Multi-centric question

I had three tumors in different quadrants, and each were tested for ER, PR and HER2. Only the largest was tested for the Oncotype because all the tumors were histologically similar. I have heard of other women having two separate tumors tested using the Oncotype and resulted in different numbers. I don't know if hers were histologically similar however.

Tammy, I had 4 lesions taken in two separate surgeries in 2008.   All were tested, except the smallest one, which was too small (1mm) to test for Her2.  What was interesting to me is that mine were a mix of IDC, ILC and Tubular.  Also, the ER/PR varied quite a bit in them, which seemed odd, but the Her2 was consistently negative in the ones that were tested.  Do you know if all of your 5 lesions were all the same type of bc?    

I never had the Oncotype-DX because it wasn't commonly done for node positive bc back in 2008, and my insurance company didn't authorize it at the time.      Deanna

grejulian... Was your DCIS diagnosed from the mammo only?  Have you had a biopsy?  I'm not sure how any surgeon can say that you have only DCIS without excising the area to be sure.  The reason I say that is, it's not uncommon for a tiny bit of invasive bc to be found within an area of DCIS, which is a non-invasive form of bc.  And anything smaller than about .5 cm may not show up on imaging -- even on MRI.  (I had a 4th, 1mm spot that didn't.)

Pure DCIS does not travel, so would not be in your lymph node(s).  That part of what you've been told is correct.  What I don't quite get is how your surgeon can be 100% sure your dx is 100% DCIS.

My best advice would be to get a second opinion, preferably from a breast-only surgeon.  You can find that type of specialist at these NCI-designated medical centers:  http://cancercenters.cancer.gov/cancer_centers/map-cancer-centers.html   Unfortunately, general surgeons (the type of surgeon many women are initially sent to) may not be quite a thorough in his/her assessment.  Don't be afraid to follow your gut instinct and seek a definitive explanation for the swollen nodes.      

Please keep us posted on what you find out.    Deanna 

I had a BMX for IDC in the left breast, and an inconclusive MRI finding on the right. It turned out to be ILC on the right. Both tumors were oncotyped, as well as having ER/PR/HER2 testing (done as part of the oncotype testing). The smaller tumor on the right was actually the higher oncotype score which necessitated chemo. Glad I trusted my intuition and not the doc's initial recommendation to do only a left lumpectomy.

I just had a call from the onco, who was at a tumor board discussion of my case. I had ILC, 2 tumors 1.6 and 2 smaller. My oncoscore was 8. But with the size of the tumors, and my age (at 65 too young to say AI only, and too old to say chemo for sure), they decided to oncotype the 2nd tumor. If same low score, no chemo.

 Seems that all large tumors should be tested, not just one. How did they choose the one? Of course I'm  hoping the 2nd tumor is consistent. I think the path on the tumors right after surgery showed all to be low mitosis. Not positive if all the tumors were tested, though. Is that usual? I may have to call my BS for that.

All of my tumors tested ER/PR + and HER 2 negative

primary tumor was grade 3 and 2.5 cm - Ki 67 - -65% @ 2 o'clock

secondary tumor was grade 2 - 12 mm ki 67 - 40% also @ 2 o'clock

third tumor was grade 1 - 7 mm ki 67 40% at 8 o'clock

I believe all the tumors were tested on path, but the oncotyping was only on one. I'm still waiting for the 2nd oncoscore. Fingers crossed it is also low.

My insurance is paying for the 2nd test or the oncotype company is working it out somehow. A rep of the company was at the tumor board discussion, and according to my MO said they would work things out. Also, when it is questionable about chemo, seems more cost efficient for insurance to pay for the 2nd oncotyping, and save on chemo therapy if that is the best course for the patient. Chemo is much more costly than the $4000 oncotype test.

Lisa-e, what did you do about chemo with one low score and one intermediate?  My MO recommended chemo even with the one low score (8) but I had a node involved and am at an "intermediate" age (65).

ILC does tend to be more similar, I think. All had same ER, grade, etc. 

Wow, Lisa-e, we had the same scores. My second oncoscore came back 16, recurrence 10. My first tumor was 8 recurrence 6. MO concerned (since I had one positive node and 16 is toward top of low range) but recommended no chemo...she knew I was leaning in that direction. So onto to the AI again.

 Insurance did pay for both, even with the mistake of a wrong sample being sent.  Makes financial sense on their part, as chemo is so much more expensive.

My two larger tumors were hormone tested after my two biopsies. There should be path results of each of your tumors, even if you didn't have more than one oncotype test done, I would think.

 But if you had one ER/PR plus tumor, my understanding is you will be treated as ER+ even if the other tumors were not....which I believe is rare but happens.

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Mary, I just found out today that my right side had two entirely separate and unrelated invasive cancers, although my IDC was just 3 microinvasive foci. I had IDC, ILC, DCIS, and LCIS in the right breast, two different quadrants. I haven't met with MO yet, but my margins were clear and I expect no rads and no chemo. My ILC was found with core needle biopsy and I don't know what what the "architecture" of it was. For my DCIS, my path report says, "cribriform and micropapillary," with "central, expansive comedonecrosis." My dad's mom died at 49 of a breast cancer that apparently took over ten years to kill her, from the time she first noticed it. As far as I know she went without treatment until way too late and died in the early 1950s. I'm in my early 40s and still curious if my odd mix of results is linked to my grandma that I never met. (My dad had no sisters and his brother has one daughter who has had no bc so far).



I'm BRCA negative and waiting on breastnext results from Ambry genetics. I'll be surprised if I get a positive result. Based on my pathology I'm glad I had a bmx.

One of my tumors was ER/PR+ and HER2- and the other was ER/PR- and HER2+ - go figure...