Oncotype DX test score at 18 - chemo or not?

Hi Julie,

I had bilateral BC and they oncotyped both tumors.  One was a score of 14 and the other 19.  I spoke to 4 oncologists, none of whom could tell me for sure that chemo would be effective for me.  So, I didn't do it.  I guess it was a good decision; I am 2 1/2 years from my diagnosis and seem to be OK.  I do worry, however, that I could be at a higher risk of recurrence because I didn't have chemo.  It seems as if every other BC patient I know did have it.  I am taking tamoxifen and tolerate it well, so I'll be able to stay on it for all five years.  It's a really tough decision - good luck to you.

You can see my stats below.  I am having BLMX and reconstruction with TE/implants.  I already had a lumpectomy and got the oncotype on Friday of 17.  That is technically in the low risk, but it's the highest number in the low risk group.  It is freaking me out a bit - I was hoping for  a much lower score.  I am 45 with a 4 year old son so that is why I have opted to go BLMX.  I have no family history of BC at all.  I had told myself if I was in the intermediate group and given a choice I would do the chemo (ICK!!!!).  I have not been able to speak to my med onc yet about test results.  The nurse called and said you are in the low range so the dr won't be recommending chemo.  I said she needed to have the doctor call me because she told me in the intermediate range it was my choice and I am only 1 point below the intermediate range.  I am waiting for her to call me back on Monday to discuss.  Right now, if they will give chemo to me, I will probably do it.  I figure it's my shot to kill anything lerking anywhere.  I have not had any scans at all offered to me yet....I need to ask about that too.  Let me know the outcome or private message me if you want to compare notes. 

As I understand it from the docs, there may be single cancer cell in the lymph or blood systems that can't be detected by current methods - although there is that new test being tried at MD Anderson and 2 or 3 other places. I want my daughter to go after her cancer aggressively and take every step to prevent reccurance. She has no choice about chemo due to one node positive. My fear is that too many woemn are being under treated only to come back to 2 to 5 yrs with another tumor.

Julie

big hugs--this is so hard..it often feels to me that more people come back in the intermediate range than any other--and that they keep shifting what the actual ranges are.  My score was a bit higher than yours- and I had young children, so I just decided to do it---I knew that I would not be able to sleep at night if I didn't, but that is just me.  I also had no nodes, clear margins, etc.  I can tell you that I have not lost one moment's sleep since then...... but again, my score was in the low 20's- although at that time, anything over 30 was considered high-so in the 20's was still intermediate and grey......

Talk to your onc about what kind of chemo they might recommend---I did 4 rounds of AC over 8 weeks--it felt like it was over before it began..... best of luck----

Oncotype DX Influences Breast Cancer Treatment Decisions

The Oncotype DX® breast cancer test may change treatment decisions for more than a third of women with early, estrogen receptor-positive breast cancer. These results were presented at the 2010 San Antonio Breast Cancer Symposium.

The Oncotype DX breast cancer test measures the expression of 21 genes in a sample of tumor tissue. The test generates a Recurrence Score® that provides information about the likelihood of cancer recurrence and the likelihood of chemotherapy benefit in women with early-stage, estrogen receptor-positive breast cancer.

Previous studies have indicated that use of the Oncotype DX breast cancer test can influence breast cancer treatment decisions. Test results may, for example, change the treatment recommendation from chemotherapy plus hormonal therapy to hormonal therapy alone (or vice versa).

To provide additional information about the impact of Oncotype DX on breast cancer treatment decisions, researchers combined information from seven studies that enrolled a total of 912 patients.[1]

• Physicians who used Oncotype DX changed their treatment decisions for over one-third of patients.
• Overall, there was a 28% reduction in use of chemotherapy as a result of the test.
• 4% of women had chemotherapy added to hormonal therapy as a result of the test. These women were initially considered low risk but were reclassified as high risk based on their Recurrence Score.

These results provide additional evidence that Oncotype DX can play an important role in treatment decisions for early breast cancer.

In another study presented at the San Antonio Breast Cancer Symposium, researchers evaluated a combination of the Oncotype DX Recurrence Score and factors such as tumor size and tumor grade.[2] The combined score did not predict chemotherapy benefit as well as the Recurrence Score alone.

References:

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[1] Hornberger J, Chien R. Meta-analysis of the decision impact of the 21-gene breast cancer Recurrence Score in clinical practice. Presented at the 33^rd annual San Antonio Breast Cancer Symposium, December 8-12, 2010. Abstract P2-09-06.

[2] Tang G, Costantino JP, Crager M, Shak S, Wolmark N. Comparing the prediction of chemotherapy benefit in patients with node-negative, ER-positive breast cancer using the Recurrence Score and a new measure that integrates clinical and pathologic factors with the Recurrence Score. Presented at the 33^rd annual San Antonio Breast Cancer Symposium, December 8-12, 2010. Abstract S4-9.

Hi Julie -

I was diagnosed back in 2005 with a stage 2 (2.1cm), grade 1, er/pr+, her2+ tumor. I was 44. My oncotype was 17. The test was very new back in 05 and my onc strongly suggested chemo due to age and tumor size. My surgeon was more cutting edge and she encouraged me to have the Oncotype testing done, over my Onc's mild objections. (because he was sure I would be high risk and testing was a waste of money). He did, however, better educate himself about the test while waiting for results, and once that 17 came back, he changed his tune to "no chemo" because the risks of developing complications, including leukiemia down the road, more than outweighed any slight benefit I might get from chemo.

I think it's important, whatever your decision, that you make it and don't look back. I knew that if my cancer ever came back (so far so good) that I wouldn't beat myself up over not doing chemo. I look at it as a weapon I still have in my arsenal, if the need ever arises.

Best wishes to you!

Stay strong,

Phyllis

HI there, just a thought, you may also want to have a few Oncologists weigh in and give you a recommendation. I saw 3 for opinions as I was young. 45. Most Oncologists given what you shared on your path would be comfortable with you not opting for chemo. I too struggeld with the decision and decided against. As your Oncologists what the "true" % benefit is for you which I believe they can give and deduct the % of side effects.

Good luck on your decision

My DX score was 29, the high end of the gray area.  My med onc suggested chemo but ran Adjuvant survival graph, decided little benefit compared to risk and recommended Arimidex.  I've been researching everything since diagnosis.  I did not intend to have chemo and after researching the side effects of Arimidex I've decided to not go that route either.  The possible benefit of 2 - 3% increase in survival simply do not outweigh the side effects as far as I'm concerned.  I compared the Onco report with Adjuvant and created my own graph using Lifemath.net which matched the Adjuvant chart pretty much.  The Oncotype DX score is comprised from a very small group which included Stage 2 and Tamox treatment which is for premenopausal women; not postmen like me.  Do your research; check the math and do what's right for you; doctors don't know everything and remember there are no guarantees.

My Oncotype story is a little different....I had problems finding an oncologist on my Medicare plan that I had confidence in, and had already decided against chemo due to my age and physical conditions.  I finally found an Onc that I trust and the first thing he did was order the Oncotype test.

What was discovered is that there was a huge discrepancy between the Oncotype test and the early pathology reports I received post biopsy but pre surgery.  The major discrepancy was that the HER2+ FISH diagnosis in the pre surgery report was found by the Oncotype test to be just barely within the "equivocal" range and within the range of error.  The ER number was also much higher on the Oncotype.

I had a lumpectomy and APBI (partial breast irradiation) and will be treated with Tamoxifen due to possible cardiac SEs with the AIs. Previous oncology suggestions for treatment were TCH based on the early report.

My Oncotype score is 26, mid-range intermediate risk.  If I were younger and had young children I would choose the chemo path. As it is, I chose quality of life. After the scare of the early report, a 17% recurrence rate which is not much different than the rate with chemo  is, at my age "doable".

My oncologist said that he thinks the Oncotype test is more accurate due to it being done at the molecular level and recommends it for all his ER+ patients. I am highly disappointed with the pathology report by the local lab.  Many ladies say their FISH test was not done locally, but mine was.

worldwatcher - thank you for your rapid answer!

Does oncotype result has any affect on the type of chemo drug? I mean if the oncotest score is high I'll get harder drugs?

Worldwatcher - thank you again, it was a big help for me!

ch08567,  Recently I was in about the same situation you're in now -- the difference being that my pathology was a bit scarier than yours (IDC, 3 cm. Stage IIb, Grade 2,  2/18 nodes, ER+/PR+ HER2-. plus [rare foci of] dermal lymphatic invasion).  My Oncotype score was also 21, so I was  sure I was headed for chemo.  But my second-opinion oncologist surprised me by saying she would be comfortable with it if I decided against it. Alternatively she recommended mastectomy followed by radiation, and since I am postmenopausal, 5 years of Arimidex. I asked her, if it were her, would SHE have chemo, and she said "No."  She also commented that even if I did have the  chemo, there would still no guarantees. So I ended up deciding against it and am happy with my decision. That is not to say that YOU should not have chemo, but only that it's important for you to have complete confidence in your decision once you reach it.

BTW, my oncologist is at a teaching hospital and doesn't sell chemotherapy for her living.

As for bad cells traveling in lymph vessels, I guess that's what lymph nodes are for -- to catch the bad cells and stop or delay them from going distant sites. I wonder if your Onc will recommend that you have your remaining axillary nodes irradiated as a precaution. 

I'm so sorry that you are having to deal with this.  The indecisions and uncertainties are the worst!    God bless, and good luck.

Rads are much more advanced than those from years ago.   I had IMRT which is more direct focused since my BC was in my left breast. There are many types of Rads.    My Dad died of Heart disease when he was 44 so I did not want to do anything that would be harmful or make me more susceptible to heart disease.   Oncotype 16 No chemo.

cho8567, Is your problem on the left, so that's why you're worried about damage to your heart? (mine ws on the right, so it wasn't an issue.)   If that's the case, look for a state-of-the art radiation center that does very precisely targeted treatments with minimal scatter. I had 28 treatments plus 5 "boosts,"  ending on Dec. 17 2010. Feel free to PM me if you would like to. It wasn't a bad experience at all.