Question about the "intermediate range" on OncotypeDX

When is this test usually done? Before or after surgery?  Also I am reading people talk about MO (Med Oncologist) when do you seek that out. Right now I saw the Surgeon (sched for 4-30-13) and I have an appt with the RO (Rad Oncologist) on 4-15-13.

Is this the test that decides whether you proceed with removing the other nodes? Just so confusing and I am trying to get this straight. I am writing a whole list questions to ask, however which Dr do I ask now is another question?

I have learned so much from all the various forums I would be totally lost if I had not found this. Thank you all for sharing!

Thanks for your response Renee, no I have not had surgery it is scheduled for 4-30-13 (LX). I saw the surgeon on 4-3 and when she was discussing everything (actual alittle fast for my comphrehesion) It was just so overwhelming. I have been reading the forums and trying to put everything to together.  

During the appt, she discussed the sentinel node biopsy and the procedure. I indicated that if it is the standard protocol (persay) to continue to take out all the others (to not have to go thru another surgery). However after reading about this test, I am wondering if I should wait to see the test result of the Oncotype before removing them all (or do they only remove the bad ones)? Am I understanding this correctly?

I can not express enough how grateful I am for finding this forum.

Jude....Are you premenopausal?  If so, AnniceMD started a thread for us premenopausal, Grade 1, Stage 1 gals.   Come join us...her thread is PACKED with helpful information......

http://community.breastcancer.org/topic_post?forum_id=108&id=773534&page=1

Jude yes being ER/PR+ is a good thing, but has nothing to do with still having your period. Even after we stop that we still have estrogen in our bodies. It comes from the fat we have around our waists. I was 57 when the cancer was found, and hadn't had a period for several years.

I'm also on Tami. Tried the Al's but the SE's we very suvier so Dr. took me off them. I also have lots of extra fat around the middle.

I think the meds continue till natural menopause. If you need chemo that quite often does stop it.

I well remember the feeling of to much info, and sort of I've totally lost control of my life. This will last until you're final path report, and a plan is truly set in place. I'm almost 3 years past, and am enjoying my life again. You will find lots of support from others here. You will even find there are several groups of ladies that try to get together around the country. We have a very active group here in Tampa Fl. has had been great for me.

Jude 123- my diagnosis is similar to yours in some respects. I only had the sentinel nodes biopsied and removed.   As I understood it from my surgery, they would check that one first and if it was positive, they would have gone further. But there were no issues there and it sounds like you are hearing the same. 

You are going to do the internal radiation which is much easier than the external radiation as I understand. I had something similar, but a series of catheters vs. the balloon. It was very do-able, but you may feel some fatigue afterwards.

Also, I had the oncotype tests too which will give you the risk of distant reoccurrence and help to determine if you may also need chemo (not always recommended for early stage cancers with no node involvement). Based on my results, the benefit of chemo was not going to be worth it. My med onc did suggest I consider taking Arimidex but for a longer period (10 years).

Also, there are better treatments available for those who are ER/PR positive. That is probably why your nurse said it was good that.

Good luck and keep us posted on how you are doing!

For my insurance company, if your lymph nodes come out positive, they won't cover the Oncotype because they assume that you will have chemo-- therefore to them, paying for the test would be pointless.

Hi ladies- one thing to share with you about the Oncotype DX test with respect to insurance. My insurance approved it then denied it once they were billed. Genomic Health asked for my help to appeal it, which I did. This finally got resolved, but they did not get the full amount they were looking for (like half, which seems to be true of most things billed to insurance) so now they want me to go back and help them to appeal for more money. So this goes on and on, and just thought for some of you who get approvals, be ready for a hassle to get this test paid for.

Jazzygirl...same thing happened to me. BCBS approved the test and then reneged. Genomic said that was typical of them but they didnt seem worried they could/would get it approved. They told me they were going to appeal the decision but they never asked me to help them. I would have to be sure because that test was my survival kit and besides they approved it and pulled the Charlie Brown stunt? I also know that Genomic, if you have to bear some of the burden of the cost, will work with you on a sliding scale. In addition, a radiologist who goes to our church, told us at a meeting the other night that the cost is coming down. Frankly we didnt have an extra 5k upfront, with all the other bc expenses that insurance paid a portion of, but we would have paid the sliding scale amount whatever that might have been. My ONC said this test is crucial when in doubt about a treatment decision and the radiologist I mentioned, agreed. She said it is an accurate barometer of your particular tumor and one that if you can qualify for, you should have. Over treatment and subjecting women to pain and financial stresses they dont need have made this test for some drs, a must have. diane

Hi Edwards750- yes, it was BSBC for me as well. I was glad that the appeal for payment was successful. I got a check and sent it off immediately to Genomic and they said they got it. So I was surprised they called this week and said they were going back for more. And that is fine too, I was just hoping it was done. They indicated they were not going to require me to pay anything- it is completely between them and BSBC. I went through the same thing with my BRACA test with another lab. These genetic tests were the only things I have had to work at to get paid.

I am glad I had the test as it resulted in a good discussion for me to not need to do chemo. I am not one who wants to be over treated for anything and know the stats around that with breast cancer. 

Appreciate knowing you had a similar experience and figured other women here might want to know about this financial aspect of this test.

I had BC/BS as well. They paid the majority of my bill and what they didnt pay, the Genomic health people waived. They (Genomic Health) have a program you can get for assistance to pay for the test.  Even with a 6 figure income we qualified and they waived the balance for me -which was a pretty sizable balance. They really want people to use this service and their test and as such are very helpful in getting bills paid and working with you on a financial solution. Most insurance companies will pay as it's cheaper for them to pay that bill and than to pay for Chemo.

Good luck. Call their customer service people and ask about financial assistance. Well worth the few minutes on the phone it took me.

Bevin

Hey jazzygirl...I doubt they will bill you for the balance and wouldnt think they could force you to pay the difference either. Genomic Labs told me they would keep me posted when BCBS reneged but they never did. We have a 6 figure income too; have no idea what they would have had us pay based on our income. Thing is Genomic Labs called BCBS before they even accepted my tumor sample so really unfair to screw them over. I agree they are trying to encourage more people to do the test. Definitely worth it if you can. diane

Hi Jacquie,

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