Oncotype test - too small IDC to test?

Hi Kimag,

My spot was 2mm and I had second opinions at MD Anderson, John Hopkins and UofM.  They all told me too small for the test, and they left the use of Tamoxifen up to me.  They told me the benefits of Tamoxifen were maybe 1-2%.  I had Lobular C., ER/PR+, Her2-, and no lymph node involvement.  But I did decide for a BLMX for my own peace of mind.  Are you going to take Tamoxifen?

Sharon

kimag - mel147 here from the July 2014 thread...I was just going to PM you and noticed you had started this thread so I'm posting on this one.  I am in a very similar situation regarding the Tamoxifen.  I had four small invasive tumors - largest was 3mm and the others were 1.5 mm and less.  My oncologist and I discussed Tamoxifen but he is thinking that I might not tolerate it very well since I have reacted negatively in the past to hormones.  I tend to agree with him and am also worried about the possibility of blood clots since I have some bad varicose veins in my legs.  The problem is, I am wondering if this is the right move or not.  I was so excited that I had no positive lymph nodes and clear margins and I thought I was in the clear, but then I read how the cells can travel through the blood stream and pop up later after they have metastisized in other places like your bones.  That scares me a lot!!  I have been reading so much on these boards trying to see what other people are doing and I do see others with my same stats and they are taking the Tamoxifen.  My MO said I was in a grey area and it would be difficult to guess my risk but he was saying 5-10% as a range but said it was probably more like 5%.  He then said if I had a 6% risk then the Tamoxifen would reduce my risk by 50% and it would then be 3%.  I wish they could tell us more concrete info, but I know they can't.  I feel so fortunate that my cancer was small and all removed, but I am still worried about the future and want to make the right choice.

I have been on Tamoxifen for 31/2 years. It is no walk in the park but more of a necessary evil. I have IDC Stage 11, Grade 1 BC. My tumor was larger enough to have the Oncotype test done. My score was 11. Recurrence rate is 8% but that includes 5 years of Tamoxifen. I had a lumpectomy and 33 Rads treatments. 

If my dr told me it was optional I would take it. A drug that can reduce the chance of a recurrence and its optional? Sometimes I think the drs are too blasé about treatment plans. I know they have over treated women for years but no need to go too far the other direction either. 

It's an individual's choice of course. Just be sure you don't look back and say what if. Get a second opinion if you have to. 

Diane 

My tumor was 6mm, and I was able to have the OncotypeDX test performed on the tissue.  There was some discussion as to whether my tumor was large enough for the OncotypeDX test.  If you want to confirm that your tumor is too small for the OncotypeDX test, I would call Genomic Health directly, the company that performs the OncotypeDX test, to ask how large a tissue sample they need.  They had a very helpful patient hotline...

I am waiting on the test results of my Oncotype DX & am scared that the numbers will come back high & will have to have chemo! What is the highest number I can have and not need chemo? I am PR/ER+ HR-. Thanks for any info in advance!

Mimi - the intermediate range starts at 18 and around there docs start talking about the benefits of chemo. 

Mel - my tumor was 1.1 cm, my doc discussed it and asked if I wanted it.  I believe that generally it is for node negative invasion cancers under 2 cm, but I have seen exceptions on these boards (i.e. 1 node, bigger than 2 cm). There is a newer test for DCIS some docs are using. I'm not sure about a low end cutoff for IDC. You can read more about it at  http://breast-cancer.oncotypedx.com/en-US The professional area has some very interesting graphs.

ThinkPink: from your signature line, you state that you had DCIS in 2001. I'm not sure when the OncotypeDx test was implemented, but if you had pure DCIS, there would be no recommendation for chemo. I also see that your current IDC diagnosis is ER+/PR- and I think that's at least a pretty good part of why your score was high. PR- almost always adds to the risk as several research studies find hormone therapy to be a little less effective than if you were PR+. 

I hope chemo is gentle for you.

Best wishes.

mmm....this is all so confusing. I was told prior to surgery that the tumor was  less than a 1 cm

 I was scheduled for a lumpectomy, sentinal node. If the node was clear, pathology would do a oncotypeDX.

If the node was involved chemo would be indicated regardless of the Oncotype.

At no time was it ever said that small tumors couldn't benefit from OncotypeDX.

 It turned out to be 3.2 cm. I had the oncotypeDX, it cam back low 12 so no chemo.

 However, everywhere I read the general treatment is chemo is always given if its StageII . So tuesday Im going to bigger cancer instittute for a 2nd opinion. I want so much that they all agree because I really dont want chemo but I also dont want recurrance.

There was never the option of NOT taking hormone therapy.

Raidergirl- Stage II is not automatic chemo; neither is lymph node involvement. The Oncotype test is recommended when the ONC is unsure about treatment, I had the test; my score was 11. No chemo based on that score. My tumor was Grade 1. Higher grades may warrant chemo. Again your ONC makes the call. Of course you can choose not to agree with your ONC. Your decision ultimately, your life. 12 is a low score. 

Diane 

All: My tumor is 2mm, and I'm wondering if my onc -- who said he'd send tissue off Monday for test -- might come back and say it's too small for accurate result? If so, what usually happens next....chemo is off the table, and you move forward with radiation? I.e., the tumor is so small that it's nearly certain chemo would be of very little benefit (as indicated by NCCN guidelines)?

Or -- depending on path report/tumor biology, is it wise to get another opinion, since you don't know what recurrence risk the test might have indicated? Everything on my path report pretty good except PR- status, which it seems confers higher recurrence risk. Don't know if this higher risk is independent of tumor size and other variables.

Anyone with small tumor had the test done and were told that results were inaccurate or inconslusive? Do they charge the full amount if this happens?