Oncotype DX dilemma

Colette, I had an Oncotype score of 14. Even with 2 positive nodes my MO said no chemo. You don't mention if you are ER/PR+. That is a factor to be considered as well as one's age. Younger women tend to have more aggressive cancers and are often given chemo despite the Oncotype score.

Hi Collette!

I recently participated in a podcast about the Mammaprint test, along with the Director of Breast Oncology at the Bon Secours Cancer Institute.  Dr Pellicane shared some wonderful information that may be of help to you in general.  I've attached a link to the conversation.  I know I learned some new facts from this as well!  Hope you are weathering your treatment well.

http://knowyourbreastcancer.com/breast-cancer-dialogues/?utm_source=facebook&utm_medium=social&utm_content=1450517

yorkiemom - Oncotype Dx is only done on ER+ patients.  The results assume hormonal therapy, which would not apply to ER-.

I looked at the transcript of the podcast - it was very interesting.  I did not have an Oncotype Dx test done, I had Mammaprint from the outset.  It was actually done on my biopsy sample, prior to the knowledge that I was Her2+, which almost always comes out with a high risk of recurrence rate.  So I knew I would need chemo and Herceptin at my first appointment with my breast surgeon. I found this portion of the conversation to be of critical importance for those whose Oncotype Dx result is in the intermediate range:

"The problem is we’re intuitive creatures, and so when we look at a continuous variable test like Oncotype, we just assume the variable stage continues.  In other words, as the recurrence score goes up, the risk goes up and that’s just not how Oncotype works.  So we intuitively look at those intermediate patients and we say, “Well, you’re in the low part of the intermediate group, so you probably don’t need chemotherapy,” or vice-versa, “You’re in the high part of the intermediate group, so intuitively, you probably do need chemotherapy.”  Unfortunately, if that were the case, there’d be two groups of Oncotype, and there just isn’t. And what we’re finding when we’re running these MammaPrint tests on intermediate Oncotype patients, we’re finding about a 50:50 split in those patients where about half of them are low risk and half of them are high risk.  The problem is they’re spread equally over the whole intermediate subgroup, so in other words, if you come back as a 19 recurrence score which is as low an intermediate score as you can get, you are just as likely to have a high risk MammaPrint as you are a low risk MammaPrint, and so there is no way to tell the difference based on where you fall in the intermediate group, so you cannot take solace that you’re a low intermediate risk patient.  It just doesn’t work that way.  You need a test that’s definitive.  Oncotype is not sophisticated enough to differentiate those intermediate patients whereas MammaPrint is."

I only got the oncotype done on my node positive side(long frustrating story). Both my tumors were ER+PR+HER2-. Tumors were about the same size 1.3cm & 1.6cm. Both were grade 1. So, I was told they'd treat the node positive tumor & it would cover the other. Surgically I had a BMX. I regret not having the other tumor tested though. My oncotype was low "4". My MO left the decision up to me. I told myself that if the oncotype came back anything but low I'd have chemo.

Are you tolerating chemo ok, or are you seeing severe neuropathy or chemo brain? If you are doing ok, you may want to stay the course, but if you are looking at permanent SE's maybe talk about stopping.

Thanks everyone. I was in two minds about doing the Oncotype. I am Er,Pr+ and Her- Grade 2 ,1cm tumor on my left breast and 0/3 lymph nodes. My k67 is borderline 20 percent actually. My Oncologist said that if I dint choose to do the Oncotype test hed have to suggest 4 low dose chemo cycles because if the cancer came back later on in any other part like the lungs or bone it could be life threatening too. It scared the hell out of me! For these few days actually Ive been thinking that maybe just doing the chemo would be safer for the future. But now that Ive read all your posts I think he might have been trying to really scare me or just be extra cautious. I felt that Oncotype would just be a formality for him to put me on chemo anyways. I guess no I do have a chamce if my score comes out low right? I mean if my Oncotype score comes out low I can say no to chemo and it wouldnt be a bad decision at all ? Has anyone had the Oncotype score low and had a reccurence? Do any of u know? Id really appreciate some input.....

Even though I have a low oncotype score of 9, my onc didn't hesitate in recommending chemo and yes, it's not a walk in the park, but it was manageable.  Now after 5 TC treatments, I'm NED and the numerous mets on various bones are healing with no cancer indications.

I don't know if this helps you make a decision but for me, knowing I did all I could to eradicate the cancer from my body was a no-brainer.  Good luck to you!

Edwards750 I think she wanted to take on the bone mets which she did and appears to have won. My tumor grade was 2 and with the removal of both breasts the cancer was removed, but my onc couldn't do anything for the bone mets except chemo.  

It's all very confusing to me but if I recall correctly the oncotype was ordered and back before the bone scan revealed mets.  Anyway, I believe the chemo was a huge factor in my current state of recovery and hopefully will have proven to have been the right thing to do, in years to come. 

Mets mean metastasise or in my case bone metastasise. Spread to numerous bones in my body without any warning or symptoms whatsoever.

Hi All,you are all very educated,I'm impressed.I went to Sloane Kettering in ny,had my lumpectomy and sentinal nodes which came back a 1.8cm tumor and 1 positive node,8mm.I was offered to be in a study if my onco type was low to forgo chemo.I seriously considered it(my onco dx was 18).I'm er+,pr+her-.The problem for me was that my node mets were greater than 2mm.Therefore the way my docs looked at it my cancer now had grown legs and could have spread microscopically.I'm almost done with dose dense ac and taxol(2 more taxols to go)and glad i didn't decide to be in the study.I just wanted to have no regrets.Maybe in 5 yrs they will determine chemo wasn't necessary for me but they're not there yet.I'm not going to lie, chemo has been REALLY hard physically,emotionally,and financially but I had to do it for my kids,husband,parents,brothers and sisters.Going through this again would be unthinkable and it's 6 months of torture for peace of mind.Love to all my sisters,Angela

Hi girls. Thank you so much once again for all your input. I feel that my onc should have suggested d bone test first the. Before even asking me to do the onc test. I mean i dint even think of that and i think before i make any decisions on chemo or no chemo even if my onc test results are low it would be best to do d bone test to rule out any kind of spreading later. In the end for me its not as much that im just looking for an excuse not to do chemo but doing whAts bext for my future because my children n my family's future depends on it as well. Thank you so much and Id like to tell you that all your different input has helped dar more than even my Oncologist! Hugs to all of u.