oncotype dx score of 21 - question to do or not do chemotherapy

Regina, there are other recent threads here that might be helpful to you.  Most have the words "Oncotype-DX Roll Call" in their titles.  I just bumped a 24 page one for you.  If you go to "Active Topics" (upper left) and scroll down, it will appear on the actives list for the next 24 hours.

Another thing you might do is get a second opinion from a different oncologist.  He/she might feel more strongly one way or the other based on your age or other specific stats than your current onc does.

Hope this helps, and glad you've found BCO.   (((Hugs)))  Deanna

PS ~ Not sure bumping made that thread active???  If you don't see it in Actives, use the SEARCH feature (to left) and type in ONCOTYPE-DX ROLL CALL to find it.

On other was 17 but I had angiolymphatic invasion in my tumor. I was 45 at diagnosis with a 4 year old son. I did get two opinions. One said no chemo and the other thought I may benefit. I did the chemo. I had TCx4 and used cold caps to keep my hair. It was not as bad as I imagined it to be. It was not fun but doable. Good luck!

My onc originally said she didn't think I would need chemo based on first pathology report. I had the Oncotype and mammo print. I did get a second opinion. Pretty much the same. Totally up to me. I went to the chemo class, listened to how the chemo would work -- that is chemo would work on fast dividing cells, my mitotic rate was 1 -- so the thing is if the cells are dividing slowly chemo will not be as effective. That means chemo is less likely to eradicate any stray slow dividing cells. Hormone therapy was more likely to stop the division of hormone positive cells. Looking at so many posts about Oncotype testing I think there is a great deal of misunderstanding about the info the test supplies. It matches statistics based on the outcomes for a relatively small sample (961 I think) with the characteristics of one's tumor. In the end my 4,000 dollar Oncotype test gave me the same recurrence stats as Cancer Math. As my onc said "it's a crap shoot" for people with results like mine. I could have chemo and still have mets later, have no chem or hormone therapy and never have another problem.

My onco score was 19 stage 1 grade 2.... MO said I would not benefit from chemo, so

lumpectomy it was.

Hi Regina. I was diagnosed on 12/27/12 (my moms birthday) with IDC. I had a lumpectomy on 01/23/13 and was told it went great and there was no evidence of node involvement but would get the final pathology in a few days. The final pathology showed that the margins came back clean but 1 of the 3 nodes were positive with a 4mm tumor in the node. My onco score was 20 also and my oncologist ordered another test by Agendia. It tests 70 genes in comparison to the 40 by onco and they only provide a low or high risk result, there is no intermediate leaving that grey area. I haven't received results yet but am hoping for a low risk result as I am terrified at the possibility of chemo. Maybe you could ask your doc about the mammaprint test by Agendia. I'm hoping that it will make the choice easier. Best of luck to you.

It is a really hard decision to make and my number was lower than yours.   I am upset and in such a quandary over this.  My surgery was December 17...I want to move forward with radiation and be done with this!

mreginab...11-30 is not a gray area for Oncotype. There are low scores which I believe range from 0-to like 17; an intermediate range(most problematical) to 30 and anything over 30 is considered a high score. Of course you can have a low score and still benefit from chemo which I was told depends sometimes on the grade of your tumor. Mine was Grade 1. It is a crap shoot but my Oncologist was convinced with a score of 11 with a non-aggressive tumor chemo would not be beneficial to me. I had 33 RADS treatments instead. They were a piece of cake compared to chemo. I don't know what I would have done had my score fallen in the intermediate range. I guess if the stats suggested a drastic difference in survival rates I would have opted for the chemo but as luck would have I didn't have to make that decision. diane

My stats are below. I had no chemo and no regrets at all. Chemo can have long-lasting negative affects on cognitive function. I wasn't willing to gamble with that at all. The oncotype and all other factors indicate more harm than good with chemo, for me and IMO yours too.

Also, Stenokim, in my opinion, listen to your onco not the surgeon. My surgeon, as many I suspect, was not well informed and tried to scare me into chemo. He was not up on his research. The ladies on this blog know a lot more than he did.  Mreginab and stenokim, stay strong and listen to your gut and your calm rational minds. Good luck.

Oncotype 16

I was onco-score 21. MO pretty much left it up to me whether to do chemo. I think my benefit is supposed to be around 4-6%. Opted not to do the mammaprint. Thought it  might make it more confusing and didn't want to wait another 2-3 wks. I think I read somewhere that the chemo benefit also decreases as you pass 60 yrs. I am approaching 59. So, it is a crap shoot and we all just have to make the best decision we can for ourselves. I just completed my chemo and it has not been bad. I am happy with my decision. The onco test was based on using Tamoxifen and CMF chemo; neither of which I am doing! There is a clinical trial going on now that is supposed to be completed in 2015 regarding the intermediate score/chemo benefit. It would be nice if it were more black and white, but we still have more to work with than our mothers and grandmothers did!

My first Oncotype was 19. No chemo ….had a recurrence in the other breast at 1 yr later. It was a second primary tumor. This time I had to have chemo because the new tumor was triple negative. If I had to do it again, I would have done the chemo the first time. I lost 40 lbs and took arimidex, but still got another tumor. My MO said Arimidex would be my best friend in fighting BC. Well, maybe…I have 2 types of tumors to fight now.

thanks for your replies, magnolia and Sydney.  I am meeting with onco next Monday to get my peace of mind back, but over the phone her comment was "all surgeons say everyone needs chemo.  I'm a chemo doctor and I say you don't".  She said if I choose to go through it for a 1% benefit, that's my choice.  She was the first doc in my area that started working with the oncotype back in '05.  I'll let you know what I learn next week but thanks again and good luck to you all!

Edwards, thanks for the reply and I agree with the second guessing. BS said at least get another opinion on chemo. I really like my oncologist, she's very confident, a true optimist, and I trusted her initial treatment plan and feel that if I got a second opinion on chemo, they'd say get the chemo, then I'd go for a third to break the tie, and I could just drive myself crazy doing that. I could find five for and five against, I'm sure.  Just gotta make my final decision and don't look back. It could recur with or without chemo.  

Stenokim...after my Path report they found a micromet in my SN. My BS said that's going to get you chemo. My Oncologist was unsure about treatment so she ordered the aforementioned Oncotype test. It saved me from chemo. Obviously I sided with my Oncologist but not because the test came out okay; it was because she/he is your medical lifeline after its all said and done. Sorry you are dealing with this again. I think for me I rehearse over and over again telling myself there are no guarantees but in the back of mind I also think okay I have a low this and an early stage that so I am in the more than likely wont happen to me category but it can and it does. All you can do is act on the information you have.  It definitely can recur with or w/o chemo. Good luck...diane