Low Oncotype score- Will Chemo give extra insurance?

I was a 17 and grade 2 and my tumor was a similar size.  I did the chemo but I also had angiolymphatic invasion present in my tumor.  That freaked me out.  One MO said no chemo.  The other one thought I could benefit from chemo.  I had to decide so I did the chemo.  It was a hard call but I also felt like you do - I wanted to know I did everything I could.  My son was only 4 when I was diagnosed and that factored into my decision too.  Good luck! 

I also had a score of 11, grade 2 tumor, 1.8 cm.  I was told that with my score, chemo would not be beneficial, in fact, the risks outweighed the benefits. I chose not to do chemo. I think my oncologist would have given me chemo if I had insisted, but I didn't. 

Mary

With a score of 11, with ER/PR+, a doctor who would give you chemo without any other risk factors would be doing his job poorly.
Chemo, even light chemo, can cause heart problems, leukemia, and side effects that never go away (I had a friend who did "chemo lite", and her hair never came back)
If you are premenopausal, chemo is more likely to be helpful, if you have positive nodes, ditto.
We have been taught by movies and TV shows that chemo is what cures BC and protects us from recurrence. Doctors have discovered that there are several types of tumors for which this is not true.
Your pathology is very similar to mine - I was told that hormonal therapy - tamoxifen or an AI - would be the most important factor in preventing recurrence. It may seem like "just a pill" but they do a powerful job of preventing issues for most women, for many years.
I know this is a very scary time; I also got a second opinion. Both docs refused to even consider chemo

@neugirl, you didn't say whether you had any positive nodes, or lymphovascular involvment. If you do, chemo might be advisable, but I don't know for sure and suggest you ask your oncologist. Otherwise, with such a low Oncotype score, Icandothis is right--the risks of chemo outweigh the benefits.

I had an 11 score as well. I was offered chemo by  all 3 Oncologists due to young age at onset and grade. 2 stated they'd feel comfy if I didnt' take it, one said he felt better since I was so young at diagnosis if I took it.  I chose not too due to the risk of complications with chemo.  I have to say though, I do look back and wonder if I made the correct choice.  I'm a bit of a worrier by nature.

So- given risks at that score normally out weigh benefit, you need to decide if you can move on and not questiong your choice.

I would have opted for Chemo if I even had a micro met in a lymph node or or if I had blood vessel invasion. Both of which I was clear of.

Good luck to you. Seek additional opinions from Oncologists if you're struggling with a decision.

My oncotype score was 25: exactly halfway between "don't need chemo" and "must have chemo". My oncologist was very good at explaining the arithmetic behind the risk factors. She showed me how much my chance of recurrence percentage was lowered by surgery, radiation, AI, and what additional benefit there would be to having chemo (I did have the chemo). As others have said, it is not just an equation of your risk of recurrence, but also of the chance of side effects that could be just as bad: not hair loss or yucky fingernails but heart damage or leukemia. At some point, the risk of life-threatening side effects outweighs the benefits of a reduced recurrence rate.

Count yourself lucky!

With the latest news coming out of San Antonio this week, you have many choices ahead of you that will probably keep breast cancer from returning.  Here's some great news, followed by some other important information about other choices you have:

http://www.sabcs.org/PressReleases/Documents/2012/9957ec3ea6c7a19b.pdf

Extending Duration of Adjuvant Tamoxifen Treatment to 10 Years Reduced Risk for Late Breast Cancer Recurrence, Improved Survival

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This is the latest newsworthy information coming out of the distinguished San Antonio Breast Cancer Symposium which was held this week.  Following this announcement, I listened to an interview with Larry Norton, MD from Memorial Sloan-Kettering discussing this important new finding.  While he mentioned that he and his colleagues have to scrutinize the study more carefully, he said that for most breast cancer patients this was "thrilling" news in the respect that he thinks endocrine therapy will eventually be used as a lifelong drug for prevention.  That said, I realize, as does he, that some women cannot tolerate endocrine therapy.  Likewise, it was also mentioned that when scrutinizing the data, it was important to look at how aggressive each patient's tumor was to see how much benefit was derived.

In Eric Topol, MD's terrific book, The Creative Destruction of Medicine, he describes a day where clinical trials of this magnitude will be unnecessary.  He describes clinical trials based solely on genomics that will be able to pinpoint whether a treatment is right for someone.   This study illustrates EXACTLY what he's describing.  When I looked at the press release, I wondered, how young were these patients in the study for them to be taking Tamoxifen for 10 years.  How many of them had chemo before taking the Tamoxifen?  What stage and grade were they?  What Dr. Topol argues in his book is that using genomics in the future might be an easier way to identify patients' uniqueness and then it might be easier to choose a treatment.

With the information you have, you have MANY choices.  You also don't mention whether or not you are pre or post menopausal.  If you are pre-menopausal, you might consider ovarian suppression rather than chemotherapy.  There are two trials underway looking at whether or not these treatments are beneficial.  The SOFT and TEXT trials.  Likewise, if you DO decide to do ovarian suppression and are close to menopause and are doing ovarian suppression, there is another study involving Zometa, a bone building drug that is also showing promising results at preventing recurrence.  Furthermore, diet and exercise are being studied carefully as well to measure how well they keep recurrences at bay.

You have MANY choices and an excellent prognosis!  Good luck!

I had a score of 14 and every dr in my area insisted that NO ONE would give me chemo.  It would not help and there is too much risk

Just pop a pill and you'll be ok.

Just for another opinion I went to Memorial Sloan Kettering, the number 2 cancer hospital in the country.  I saw the head of clinical oncology.  First of all, they don't see you unless they see your slides mammos, mris, first.  Other places just looked at the reports.

They found lymphovascular invasion and a micromet in one node.  I had been told I had neither,  She said I should have chemo.  She said that if I was in my 70's she might not think so but at 62 I could live another 30 years and that gives it time to come back.  Also, the tumor was over 2 cm.  That was the old cut off I think for chemo.

Also, she said the Ai's have only been in use for 6 years.  It takes decades to know what will really happen.  She suggested CMF, chemo lite, which she said has been studied forever and leaves no permanent side effects.  It would give me a 3% advantage over arrimidex alone.

I decided to do the chemo.  It was doable.  Not fun but not incapacitating.  I didn't even lose my hair!  But i can see why they try to avoid giving it.  I'm still not myself, 8 months out.

April 15 I went on arrimidex and at first it was fine.  But after a few months the pains became unbearable.  It also made me cry all of the time.  Terrible fatigue, depression.  It's not that easy to "pop a pill" sometimes.

So about 3 weeks ago I went off of the arrimidex.  The Sloan onco said I may be one of those who can't tolerate it.  She said "at least you had chemo".  But she never said the other drs were wrong not to suggest it.  She said they MAY have been right.  No one knows the "answer".  The whole thing is fraught with uncertainty and I think making the decisions were the hardest part of the journey.

Good luck.

Also, when I asked my surgeon why we didn't take off the other breast as well (I still wish I  had), she said that once it's invasive it could be anywhere in the body.  That knocked the wind right out of me but I can see how it is true.  My mother had a radical mastectomy when she was 61.  Clean nodes.  It came back in her lungs when she was 80.  She'd had no chemo and they didn't have AI's then.

The thing that bothered me about the chemo...it means you are off of AIs for the time you are on chemo.  I've asked a couple of drs and they say it's ok, it doesn't up recurrence.  But Ihave a hard time understanding that.  If estrogen is the "food" for the cancer, wouldn't it be bad to allow all of that estrogen to circulate for months after surgery? 

Thanks for that great article voracious.

I was told that if I did nothing I had an 85% of no recurrence.

The AI's raised it to about 92%.  Chemo, maybe, 95%.

The Sloan dr said "It's only 3 % but but if you are one of the 3% it's a lot".  I agree!  I don't understand ignoring a benefit if there is one.

I hope I'm wrong but my cynical mind goes to cost.   There is tremendous pressure on drs to hold down costs. And with Obamacare around the corner, I think it will get much, much worse. And we won't have the same choices.  The government will have the power to decide since they will be footing the bill.

Chemo is very expensive.  Each infusion cost over $3000. Eliminating chemo could be a huge money saver and it seems that's the priority now days, not lives.  I think each life is priceless.

http://www.atlantamagazine.com/features/2012/02/01/dr-otis-brawley

Here's another great article about him and his ideas.  Included in this article is this terrific quote which is also in his book:

"But don’t some people believe that all this money buys us the best healthcare in the world? When we look at outcomes, such as life expectancy, we rank fiftieth. We have very high infant mortality rates. Even if you look at white male life expectancy in the U.S., it’s lower than places like Canada, whose healthcare system we criticize. We have tremendously more CT and MRI scanners than Canada per capita. People in the United States may not live longer than people in Canada, but we sure as hell do a better job taking pictures of them. We do not get what we pay for out of our healthcare system."

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Again, I want to come back to Dr. Topol's book.  He believes healthcare CAN become affordable, once the revolution occurs. Obamacare does NOT address the rapid changes in medicine that are beginning to occur.  However, it won't be until we look in the rear-view mirrow, that we will be able to say EXACTLY when the revolution began.  Genomics and technology SHOULD drive down the cost of medicine and improve mortality.  Individualized medicine based on genomics and technology will take the guess work out of treatment protocols....AND SAVE LIVES.

http://www.amazon.com/Creative-Destruction-Medicine-Digital-Revolution/dp/0465025501

Interesting.  A 12 for me from Onctotype.  Was told an 8% risk without Chemo and 4% with it.  I can live with a single-digit risk so no need to subject myself to any Chemo.  Was 51 when dx'd.

next Wed am having blood drawn for the Brca testing.  will learn if I made a poor decision.  three consecutive generations of breast/ovarian cancer (me, breast; mom, breast; her aunt, ovarian (died from it).  turns out that one of the aunt's brothers died of pancreas cancer and his daughter is on Arimidex but she's not yet with full-on breast cancer.  this is all from my mother's father's family