Do you know you have a choice? Radiation? and more?

Wow, a lot of good information. Your diagnosis is similar to mine (IDC, stage 1b, micromets in one node, ER+, PR+, HER2-, lumpectomy). You're brave to forego radiation. I've chosen to have it, and I'm currently on the fence about chemo. I'm waiting for the OncotypeDX results to see if that sways me one way or the other.

Keep in mind that the cutoffs for the categories "low risk", "intermediate risk", and "high risk" for Oncotype DX scores are arbitrary. 

The relationship between Oncotype DX score and risk of distant recurrence is actually continuous.  (See this page from Genomic Health for details:  http://www.oncotypedx.com/en-US/Breast/ManagedCareOrgs/OncotypeOverview.aspx).

Although a score of "17" is classified "low risk" and a score of "18" falls in the "intermediate-risk" category, the actual recurrence risks with those scores are almost exactly the same. According to the Genomic Health website (http://www.oncotypedx.com/en-US/Breast/HealthcareProfessional/ReadingReports.aspx), a score of 17 represents a recurrence risk of 11%; a score of 18 represents a recurrence risk of ... 11%! (mathematically identical); a score of 19 is associated with a 12% risk; etc. On the other hand, even though "18" and "30" are both in the "intermediate-risk" category, the risk of recurrence with a score of 18 is 11%, while the risk with a score of 30 is nearly twice as high (20%).

IMHO, we should be looking at the actual numbers, not just whether or not our scores fall into the "low", "intermediate", or "high" risk categories.  I think everybody here already knows that, but just in case...  I'm all for making choices, but, let's be sure our decisions are based on the best available information, right?

otter

Yes, and also note the hormonal therapy cuts risk in half.  So, in my case, I can count on my 8% distant met recurrence being 16% without hormonals. 

It's one person's opinion based on my research, but the numbers seriously substantiate the benefit of radiation in Stage 1+ cancer.  Its side effects, including causing other cancers, is so much lower than the protection it offers.  Also, the studies also seem to indicate it has a role in preventing distant recurrence as well.  Can't find the source on that at the moment, but I did read it in my information journey.

Also please understand that distant recurrence means Stage IV palliative care.  That is how my oncologist put it.  An 11% chance of becoming Stage IV is nothing to sneeze at.  The medical community is racing to try and figure out how to be less scattershot in treatment, but bottom line, it's about staying away from Stage IV!

Miles2Go, I really appreciate having the opportunity to discuss this.  I do not intend to be combative!

I've just been diagnosed IDC grade 1 stage 1, small 5mm, no results yet on HR & HER info.  Dr. recommended lumpectomy and possible radiation.  Chemo was not mentioned, but I won't do that, and I have reservations about radiation.  I am over 70 and read that it is not necessary with my size tumor which is about size of a pea.  Hopefully no node involvement since it was caught early.

Miles2Go understands what we're saying -- at least, I hope she does.  IMHO, she's just arguing semantics. 

It's commonplace here on the BCO Boards to refer to tamoxifen (a "selective estrogen receptor blocker") and the aromatase inhibitors (inhibitors of the enzyme "aromatase", which converts androgens to estrogens) as "hormonal therapy".  Even the editors and writers of the BCO educational pages use the term "hormonal therapy" -- e.g., "Hormonal Therapy," under "Treatment and Side Effects" (http://www.breastcancer.org/treatment/hormonal/).

It is literally true that tamoxifen and the AI's are not "hormones"; in fact, they fool the body into thinking there is little or no estrogen present, or they actually deplete the estrogen.  So it is technically accurate to call them "anti-hormonal" therapy, leaving the term "hormonal therapy" for those treatments that actually involve administration of hormones (e.g., "estrogen-replacement therapy" or "hormone-replacement therapy").  But that isn't how the terms are generally used in breast cancer treatment.

As for the source of elimar's statement about the Oncotype DX score "assuming" tamoxifen or AI therapy... that isn't elimar's assumption -- it's one of the the assumptions on which the predictive ability of the Oncotype DX test is based.  The actual source of the information is the published clinical trials in which the Oncotype DX test was developed.  The women in those studies all got 5 years of tamoxifen; so the ability of the Oncotype DX test to predict recurrence risk assumes 5 years of estrogen-blocking therapy as a part of the treatment plan.  Here's a statement from Genomic Health's "Patient/Caregiver" page ( http://www.oncotypedx.com/en-US/Breast/PatientCaregiver/OncoOverview.aspx) that points out the assumption:

"The Oncotype DX test looks at a group of 21 genes within a woman’s tumor sample—16 cancer genes and 5 control genes—to see how they are expressed, or how active they are. The results of the test are reported as a quantitative Recurrence Score® result, which is a score between 0 and 100 that correlates with the likelihood of a woman’s chances of having her cancer return, and the likelihood that she will benefit from adding chemotherapy to her hormonal therapy."

The percentages for recurrence risk can also be found on the Genomic Health website, in the "Healthcare Professionals" section.  I haven't read back all the way, but I couldn't find a statement in this thread in which elimar used the phrase, "disease-free survival (DFS)" in reference to the Oncotype DX test.  The Oncotype DX test predicts the "10-year risk of distant recurrence" ... that is, the likelihood of development of metastatic breast cancer ( = "distant recurrence") some time in the 10 years after the definitive surgery.

I hope this helps.

otter

If we are talking semantics I will second Otter's outstanding post, Tamoxifen is not an "anti-hormonal".  It is a hormone modulator.  This is why "hormone therapy" is used as catch-all phrasing for Tamoxifen and the AIs.  There is a huge amount of misperception about how these drugs work and their relationship to one another.  I still find Tamoxifen baffling (and I believe the research indicates scientists aren't entirely sure of all its mechanisms!)

Sometimes, it's about how things are stated.

Joycek, your statement: Went back to my Onco and she told me that for every 100 women she puts on Arimidex (with my diagnosis) it will only help 1  !!!!!!!!!!!!

What I think your doctor is saying is that by Cancermath guidelines, for instance, you have about a 1.5% chance of 15 yr distant recurrence.  So, yes, about 1 in 100 would be helped by additional treatment.

It is true, each person has to make choices, and they are tough.  I am a believer in research, people can do a whole lot between Cancermath, Oncotype, and reading studies.  The studies can be maddening.  I found some arguments against radiation in overall survival, but at the end of the day, the overwhelming evidence was that radiation is a highly effective tool in the BC arsenal.j

I guess what I'm saying is, I believe in intelligent choices based on research.

I had heard that the Oncotype test was unreliable, so - when my MO recommended the "works" - I agreed to aggressive treatment.  No hesitation.

What was your Oncotype DX result? I am currently waiting for my result. 4 weeks! It seems like a year! If it comes back in the middle range I'm not sure what to choose. Any others in the same boat of which way to go?