking tamoxifen for 5 years.   To me, it seems like he added the advantage tamoxifen gives you to the recurrence score, in effect double counting it.  

I think the 15% chance of reoccurence represents the chances of a distance recurrance if you take tamoxifen for five years.   

Christine, you could always flip a coin.  I know that is a sarcastic response, but sometimes when you look at the stats there is no clear choice.

 I've read that stats that chemo would decrease the chance of recurrence by 33% (relative to your chances of recurrence).  So if you had a 15% chance of recurrence, chemo would reduce your chances of recurrence by 4.95% (15% x .33%).  That brings your chance of recurrence down to 10.05%.  But you have to look at chances of permanent side effects from chemo.  My onc gave me a ball park figure of a 3% to 4% chance of permanent side effect.  

Although I think my chances of recurrence are similiar to yours, my situation is different.  My bc was multicentric (two tumors) with no definite  lympphvascular invasion.  I decided I could live with a 15% chance of recurrence.  Chemo didn't offer me enough of an advatage to out weigh the chances of permanent side effects.  So far, I think I made the right decision.

It is a hard decision.  A lot depends on your tolerance for risk.  Good luck in making  your decision.

LIsa-e - I also had two tumours within the DCIS (DCIS 4.8 cm, Grade III) on my left breast. They were both rather small - one .7cm (invasive microcapilliary), and the other 1.7 cm (invasive ductal).  Both of these Grade I,  as I have stated before.

I think I've made my decision and it is the same decision as earlier, just not completely comfortable with it yet.  Don't know if I will ever be.  I am going to forgo the chemo.

Thank you so much for pointing out the discrepancy with the onco type testing and percentages. Guess my rad onc didn't realize that the testing figures are with Tamoxifen (or other) taken into consideration.  It does make a difference.

Take care,

Christine

I went to the Dr., armed with a list of questions.  He told me absolutely no chemo...no, no, no.  My IDC was 1.2cm, grade 2, no lymph node involvement 0/7.

He told me if I do no further treatments of any kind my survival rate is 85%.  With ovary removal (which I will be doing) add another 5%.  Add Tamoxifen (I don't know if I want to take this) add another 5% to my life.  I guess I seemed incredulous, so he referred me to a Dr who specializes in Onc.  The Dr. that gave me the above info is the onc. surgeon.

My oncotype score was 17. There was no doubt in my oncologist mind that I would get chemo despite the oncotype dx score being in the low risk category.  I also had mutliple foci of cancer tumors throughout my left breast with DCIS too.  I had three solid tumors.  Also, given that I am 32, my oncologist felt it was best to go aggressive being young.  I did meeet with another oncologist who said it was totally my choice.  I really wanted to feel like I did everything to decrease the risk.

Hi Mini1

My score was 18. I had a lumpectomy, a re-excision because they found a bit more cancer in the tissue. I have post hormonal treatment, Femara, because my cancer is estrogen based. Maybe yours is not Estrogen Receptor Positive.