Low-risk oncotype with higher tumor grade?

msShelly, Grade 2 is still considered low grade. An oncologist explained to me that only Grade 3 is high grade. There are 3 levels of scores to each grade, so you can be a borderline Grade 1,2,or 3. So, if you have a score of 4, that would make you Grade 2 but just barely. For these borderline situations, different pathologists can make different calls. 

Not sure if I'm making sense or am entirely correct, but hope you get the gist of it! 

For those who would like to understand grade better here is a link that shows the criteria that go into each of the three portions that comprise your grade.  There are three areas - tubule formation, mitotic count and nuclear  pleomorphism.  Each of these scores a 1, 2 or 3.  The scores for each are combined to give you the total grade.  Mitotic rate is generally the thing most similar to Ki67 - these are both cell turnover and proliferation rates.  So, you could score a 3 in one area and a 1 in another and combined you may be a grade II, but the breakdown shows the high or low areas specifically.  This breakdown should be on your pathology report, or can be made available to you if it is not. The little chart shows the scoring:

 http://tvmouse.ucdavis.edu/bcancercd/311/grading_diagram.html

jsrose - I heard the same thing about the Oncotype test and in fact I had it done as well at the request of my Onc. I had a micromet in the SN and my BS said that would get me chemo. Not. The ONC has the final say and she wanted me to have the test because she said ONCs tend to overtreat women and subject them to a lot of pain and expense that is unnecessary. So I had the test and my score came back 11. I am a Stage 2 because of the micromet and Grade 1. The Oncotype test evaluates only your particular tumor and does I think 21 different tests. Doesnt matter about family history, etc. They are only concerned with your particular tumor. I have read other posts where ladies have opted out of chemo with a score and grade level similar to yours. BC we all know is not one size, fits all. I would always yield to either a second opinion and/or my ONC. Thing is dont second guess yourself or look back. We all make the best decisions we can with the information we have. The one thing we all have in common is we have bc...in varying stages and grades and a fear factor that goes along with it. Less than 2% isnt a lot.  diane

My 2 cents is I had an oncotype score of 11 on the biopsy tissue (pre-mast).  After surgery, SNB and tumor testing, the tumor had all grades 1 to 3, so the previous onc score was probably not a good indicator going ahead regarding treatment.  So yeah there can be high grade score with a low onc score. 

I don't know if I count as high grade since mine were 2, but I also had a low oncotype score of 6. No nodes & no lvi. Tumors less than 1 cm. Highly estrogen + (95%), so I'm a tamoxib*tch. Little over a year out.

Cookie can you ask your NN what's best about G2? I've never heard that.

edit: I just realized this is the IDC board. I had ILC. Sorry!

Grade 1 is better than Grade 2! The lower the better because lower Grade cells are more like normal cells.

Cookiegal - you may want to ask your onc directly instead of the NN.  Mine says grade 1, lowest is least aggressive, 2 is next, then 3 is quite aggressive. 

I might be wrong about this, but it seems that when a person is Grade II, there is more variance in their Oncotype scores.  I am guessing that if the mitotic rate, which is one component of the grading system, is high, then even if you fall into Grade II, there may still be some benefit for some people to do chemo seeing as how many chemos work during the cycle of cell growth.

A good physician will look at all the pathology and genetic information and not just one individual test to make the best, informed decision about a patient.  So my answer to your question is that no, the Oncotype does not override the grade.  They are both (sometimes conflicting) pieces of the puzzle.  We all know they don't have cancer figured out yet.