Low Oncotype score- Will Chemo give extra insurance?

I wish I could insert a utube of a talk that the head of Memorial Sloan Kettering gave.

How do we define "overtreatment"?  that is the question.

His philosophy was that treating 100% to save 3% is worth it.  As a public health measure

multiply that 3% by hundreds of thousands and you are saving a lot of lives.  

I think saving one life is worth it.  If it works.  I realize the bad effects have to be weighed against the good but I don't think the cost should be weighed against the good.

Every drug, every treatment has a physical price to pay.  Unfortunately.

His statement is sooo misleading!  Our life expectancy as a country is not as high as others but that is not the statistic we should look at.  We should look at life expectancy for people with various diseases!

Our life expectancy is the best in the world for cancer.  That is the true measure.

Simply put, overtreatment is defined as unnecessary invasive treatment that DOES NOT show any demonstrable benefit to the patient and may in fact do harm.



Timbuktu... What you are confusing is the cost of treatment compared to the number of patients needed to treat to see a measurable effect. These are TWO different topics. One measures a treatment against a person while the other measures a treatment for a group.

With all due respect to the posters I really love, blanket statements like "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." can be potentially dangerous.

Age and tumor grade are huge prognostic factors.  University of Chicago, one of the leading SPORES research hubs on breast cancer reported with my 12 Oncotype that given my age (39) and grade (3), they simply didn't know the correct protocol.  So much more research is needed.  Women diagnosed under 40 are sometimes referred to as having a different disease.

My best advice is to get three, not two consultations/opinions.  You have one shot at getting the most information you can up front.  In my case, I got "yes", "no" and "maybe".  I went with the doctor who was as passionate about my treatment as I was about getting back to my life.

Your doctor can provide you statistical analysis on the addition of chemo.  Ask your doctor to provide additional information on studies about age as a separate prognostic factor if you are in the 40 yrs old range or under.

I don't know how to insert links but I just looked up "world breast cancer survival rates" and the US DOES have the best survival rate in the world.  83.9% for five year survival.  Survival is tied to expenditure so I would assume that the emphasis on saving money will be at the expense of lives.   Dying is cheap.  Quick treatment is one of the variables, which will most likely go out the window with Obamacare.  It was a BBC article.

Wow, I have gotten some extremely expensive treatment, the works in fact, yet have not had chemo due to my low Oncotype score. I see my surgeon every 6 months, at which time I have either a diagnositic mammo on my bc side, or a diagnostic and regular mammo on my good side. I see my MO every 3 months. At those times she takes blood for numerous things, including tumor markers, and I get an infusion of Zometa. Once a year I get a body CT. I would have gotten chemo in a New York minute if the 3 MOs I talked with had thought it would benefit me. This is despite having 2 nodes with micromets. I absolutely do NOT feel like cost was a consideration. Our insurance company has been awesome, paying the vast majority of all bills. I have had reconstruction for a lumpectomy, with resizing and lifting of the other breast. Since this is the most recent bill, it's in my memory. We were charged $25.00 for the surgery. I see zero evidence of a conspiracy to deny people with cancer treatment to cut costs. Of course I'm just one example but my experience has been I get whatever I need, no problem.

I have been an avid lurker since early October. I think just to unsure and overwhelmed to weigh in on any thing. This topic speaks to exactly where I am at currently. I have a second appointment with my mo (it still sounds so weird to say my mo) on Tuesday when my oncotype results will be discussed. I went in to my first post surgery appointment 99% sure that I was going to refuse chemo if it was suggested. I was trying to keep an open mind because I am really not interested in dying from BC anytime soon. After exhaustive study on mucinous type IDC, which says early stage node free BC typically does not call for chemo, I was still willing to listen to my MOs opinion. Truthfully I was hoping he would not recommend. Well he showed me adjunct online statistics, and said that he would be much more comfortable if I followed a TC 4x course. The adjunct online did not take into consideration the mucinious type and the low proliferation numbers Ki67 8%. Mitotic grade 1. The upshot of the conversation was that MO would order oncotype. He was clear that he understood my concerns of over treatment and quality of life versus long term SEs but that he was hoping that if the oncotype results were in the inconclusive range that I would go ahead with chemo. My questions...what exactly is chemo light? Does anyone else have my same tumor situation? If so what did you decide?

I have read your posts on several topics voracious reader, I have been having difficulty with the pure aspect of mucinous. I will head back to that topic. Thanks

I really count on VoraciousReader to help parse things for this weary brain, but wanted to say that if I understood the San Antonio reports (another thread), Dr. Wolf says the Oncotype should be part of a comprehensive evaluation, not a solitary determination separate from all prognostic factors.

Hi there



My largest tumor (2cm), was oncotype 11. And yes we are in that fuzzy zone which is what the clinical trial is all about. However my docs are recommending chemo because I had a positive lymph and 4 lump (invasive ductal carc) in one breast and in situ dc in the other. I am also grade two. I am getting 4 cycles of TC just in case and also probably radiation. So I guess some docs are more aggressive than others. You might want a second opinion.

@Yawls, as Timbuktoo mentioned, CMF is sometimes called "chemo lite". My tumor was a similar size and grade to yours, but not of mucinous type. I'm not sure how much difference the mucinous type will make in treatment. Also, you didn't mention your age, and that can make a significant difference in what treatment you will be advised to take. I had a 1-mm micromet in one sentinel node, and scored 28 on Oncotype, so I decided in favor of chemo. My oncologist originally suggested TC to me, but after finding out here at bco that taxotere can cause permanent hair loss in some cases, I asked what my other chemo options were, and after hearing them, decided to do CMF, which for me is 6 months of daily Cytoxan pills plus weekly infusions of the methotrexate and 5-FU and down to my last five treatments. I think this is a different "recipe" (dosage and timing) of CMF than Timbuktoo is getting.

I also have had hair thinning, not complete hair loss as is typical of many other types of chemo. As I recall, one of the three medications can cause cancer, but not leukemia, a different kind, but this happens in less than 1% of patients treated with that med.

There is a huge thread here at bco about CMF chemo, which you may not have seen because it isn't in the chemo forum. You can check it out here.

Curveball... Us mucinous gals, along with our tubular sisters, have our own NCCN guidelines which is separate and distinct from traditional IDC-NOS BC treatment guidelines.

Though not a doctor, I would like to challenge some assumptions about tumor grade.  Part of the point of the Oncotype is there are subsets.  While it is less likely a high grade will yield a low Oncotype, and a low grade would yield a high one, I am here to tell you that in my posse of chemo gals at my clinic we all broke "the rules".  The two grade 1 patients had high Oncotype scores, and my grade 3 was low.  I believe part of the point of Oncotype is there are different subsets within the tumor grades, and they are not all alike.  If tumor grade were where it's at, there's not too much point to Oncotype, they would just tell all the 1s to forget it, and the 3s to sign up for the chemo chair.

Also, Bevin got the same advice I did, apparently.  Studies indicate chemo is more effective for early stage patients 40 and under.  More studies are needed to understand why.

The truth is, we are asking a lot of solid smart questions for which they simply don't have answers.  I figure if University of Chicago and one of the most famous breast cancer docs in the country (a MacArthur Fellow!!) can't give it to me straight, there's just a lot more study to be done.

Also, found my old notes going to the oncologist the other day.  My third opinion at U Chicago told me 20% approximately of ER/PR+ tumors do not respond to hormonal treatment.  This is also why in the presence of other risk factors, chemo may be warranted.

I'm not saying run for chemo, but there are many, many sides to this discussion, and I find age is rarely a discussion point on these boards still.

I'm just guessing, but I wonder if all the relapses that happen years after original diagnosis are really relapses. Is it even possible to tell a relapse from a new primary if the hormone & HER2 status are the same?

Also, if normal cells become cancer cells as the result of mutations, isn't it possible that an additional mutation would turn a quiescent cancer cell that is being suppressed by hormone therapy into an aggressive cancer cell that is resitant?