I think Oncotype DX is a SCAM!!

The way I see it -- cancer grade is one predictive tool, Oncotype DX is a separate predictive tool. They look at different characteristics of the tumor to make their predictions so they don't necessarily overlap.

Yes. If a tumor is ER+ then you are a candidate fir endocrine therapy.

I won't pretend to know a lot about the oncotype test but my thinking has been along the same lines as MaryNY. Grade/aggressiveness is but one aspect of the tumor. In and of itself, it may not be the only factor in determining the potential effectiveness of chemo. Other tumor characteristics may play a role in the efficacy of chemo. I think that this is quite an advance in that tumors are being analyzed for their particular characteristics rather just grade/size which seems somewhat limiting.

TN's do not respond to hormonals as others have stated, so oncotype, which assumes use of hormonals currently has no value for them. Very interesting discussion!

Caryn

I'm not sure if anyone relies heavily on the results of the Oncotype DX test. For most, it seems to be just another tool to help in making the decision about chemo.

My Oncotype score was 18. If I wasn't node-positive, I might have considered foregoing chemo, but with two positive nodes and an oncotype score in the midrange, I think chemo was the best choice for me given the information I had.

Peppopat: If you have gotten an Oncotpye score in the single digits, would you have skipped chemo? If you didn't have the Oncotpye test, just glancing at your diagnosis I would have thought that chemo would be standard of care for you since you had a positive node (though you do note that was a micromet). However, I don't know anything about ITC -- maybe that changes everything.

"I'm not sure if anyone relies heavily on the results of the Oncotype DX test. "

Not the case.  I had one hospital (of my three opinions) using it as the only decision making factor for chemo. For the record and those coming forward:  there is little-to-no definitive evidence that diet and vitamins are "treatments".  They may be preventatives (though still very much in question, sadly, with many of them), but to call them treatments is misleading to future readers.

Additionally, as far as I understand from my oncologist, they simply don't know why some grade 1 tumors are high scores (you can't just attribute it to borderline PR status, for instance).  They just don't understand the genetics to that fine a point. 

http://www.cigna.ca/customer_care/healthcare_professional/coverage_positions/medical/mm_0298_coveragepositioncriteria_assay_genetic_expr_breast_cancer_patients.pdf

The above link from Cigna insurance provides a good summary of all of the current genetic tests for breast cancer that are presently available and in research.

I haven't had the Oncotype testing done as I live in Canada and its not routinely done, and I am fairly young and node positive (micromet). From what I've read, and I can't now miraculously produce the link but I will if you want me to, PR- in addition to moderate-high mitotic rate will always produce moderate-high Oncotype score. As chemo was never in question for me, I didn't give it too much thought, but now, reading all your posts I wonder.

The idea that "different methods produce different results" scares me.  Why even get tested then, if some TN might turn out to be ER+/PR+ when different method is used? I knew about slight variations in results, so if one IHC method returns me as weakly positive in 30% of tumour, then its possible that another method would return moderately positive, or in 25% or 50% of tumour. Not in 95% and not strongly positive. That just blows my mind. Does that mean I might be HER2 + and could benefit from Herceptin, but because of the method used I am considered negative and am not getting all the benefits I could?

I am now going to read voraciousreader's links. I should've done it beforehand, but my fingers are too fast

Mary, I went with a hospital that took many factors into account, I'm just pointing out that there ARE hospitals out there that suggest Oncotype trumps all, and all of my hospitals used it as a major factor.  I think once Tailor X trials are finished, it will be used even more as a dependable tool.

I was not node-positive, I would think that would change things up tremendously.  It wasn't until recently the node-positive women were even encouraged to get Oncotype. You are very correct to point this out to readers--because that may very well be all the difference.  Though, there are studies indicating women with up to three positive nodes have very similar outcomes to those who are node-negative. 

During my first year of treatment/post-treatment, I read every study, looked at things from both angles, freaked out that studies even indicate unless your rogue cells are active, even if they got "out of the barn" chemo may not be effective.  After a while, you just have to go with the best, most educated guess and move on.  There are too many variables, and I'd have to spend every waking moment managing research on every single thing (how about lymphedema, for instance?  sleeve, or no sleeve in the at-risk, but no signs yet group? talk about crazy making).

I had the advantage of seeking a third opinion from University of Chicago.  This is one of the top research SPORES on breast cancer in the country.  I met with one of the leaders of their trials.  She said, "we just don't know" whether I should get chemo "until Tailor X trials are complete" (what bad luck I had on timing with my diagnosis!).  If she doesn't know, then I'm sure I won't!  And I'm also sure there are a thousand questionable elements to Oncotype, and every other treatment for breast cancer.  It's the best we have for now.

For me, as I said, Oncotype was a miracle.  It gave me hope. It's not a "scam", it's not perfect, it's not the only predictor for everyone.  But, it is probably the most radical treatment advancement for ER+ patients since the advent of chemotherapy.

Even for me, Oncotype was helpful. Based on my Grade 2 and the fact that the cancer had already metastasized to the lymph nodes and with the fact that I had a clean mammo eight months prior to the one where the tumor was found, I thought my cancer was more agressive and expected to get a higher score. It was somewhat reassuring to get a score of 18, even though I had chemo anyway.

Julia2, that makes sense.  What is considered mildly ER+?  I am 40% ER+, is that mild?  I am higher for progesterone, I think 70%.  Would like to know if I should really do the Tamoxifin.  Am going to talk to the onc about it in a couple of weeks.  I know there are some who believe it diminishes the effect of Herceptin.  This really belongs on a different board, but just wondering if you know what is mildly ER+.

The way I understood it Kay, percentage means the area of your tumor that responds to ER, and then there's the response rate which can be weak, moderate or strong.

There's  numerous studies to be found on the internet, I believe the one I used when looking at my data was Allred score (0-8).

Allred score = % Staining Score + Intensity Score

I am weakly positive for ER in only 30% of tumor, so my score is 3 (for 30% percent of area) + 1 (for intensity) = 4.

With your 70% (score of 5) even if it was only weakly stained, it's still 6 which is considered a high score, and hormonal therapy is very beneficial.

Here's a link for more reading: http://www.breastcancerupdate.com/bcu2003/4/dixon.htm

My pathology report is from the core biopsy because there was not residual cancer at the time of MX. My MO said he cannot do ONCO test because of this and because the Cancer was only 5mm. I am 100%ER positive node neg NEG PR and neg HER............ RX for tamoxifen no RADS no Chemo BMX.       any thoughts

I had a Oncotype score of 48!  That is one of the highest I had seen. 32% chance of recurrance.  I was really expecting a high score even though I had no node involvment.  My Ki67 on my pathology report was a 90% and the tumor was medullary IDC grade 3.  Very aggressive and rare and given my age of 40 all that is taken into account. I had already decided on Chemo, and just had my 2nd one yesterday,  but this just kind of confirmed my decision. When I was waiting for the results I was secretly  hoping for a really high score so I would not be in the grey area.