Oncotype Dx score 19 chemo or no chemo?

Hi my score was 23. My BS was on the fence about this also. I had the mammaprint which

came back low risk and the oncotype 23. I finished 8tx I

of CMF and will start rads on the 6th. I went with the second Onco. S the first wanted to give me the hardest chemo. I asked my BS what should I do and he told me he couldn't answer that. But, he said to my husband...if you are being attacked would you want a 22 or a 45? That answered my ?. I was scared but to be honest it qas doable. This board has great people and share with each other good info. Take care, Patty

Howdy - mine was 19 also.  My onc wouldn't even consider chemo.  Now one year out I feel like I should have done it because I might be facing recurrence.  That's just my personal feeling.  19 is a low number, and chemo is so difficult on the body - you just have to gather all the facts and make your decision.  Tough to do when you're first diagnosed, your world is upside down....if you're a Believer, pray about it, you'll know what to do.

All the best, Tracye

Peachy-pie - My score was 23, and I did CMF chemo.  So many factors went into my decision.  I was 44.  My kids were pretty young, 9 and 11.  If I had been post menopause, or say 65 with grandkids - chemo may have been easier for me to skip.  But, at my age, and more importantly, the age of my kids - I decided that chemo was worth it.  I am happy I did it, and it was not hard to get through.

It is interesting to see what all of us choose, but make sure you consider other aspects besides just the oncotype score that goes into personal decisions. A 45 year old and a 65 year old most likely would chose differently, based on age alone (and years to be exposed to estrogen, etc etc). Hopefully I'm making sense!

Good luck with this!

There's lots of info missing. For instance, how old are you?  I was 39 at diagnosis, and with a grade 3, even though my Oncotype was only 12 my oncologist felt a. the Oncotype is not as well tested in younger women, and b. grade 3 is the most unpredictable cancer cell and the Tailor X trials are pending.

I sought two additional opinions, one from U of Chicago, one of the leading research institutes for breast cancer.  I got yes, no and maybe.  It just isn't a clean cut decision (and frankly, I'm a bit wary of any doctor who would say it is in my situation), but I can say with my profile, if I had had 19 I wouldn't have thought twice.

They did my oncotype test twice and the scores came back 17 and then 18.  With those scores I could have chosen not to have chemo, but for me it came down to being afraid I would regret it later.  I had a lumpectomy with clear margins.  Before I started treatment I asked for an MRI since my cancer had never shown on my 23 years of mammos.  I wanted to check the other breast to see if anything was lurking.  To everyone's surprise a second primary was found in another quandrant of the cancer breast.   It was 90% dcis so the biopsy actually removed the whole thing, again with clear margins.  So with that info,and my first tumor being rather large at 3.5 cm and grade 3,  I opted for the chemo.  I also had 35 rads.   For me it was the right decision.  I was lucky too in that I found the chemo very doable.  Of course I don't know what I might have done to my body in the big picture.  Right now I am battling recurring infections in the breast and everyone seems to think it is because I have a compromised lymphatic system from the rads.  Who knew?  I do not know what surprises I will face in the future, but at the time, I made the best decision for me.  Remember it is an individual decision and you need to make the decision that makes you comfortable.   Gather all the facts and then you will know.  Good luck................Caren

I had the BRCA genetic testing and I was negative.

Something else came to mind when you mentioned the 88% chance it will not return.  That is a good number and I don't want to be doom and gloom, but we were also told that 80% of all tumors are benign.   I'm just saying...................

Peachy-pie, I feel so much for your situation.  I was there a little more than a year ago, and it's just plain excruciating.  I think the truth is, the medical field just hasn't caught up to how wily this disease is, and it is very difficult to get clean answers.  I can offer a few more things to think about.

Find out of you had lympho-vascular invasion or not.  This is one of the criteria for chemo at my NCI ranked hospital.

Worry for lowered immunity during chemo isn't as much of a concern today with Neulasta.  You can work right on through.  I had a few days I felt bad, but I never picked up a cold or anything.  They have drugs to manage white blood cell counts.

BRCA is actually a pretty rare gene.  There is a great chance you will be negative!

Your friend's response to chemo 15 years ago is not comparable.  Please don't use that as an arbiter.  Also, you might not be on the same regimen.

There are many things they don't know yet about Oncotype and chemo, this is why the Tailor X trial is being conducted.  Look into it.  They are testing the intermediate range to see which patients do and don't need chemo.  

The truth is with chemo, none of us knows for sure whether it's a benefit.  I will never know.  However, my third opinion said when I asked, "Why can't I just hit it again if it comes back?"  Her response:  "Because you need to understand that if it comes back, your treatment will in all likelihood be palliative."  I would say that was the moment I decided "yes" to chemo.

You are Stage 2.  I am pretty sure my hospital would give you chemo for that stage regardless of Oncotype. Oncotype is not the only decision making tool at many hospitals.

My decision is mine alone, and I wish I could tell you what to do!  It's so hard.  I just wanted to share some more info.

(I'm originally a Jersey Girl, by the way!  Cape May summers....)

Peachy I scored a 23 on my oncotype and opted out of chemo.  I got two opinions and both said they did not feel that the benefit was worth the SE that chemo would give me.  My 2nd opinion did give me more information and said had my tumor been 2cm he would have recommended it and also had my KI67 been over 10% he would have recommended it. I see your tumor is over 2 cm you may want to ask about your KI67.  It should be on your path report. I am on tamoxifen and feel that is my best defense against this awful disease. Also I was 48 at diag.

"lymphovascular invasion but that just means cells were not caught in the act...it is not definitive"--what does that mean?  I thought lymphovascular invasion means the tumor literally has vessels growing out of it, meaning it has pathways into the bloodstream and rest of the body.

That's great PLJ, I want to understand more and thank you so much for your info.  I had an alarming and weird thing:  my initial biopsy showed LVI.  Final path didn't.  I must say, this was also part of my chemo decision maker.  Something about them being different left me unsettled.  After all, my ultrasound was picking up my tumor and calling it "probably benign" for over a year.  It wasn't until I called it out they looked at it.  The whole thing is really imperfect!!

As for who does and doesn't get mets...it's sad, but it is still so stinkin' elusive.  Part of the reason I did the chemo and never said no to Tamox or any other recommendation was because I just didn't feel like the numbers were on my side.  After all, my chances of getting this in the first place at 39 with no family history were really small.

My onco score was also 19 and I was 43 at diagnosis.  My oncologist and breast surgeon both insisted on chemo for me because of my age.  My lymph nodes was clear and I was so hopeful for no chemo but it didn't work out that way for me.  Now, I'm thankful that I did and feel that it gave me a little more added insurance.  I figure I've done all I can do......

Hi Peachy-pie, I think one of the hardest things for (us Jersey ; )) girls is that BC means a lot of other issues to deal with, too.  Lymphedema, osteoporosis, premature menopause, hair., etc etc etc.  It stinks!

I recommend seeing an LE specialist. Sadly, even at the best hospitals, the surgeons seriously don't get it.  You may be having some post-surgery trauma, so don't panic.  But this is best in the hands of an expert whose job is to research the latest on the (limited, sadly) studies to date.

Good luck.  You will get through this!