In your 40's with low Oncotype score, what was your decision?

I am quite convinced cancer treatments can affect thyroid.  I was about to be put on drugs for hyperthyroid, which I developed after radiation.  Two years later, it is back to normal.  I'd see if you can give it a little time, you may be pleasantly surprised.  The body does like its equilibrium, when the apple cart gets upset, it can take quite a while to get back on track.  For me, it really was two years. 

i know this thread was started a while back but i have a question regarding a comment from a while ago that slak wrote :

"Here is a related quote regarding TAILORx from Clinical Breast Cancer, Vol 7, No. 4, 347-350, 2006 'Although a trend favoring the addition of chemotherapy becomes evident at an RS [Oncotype score] of approximately 11 when the risk of replapse is analyzed in a linear fashion, the 95% confidence intervals completely overlap in the 11-25 RS range' Also, it says 'An RS of 11 is associated with a risk of local and distant relapse of approximately 10%, a threshold that has been typically used for recommending adjuvant chemotherapy'.  So the jury is still out in the low range, in my opinion."

can you, slak, or someone else explain furter... especially:

"[Oncotype score] of approximately 11 when the risk of relapse is analyzed in a linear fashion"

and "the 95% confidence intervals completely overlap in the 11-25 RS range" 

i dont get it!?

i want chemo (score 11, premeno, just over 50 yrs young, grade 2, IDc 1.2 cm, 0 nodes, no LVI) but no one really willing to offer... its so frustrating because 8% seems high with grade 2 (confirmed by 3 labs). grade 3 was said to be a big risk- but wat about grade 2?

i read dr. loves breast book and she says no matter what your risk of recurrence, chemo cuts recurrence rate by 1/3 and inreases overall survival. i also understand risk argument, but honestly, if you recurr, thats your risk. this is the cancer at hand. ughhhh .... so frustrating

why cant they get back some of the results from tailorx and use it to tell us what to do...i hate how tese trials take for ever to figure out the results...meanwhile women are recurring...

I was offered chemo with a score of 11. I declined. I was young, 45 at diagnosis, with no nodes and no lvi, to me, it seemed the right way to go.  I have to be honest, I do wonder often if I selected the right option.

My score was 21, and oh, I wished for an 18. Still I decided no chemo, no tamoxifen since I had the double mx and no lymph node involvement. A lot of research and talking to docs, surfing these message boards, etc helped me make my decision.

I don't really know the bottom line was for me. Certainly a positive node or Onc score over 34 and I would have done chemo. But, in my case, I just did not feel that the benefits outweighed the side efffects. Also, it seems counter-intuitive to flood my body right now with toxins when I still feel weakened by the surgery.

I take tons of supplements recommended by a UVa pathology researcher to prevent recurrence. Also, my oncologist does think there is some benefit to the WINS trial diet (google it) and taking baby aspirin 5 days per week. He set me up with a dietician to learn more about the diet.

I have so much more energy now. Back to work--yay! I would have started chemo yesterday, and I have no regrets about skipping the drip!

You guys take care. So happy for all your low scores--whether you do chemo or not, a low score is GREAT NEWS!!

I was 39 at diagnosis, don't know if I posted here before, but I always do the battle cry for the young survivors.  I was a 12, with a grade 3 ER+ tumor.  No lymph nodes.  Did chemo.  Studies seem to indicate young survivors have an added benefit from chemotherapy.  They don't know why, it may be chemopause.  I was in chemopause for 2 years and 2 months.  It miraculously came back, and now I am very grateful I did chemo, as higher circulating estrogen is a risk factor.  Additionally, one oncologist indicated that upwards of 20% of Tamox/AI users do not receive the benefit.  So much more research is needed to understand this blasted disease.

I'm going into this week facing the possibility of this situation. My ki-67 was less than 1% and I'm grade 1. My surgeon predicts a low oncotype. I am 48 but had 5 tumors. Oncologist meeting is Thursday. It's scary to have all these unknowns. I wish there was a test to see if any c cells were in the blood.

Thanks Cherilynn. My oncologist appt was today, but no oncotype in yet. She is also going to confirm receptor status of the 3 tumors that were not biopsied. Path didn't do that either. Then we decide. She predicts a low oncotype score. She would prefer I only had one or two tumors to make the decision easier. They have only oncotyped the largest. Soo, we wait.

Hi there,

I need some help and opinions, please......I went to my oncologist today. She had predicted a low oncotype and just tamoxefin therapy. I'd already picked it up at the pharmacy! Well, it was not as low as she hoped. It was 18. She has given me three choices.

1) take tamoxefin only and have an 11% reoccurrence rate to stage 4

2) do 4 cycles of TC chemo to reduce the reoccurrence rate to 7%

3) get monthly shots in my stomach to suppress my ovaries and put me in menopause, begin me on tamox and switch me to an AI. She said this would also reduce my reoccurrence rate to 7%.



A big thing is that I had 5 tumors, 3 around 2 cm. My oncologist says things would be simpler if I had only had one. My age, 48, is also a factor.



I have no idea what to do. Does anyone have advise or insight? She would like me to begin next week.



Thanks in advance. It's been an unexpected day.

Lmim... Perhaps a second opinion or request a tumor board make a recommendation. Good luck.

Currently, there is an ongoing trial called SOFT that is looking at ovarian suppression and endocrine therapy in lieu of chemo and endocrine therapy. On the contrary, ovarian suppression is very popular in Europe and there's been many of us here on this side of the pond who have received OS. Check out the NCCN guidelines 2012 professionals version ( not patients) and read pages 95-100. It discusses ovarian suppression studies and endocrine therapy.





Glad you are getting a second opinion. Request that the tumor board review your case as well. Good luck.

Lmimp since we are the same age and simliar but not identical situations, here's my thoughts.

My oncologist back in Phoenix also thought about using Lupron on me (that's the injectable for 2 years) to supress estrogen production - it's a chemical hysterectomy so to speak. However he normally uses it only on women UNDER 40. But he did consider it for me because like you I'm still pre-menopausal. WAY pre-men. My estrogen levels are still that of a 30 year old it's ridiculous. He looked at my numbers and was like wow, you're nowhere near menopause possibly for another decade. So he said Lupron was something to consider. But he said tamoxifen would still be my best bet. He offered chemo only if I wanted it - mine was 11 and my one tumor was 1.5cm which he considered large. But he said 11 was very low and he won't give chemo normally to any woman whose score is under 20. He said the data shows tamoxifen being the most beneficial if your tumor was very highly positive which mine was (98%, and 99% on progesterone).

What was your percentage of ER and PR? That might help make the decision for you.

Cheri

Renee....The result of supression of the ovaries vs. removal are the same.  The reason why there is a choice is because going through menopause sometimes can have rough side effects and with removal there is no going back.  Some women, including myself chose ovarian suppression with Lupron rather than surgical removal.  Some women choose both...They may start with chemical suppression and then do surgical removal.  I was close to menopausal age, so I just did two years of chemical suppression and I am now "officially" menopausal.

Likewise, there are certain risks when you do ovarian suppression, besides the side effects.  Estrogen, while bad for ER+ tumors, also is heart protective.  So if you have a family risk of heart disease, you might need to balance your risks vs. your benefits of doing ovarian suppression.  Likewise, you are at increased risk of osteoporosis if you shut off the estrogen, so you need to monitor your bone density as well.

Voraciousreader. Thanks for your perspective. The side effects of ovary suppression and removal worry me. My doctor is suggesting zoladex not Lupron. Lupron seems to have fewer side effects, so I'm not sure why. Adding it to my list of questions!

Thanks for the explanation and the thread suggestion voraciousreader--will definitely check out!

Hi Sam. Sorry about this. We sound like we are about to make similar decisions. Let us know what happens. My son is 10.