Oncotype DX testing

bethoul- Good for you for advocating for yourself!  I am probably missing something but I don't understand why the  HMO would disapprove.    Looks like you will decide to omit chemo on the recommendation of a 2nd consult - this will cost the HMO less money.  Hormone therapy and radiation therapy are standard of care.  (If you still feel uncertain you can always get a 3rd opinion - but I would again go to a major cancer center - big research/teaching hospital.)  (My own story is that the first surgeon I saw did not order an MRI and scheduled me for a lumpectomy.  A 2nd opionion ordered the MRI and found that I had multifocal bc - surgery was changed from a lumpectomy to a mastectomy.) 

Little Melons, I live in Ontario too. Government will pay for test for Node Negative Estrogen Poitive early stage cancer.  No proven studies for node positive early bc.  Adjuvant online - which our cancer centres all use had suggested that I had a 49% chance of recurrence based on my age at dx (46) tumour size, grade.  Tamox would take to 35%. +Chemo to 13%.  So it looked like chemo would be worth it because I was young.  My MO said would do test to be comfortable with decision and because I was eligible for OHIP to pay - had to fill out a request form ($4500 test in Canada as send tissue to California) plus authorization for test.  I think in the long run OHIP is hoping that they can weed out those that don't need to do chemo so they can save money!  Our tax dollars at work. We also spent a long time discussing data & studies this test is based on - so I was comfortable with that as well.

Onco DX score came back 18 - CI of Recurrence in 10 years of 11% with 5 years of tamoxifen.  I was highly ER+ so tamox should be highly effective.  Only 2% benefit to doing chemo.  Not worth the risk of short and long term SE of chemo.

So doing my rads (16+boosts instead of 25+boosts as indicated by McMaster study of same long term benefits)  same dose overall, just over a shorter time.  My RO was part of this study - must have gone to school there.  And working through my 5 years of Tamox as I must comply to get benefit of not doing chemo.

From my personal experience it was worth having all the info I could to make the best decision for me.

My understanding was that mets automatically make you stage IV, so no chemo not even a discussion (was checked-I was clean).  Also, as they are just doing study on validity of Onco DX results for node positive that it would not overrule adjuvant in deciding chemo.

Only posting all this info so that people can see it is a very complicated process to make the right treatment decisions for you.  Keep asking until you get all the answers you need to make you comfortable.  Doctors should tell you about all tests, even if they know that they are not relavent based on you dx.  At least you will understand their decision making.

Hi Everyone,

I received my Onco score today 14 - Happy, but concerned...

I have two Oncologists still...Prior to knowing my score One Oncologist has said if low, no chemo - but Tamoxifen and Ovarian Suppression...Other Oncologist is recommending Chemo and Tamoxifen even if low (due to my age 39 and Lymphovascular invasion)...14 is close to 18 as I told my Cancer Surgeon who was clear on saying no Chemo...

Another thing which concerns me is the wording on the Onco Results..."The findings summarized in the Clinical Experience sections of this report are applicable to the patient populations defined in each section. It is unknown whether the findings apply to patients outside these crtieria."

Below the above statement I just typed it says..."This study included post-menopausal female patients with Node Positive, Hormone Receptor (HR)-Positive Breast Cancer."

I am NOT Post-menupausal - So, I called Genomic Health and the response to my question of whehter this test is now Null & Void for me was -  no it's not null and void and the results do apply

Then WHY is the wording on such on the results...

I questioned this test at the beginning to as it was originally intended for node-negative...My Cancer surgeon assured me it is now done for both...

My results have two parts, one result w/ node negative and the other showing node-positvie  

What to do to have piece of mind???

On the up side - I was cleared to go back to exercising. So, today, exactly one month after surgery I'm back running! Wahoo!!  Ran 2.05 miles today 

Hi Bonnie- I hope this helps...my Oncotype score was 16. My MO was on the fence with recommending chemo for me because I didn't fit into any "box". My tumor was on on the larger side (typical for ILC, it forms more of a "line" than a "lump), but I had no nodal involvement and no vascular invasion. Healed from BMX very well and quickly. We decided to go ahead with 4 tx of TC, because of my "young age" (43) and because my MO said the Oncotype score is just one of the tools that should be considered. It was a tough decision, but I'm glad I made it. It definitely helped that my MO is female, young (about 37-38 ish) and is considered brilliant. She went into BC oncology because her Mom had breast cancer 16 years ago.

I also have 3 young children (7,9,16) and I'm determined to do everything aggressively to be here to see them grow up. If I was 65-75 with my "scorecard' I probably would not hesitate, and would turn down the chemo with an Oncotype score of 16 with no nodal involvement and no vascular invasion.

little melons- yeah I was glad OHIP has paid since late 2010, although had to fill out requisition to get them to authorize.  Glad to have as much info as possible.  I think some people in the states get the 16 vs 25 (call it the canadian protocol) but more common in Canada as the study was done at McMaster in Hamilton.  There is a reference to it on this site.  I am at RS Mclaughlin Cancer Centre in Oshawa.  Very busy - hard to believe all the people there (some from 2-3 hours away) all used to go the the centres in TO.  Thank God I don't have to battle that traffic every day.  As fatigue setting in I probably would have stayed with my sister there, instead of the drive.

doxie:  Saw MO again and discussed Oncotype DX report.  Oncotype score 27 (high intermediate); estrogen positive, progesterone negative (original pathology was positive) and HER2 neg.  Surgeon agreed with MO and will be starting CMF chemo (hopefully milder) on Tuesday.  Thank you again for your response. 

My Oncotype score is 3!!! For some reason I am thinking they somehow made a mistake and that it can't possibly be that low!!!!!!

Druanne-Mine was 4. I just wanted it to come back either high or low. I told myself that if it was intermediate I would have done chemo. Grade 1 tumors tend to have lower scores, but there is always a chance that it wouldn't.

bgirl that is quite possible! I will hear the entire results during the next appt with my onc Will ask about the ER+ levels having anything to do with it

coraleliz I was thinking the same thing.......high or low.......however.....my onc said she wouldn't recommend chemo for me even with an intermediate score......it is so interesting how everyone's treatment recommendations are so different.......and every doctor has different opinons.......

Druanne, hope you get enough info to make you comfortable with you decision.

There are a lot of factors, I think.  My MO said if i was 22 he would still have tried to talk me out of chemo.  At 25-26 he would have gone ahead even if cutoff 31.  Mostly because of my age  If I was in my 60s or 70s he wouldn`t.  Also the big trial on this test comes out in a couple of years, in it they used the cut off of 26 (lower threshold to make sure trial participants were not at undue risk).

Just got my oncotype score today of 34 and will have to have 4 rounds of chemo.  I had an LX on 4/25 with clear margins, no complications, no nodal involvement, and was feeling sure that I wasn't going to need chemo.  I am having to digest all of this, and my family members are bummed. 

My prev DX from my initial biopsy said my PR+, but now the oncotype score says it is PR-.  My Dr. said that we give more weight to the oncotype test, and I'm wondering what, if any effect the PR- plays in all of this.  She said that the main thing is the ER+ (High) in that it will respond to the tamoxofin.  Anyone know about this?