Another Oncotype question

According to the 2012 NCCN breast cancer treatment guidelines, page 17 of the professionals' version (not patients' version), the Oncotype DX test should be considered for ER + tumors that measure greater than 0.5cm. The guidelines DO NOT distinguish grade when considering the test. Considering that the guidelines constitute the accepted standard of care, I do not believe that Mass General would single out grade 1 tumors and not recommend testing them. If your tumor is smaller than 0.5 cm then regardless of grade, the NCCN guidelines suggest NOT considering the test. Furthermore, the NCCN guidelines recommend that if your tumor IS greater than 0.5 cm and you DON'T have the Oncotype DX test, they say you should do endocrine therapy +\- adjuvant chemotherapy (Catagory 1level of evidence).

Bangotti. ER/PR scores are just part of the complicated equation that goes into determining the Oncotype DX score. It would be nice if it was that simple, but it isn't. There have been a number of sisters that were highly ER + that came back with high Oncotype scores. The good news for you is because you are highly ER+, if you choose endocrine therapy, you should get the most benefit.

Purple... I was Stage 1 and Grade 1 and the Oncotype DX test was suggested to confirm that I would not benefit from chemo. Interestingly, with my type of tumor, mucinous, the Oncotype DX test isn't recommended in the current NCCN guidelines.



All I am saying is according to the NCCN Guidelines, there is NO MENTION of grade when making the recommendation for the Oncotype DX test and I find it hard to believe that Mass General has an ABSOLUTE rule that would contridict the NCCN guidelines. And if your tumor was 8 mm then you qualify for the test according to the NCCN guidelines. Furthermore, it is believed that the Oncotype DX test trumps grade because grade can be subjective.

voracious

I dont know why there are guidelines that are ignored...yes, I AM very annoyed. I WANT the testing!
es, I *have* checked with the team!  I didnt even know aboit any of this until this forum.  When I saw people's stats, I started to question it. First, I questioned my BS who said she does not do the test on ppl with my stats because chemo is not indicated with my known stats . Then,  I asked the MO and she said it did not matter and she does not need to quantify ER  PR %. I also asked the RO----no!  FInally, I calkled again just FRI and got an assistant ( one of the DRs was on vaca) who *finally* agreed to order the ki-67 (only) though she actually said they normally dont do that in cases such as mine and therefore my ins. probably wont pay!  ( Wonder how she is coding that bill)

I do not have DCIS.  Bonafide IDC ., I do not understand either, but I do know what I have been told by all of them.

 I have also called Genomics... at this point, if we are going to belabor the issue , I think PM might be best.  I have told you all that I can. I can assure you it is factual. I have checked and double checked.

Thx .

Purple....One more thing about the importance of the OncotypeDX test....Depending on the score, even if it's in the low recurrence category, there are still treatment decisions, besides chemo that need to be made.  Because I was still premenopausal at diagnosis, I decided on doing ovarian suppression because of my score.  Had my score been much lower, I might not have done it.  Furthermore, if you are post menopausal at diagnosis, and are older than 40, you might have a discussion with your MO about doing Zometa.  So, IMHO, the score is VERY important because it can help you decide how aggressive you might want to be....OR UNaggressive.  Your doctors assuming your score would be low seems out of step with current practice.....

Like I tomed earlier, I discussed the Oncotype testing with MO and to my surprise he ordered it without a fuss despite the fact that I do not fit the guidelines having two

0.2 mm tumors. Guidelines are just that and not law. Each physician or system can make their own judgements and decisions about testing. Obviously, Mass general has a policy not to order testing in cases like Purple's. But policies can be changed, so I also encourage you to push for it. I got a call from genomics a few days after MO ordered test stating that insurance would cover test and did I want to go ahead with it? The MO ordered it on condition of my final approval, giving me the choice to have it or not after knowing insurance status. I am one of those cases, as voracious stated above, where my score will help me make other treatment decisions besides chemo. Good luck, Purple.

The first time I met with my MO, she said no Oncotype test. Because of my 99% positive ER score (70% PR), I guess. At the time, my tumor was measured at 2.3 cm. 

After surgery it was at 2.5 cm with the highest mitotic score. Don't know if it grew. The surgeon offered to order the Oncotype test.

It came back at 25, right in the middle.  I see my MO next week. Guess I will have some decisions to make. 

None of this is easy, is it? I thought MX without recon would be pretty easy to recover from, but that has not been the case. I'm pretty terrified of chemo because of my history of problems with meds, and again the HT. But I know I'm going to need to give those a good shot.

I'm Stage 1 and Grade 1 with 95%ER and 80% PR, but the Oncotype came out as 26. I meet with the oncologist on Wed.

ER+ bit had an oncotype score of 47. I had already had chemo (oncotype was done a year later) because of my age but if I had it done beforehand, I probably would have pushed for a more aggressive chemo or have gone with a mastectomy.

lisa, I was mentioning the hormone therapy for menopause like Premarin,I finally got the copy/paste to work and think I stuck part of the article on Exchange City thread.

Hello everyone,

Just joined this forum today although I have visited it a few times a week since my dx last December. I appreciate everyone's candidacy and openness. My oncologist never discussed onco type with me just that I was stage 11 grade 1 and multi focal so he was glad I decided a mast over lumpectomy. Completed chemo and looking towards Rads but since I'm still learning more about the onco score, I'm hoping to avoid it. If in fact one wasn't preformed on my tumors (2), is it too late to get one done? Thanks for any help around this...

Raych

HI Raychld, If you already had chemo it would not make sense to have the Onco tpe done.  The purpose is to see if your tumor type benefits from chemo.  Since you've had it, it makes the cost and expense a moot point. 

Good luck and I hope the rest of your treatment goes smoothly.

HI Raych, I'm sorry you're so upset.  I was diagnosed at 43, now 45. So a bit older than you, but still young for this darned disease. 

What are your Oncologists recommending. ?  I honestlly have never heard of Oncotype being used for radiation determination.  That is not what its for as I understand.  You can also go to cancermath.com and see your recurrence with your cancer type, or adjudavanton line. just sign up like you're a doctor.

My dear friend had 9 lymph nodes involved, major disease with 6cm tumor. She had a mastectomy , chemo and then  had a CAT scan to determine if Rads was necessary. onco told her she didnt need it. Could you talk to your Onco about that idea?

@RaychID, you might ask your doctor about looking at the Adjuvant!online website with you. I only got a very quick glimpse at it during my last appointment with my oncologist, but I think it might be helpul for you as you decide about your further treatment. As I understand it, the site uses data from research to give an estimate of recurrence probability based on your tumor characteristics like size, hormone receptors etc, and can also take into account what treatments you have received and what additional benefit (if any) you could expect from adding RT to the treatments you've already had.

lisa2012,  

A lot of people find the Oncotype ER and PR scores confusing when compared with the IHC %.  One problem is that the Oncotype doesn't use %, but different ranges of numbers.  Even more confusing is that these aren't even the same amongst the ER, PR and HER2 scores.  Then they add whether the score is in a positive or negative range.  A negative in the Oncotype range doesn't mean you have 0% ER, it means that your ER is low enough that Tamoxifen may not be as effective as on tumors with higher scores.  So it is a "negative" on your overall Oncotype score making that higher than if your ER had fallen in the "positive" range.  This all gets more confusing when a HER2 score of "positive" causes a higher Oncotype score overall than if it had fallen into a "negative" range.  These numbers and more all plug into a formula to get your overall score.

One way to visualize this is to stretch out the ER chart from 0 - 12.5.  Look at where the arrow falls for your score.  Is it at about the 30% point?  When I do this for my ER, PR and HER2, my ER seems lower, my PR and HER2 higher than my pathology reports, but not enough of a difference to effect what my treatment was or needs to be.  And that's really the point of all this, right?  Giving you and your team the information to make the right treatment choices?  

The problem with those of us on AIs, is that the Oncotype takes into account Tamoxifen, not AIs.  Also CMF, not TC, ACT, and other stronger chemos.  There are some plums to pluots comparisons here, not quite apples to oranges.