can i demand Oncotype Dx testing

ask your RO for a MO recommendation . Most people can get second opinion. Both drs. should be able to be on the same page after they have a discussion about you. So that would be a red flag for me. If your RO recommends it than you are not out of line to question the MO in asking. Just my thoughts

I don't know the answer to your question, but suggest a couple of things to think about.  If your situation ends up not fitting the criteria than either the lab or the insurance company or both may say "no."  You may have to be prepared to pay out-of-pocket up-front in this situation.  I have always wondered about by Oncotype results and what they would have said about chemo.  I had chamo on a very large tumor, so I was able to monitor the progress myself, yet I still wonder how aggressive my tumor was or whether it was rather lazy and got to hang out for a long time since it didn't show up on a mammo.  Best of luck with this.

I'm not sure why I was never offered oncotype testing.  I heard about it only after joining BCO, well after my diagnosis, surgery, etc. But, at that time (9.5 years ago), I was told that insurance never covered it and that I'd have had to pay for it myself anyway. I don't know the answer to your question - but, since you're a lot more aware than I was - if you want it, surely they cannot refuse it. Oh, wait, they're "MDs," so they can do anything they want. A discussion is in order, then perhaps a second opinion if your doc won't do it, or allow you to at least understand why s/he feels it isn't necessary. Can the RO order it??

whatnow, the reason you didn't know about the Oncotype test when you were diagnosed 9 1/2 years ago, and the reason you weren't offered it, is because back then the Oncotype test was very new and not extensively used/offered.  Although I've seen some articles that suggest that the Oncotype was 'invented' in 2003,  the first PUBMED article I can find about it was published in 2004 and it wasn't presented at ASCO until 2005.  The first reference to it on this discussion board was August 2005.  So don't think that you were remiss in not knowing about it, or that your doctors were remiss in not offering to you.  For all those who think that there has been no progress made in the treatment of breast cancer over the past 10 or 20 years (and we read that so often in posts on this board), the availability  & use of the Oncotype test is one example of the progress that has been made.

zha-an, don't jump the gun here and worry about something that hopefully won't be an issue.  Based on the preliminary negative result on your SNB pathology, it's highly unlikely that you will be found to be node positive - I believe that only about 10% of women who's preliminary node pathology is negative end up being positive.  And as you mentioned, if you are found to be node negative, then your MO will order the Oncotype for you.  Hopefully you will find out tomorrow that you are node negative and there will be no issue here.  However, should you land in that 10%, at that point a second opinion from another MO probably does make sense, but it will also be important to learn more about the pathology of what was found in your nodes and your MO's rationale for recommending chemo (particularly in light of your other health issues).

Hoping for a node negative result for you, and then, a low Oncotype score!

I agree that you should press for this test.  Don't be afraid to assert yourself with your MO.  It's your body after all.  You need to feel empowered about the treatment plan that you choose.  This test is far less expensive than chemo, so your insurance should cover it without problems.  Good luck!

My MO was reluctant to order the oncotype test for me. I had to ask 3 times. My 3rd try was a phone call to his office. he was on vacation & someone else ordered it. My cancer center works in a strange way. You have to pick a MO(prior to your 1st appt) & you are not allowed to switch. Had my 3rd attempt to get the test failed, I would have had to travel 2 hours. My cancer center is the only game in town. Sometimes we have to figure out how to work the system. A new MO is not always an option. My BS & RO also thought I should get the oncotest. My MO was the odd man out. ordering it fell under his juristiction. Hopefully things will go smoothly for you.

When I first met with my MO, he first explained that I hadn't been "cured of cancer" as my surgeon had stated!  Then he asked if I were willing to have chemo.  I expressed the fact that I didn't want to go through that.  He explained the value of the oncotype dx test in a decision process but stated he would not order it if I were not willing to consider chemo.  In some ways, I think it is a trade off for insurance companies.  The oncotype test is expensive, but costs much less than chemo.  Because of this, I think it is important to say that you are open to having chemo in order to have them willing to send the tumor off for the oncotype. Of course after I learned about cancer cells that might have spread, I was willing to consider chemo and appreciated the oncotype score.

Several studies show the Oncotype test to be valid for those with node positive cancers as well. I'd push for it either way. Mine was done even prior to my surgery using samples from my stereographic needle biopsy, ordered by the oncologist to help decide about chemo even before we knew node status. Even after surgery, with one node showing positive, the surgeon (an oncological breast surgeon) is not recommending chemo/ onco score of 11 only and he says lymph node involvement does not change the genetic make-up of my cancer/ non-aggressive and low grade or tumor size, 7 mm (.7 cm). We'll see what the oncologist says on the 26th re whether she thinks node involvement changes my treatment plan any.

Basically, I think we can push for anything we want and the more info we get the better. These are tough choices we have in front of us, but for many the reality is we get what our insurance approves. My surgeon and I wanted BRCA testing prior to surgery and I got it, but only after my insurance approved it, ditto for the breast MRI and the oncotype testing the oncologist and I wanted..

I too asked about getting the Oncotype testing done and both my surgeon and oncologist said it wasn't needed since my MRI showed node positive results and that they would be recommending chemo, surgery and radiation. I opted to do the chemo first (dose dense) and have completed 3 out of 8 rounds ( a/c 4X and then 4 rounds of Taxol). Now I am wondering if I should have demanded it before I strated treatment even if I had Tom a yo outmof pocket. my genetic testing came me back all negative. I guess now it Would be a mute point to get the testing done and I guess I will always wonder what the score might have revealed. Or could it still be done when I have surgery? Any thoughts or suggestions welcomed.

NY2TXbaby and Laura, It's not too late to request the testing! A portion of the tissue removed during your surgery can still be sent away for testing.

I am node positive and knew I would be traveling through chemoland. I requested the OncotypeDx testing anyway. I wanted as much information as I could get regarding my cancer. My MO wrote the order and sent the tissue sample away. My DH called OncotypeDx, who told him they would work with my insurance company for coverage. My DH also called our insurance. We were willing to pay for the test, but were glad when the insurance paid for it. We've paid so much for insurance over the years; I'm happy our claims haven't been rejected!

I encourage you to give it a try!

Poppy

My surgeon said 3-5 days on the final pathology report. This was on Dec.30th 2014 when I had my BMX. I asked about the oncotype test and he said that would be included but did not mention it taking 2 weeks. My oncologist said I would start chemo in about 3-4 weeks after surgery and I wonder if the oncotype test is a big deciding factor in a hormone positive individual. I did score a 40 in the KI-67 antigen test the one that determines how many of the cancer cells are dividing. So 60% are not and 40% are and was told anything over 20 is unfavorable.

Just wondering

Kristin