use of oncotype dx test on node positive idc

Cacrew- sorry to find yourself here, but welcome. The oncotype will tell how well your cancer will respond to chemo. I got a low score, a 6, but I had 17 out of 17 positive nodes so I am doing the chemo. I too have mixed ductal and lobular. Lobular is very sneaky. It usually doesn't show up on mammograms or other testing like ductal does. I would ask your doctor to order the test to help you make your decisions. It will also give you a recurrance score.

There are a lot of wonderful ladies here to help with all kinds of questions so feel free to ask.

curveball,

I'm sorry your oncotype came back too high to be in the trial and you have to do the chemo. You might want to read the thread about CMF. The women there are great and can answer questions you have about it.  If you decide to stay with the TC, there are good threads about it also.  I think one of the differences to consider is CMF is usually 6 treatments and the TC will only be 4. 

Curveball- My MO wanted me to do the TC x4 also, but I did my own research and choose the CMF. The long term survival rates were really similar. The side effects from TC verses CMF is what convinced me the most. Also my Oncotype score was a 6 even with 17 positive nodes. My Mo said he would back up my decision. CMF does take longer, but I am still able to work and function most of the time. I have lost about 60-70 % of my hair, but I am not totally bald and a lot of woman don't lose any. It's a tough choice and you can PM me with questions if you want. Do your research in comparing both regimens and make your decision based on what feels right for you. Sorry you have to go through this.

curveball,

I'm just curious about your Oncoscore report that made you a 28. What were your ER/PR scores? It seems if the ER or PR is low than the number goes up. 

My score was 20.  My ER was high which I think helped my number because that means I'd get a lot more benefit from hormone tx.  On my graph it didn't look like I'd get hardly any benefit from chemo.

http://www.rkefford.com/CMF.html

Curveball- Here is a link about CMF and as I said, the side effects have not been bad and I will be done with my 2nd regimen tomorrow. Don't feel bad about getting another opinion. I got rid of my first MO and even went to Boston for another opinion. All three were all bout TC and but my MO said he would support what ever decision I made and I opted for the CMF and he has been very supportive.

Yes, I think if the amount in a node is very small, and found by  IHC (I think) staining they consider it negative.  In addition to the one positive sentinel node I had, there was one more which was only showing cells using the IHC stain and my Med Onc dismissed it as negative.

I don't know how I feel about that one....I've read that it matters and that it doesn't.

OK, well I now have a copy of my Oncotype results in hand. I got both a node-negative and a node-positive printout, but because of that one micromet I haven't even looked at the node-negative versioni.

On the back page, each of the receptor scores is shown in a box, and each also has a graph that looks like a ruler next to it. The ER ruler goes from 3.7 to 12.5, plus room at each end in case your score is less than 3.7 or more than 12.5; my score is 12.0, almost at end of the ruler, which I take to mean that I am very strongly ER positive. On the PR scale, the ruler goes from 3.2 to 10.0, again with room for "more than" and "less than" at each end, and I score 5.7, which is just barely past the cutoff point of 5.5, and I think means that I am weakly PR positive. The HER2 ruler is similar: less than 7.6, ruler from 7.6 to 13.0, with scores below 10.7 negative, between 10.7 and 11.5 considered equivocal, and above 11.5 posivtive. My score of 9.6 is decidedly HER2 negative, but not extremely so.

The front page shows the rate of recurrence* or death** up one side, and the Oncotype score across the bottom. With 1-3 positive nodes, a score of 28 means a recurrence risk of approximately 17% with tamoxifen only, which chemo (specifically CAF-T) would reduce to about 13%. I have to eyeball estimate these percentages from a scale at the other edge of the chart, so take them with a grain of salt, but they are at least roughly consistent with the Adjuvant!online printout I got from Dr F, and with the results I got from the online cancermath.net calculator. This appears to show a benefit for adding chemo of about four percentage points. However, the graph also shows the "confidence interval" on each side of the lines, and this area of doubt is at least twice as large as the estimated benefit of adding cancer. The fine print on the back says my individual hormone and HER2 scores are taken into account in determining this confidence interval. I guess that's why these intermediate scores are considered a gray area. You can't really be sure that including chemo will really improve matters over just tamoxifen. And of course if you use a different chemo regimen than the study, or an AI instead of or after tamoxifen, it really gets to be kind of nebulous. 

Nevertheless, Dr F and I agree that 28 is so close to the edge of the "high" range that chemo is advisable. I wasn't advised to have more nodes removed, despite the one sentinel with 1 mm of cancer, and frankly I think I'd be scared to depend on hormone tx alone to deal with any micromets that might still be in the nodes downstream of that affected one. So tomorrow I'm crossing the Rubicon, and starting 6 months of CMF...unless I chicken out of the weekly schedule for this regimen as done at my treatment locale. I could still go for the TCx4 if I call first thing in the AM. But I don't think I will. That 3% chance of baldness is just too much for me, and Adjuvant!online shows the absolute benefit of the CMF is only 2 percentage points less than that of TC. I've thought about it a lot over the last few days, and the conclusion I came to is if I bet on CMF and lose (i.e. I'm one of the two people in a hundred who die with CMF treatment that would have lived with TC) I'll never know it, but if I take TC and I'm one of the three people in a hundred who end up hairless, I'll never be able to escape that. As far as I've been able to find out, here's no treatment for hair lost this way--not Rogaine, not transplants. When it's gone, it's gone forever. I didn't know if I could deal with having that happen and worse, knowing I had brought it on myself. So I'm not going to take the chance.

*recurrence=after 5 years of follow-up, local recurrence, metastasis or new primary tumor
** death=after 5 years of follow-up, death from either breast cancer or other causes

@scardey cat woman.....

I don't know him personally, but there is a med onc at Montefiore Joseph Sparano, I have read his articles!!! 

http://www.einstein.yu.edu/faculty/profile.asp?id=2952 

He has played a key role in the oncotype research!

If things didn't work out with my onc, that who I was gonna try for.

I was grade 2, but I had one of 8 nodes, an RS of 22 and declined chemo 

Hi Ladies

I am pretty much new to this forum.  I had UMX on November 26th, Still healing,  Mastectomy was with expanders which were filled upto 100cc at the time of surgery but my bad, PS has to deflate them today as my incision kept opening .  

Patholgy report shows PR+/ER+  HER-.  NO Lymph node involved.  Waiting for Oncotype Dx test resuls with fingers crossed.  Should hear from the doctor on Wednesday. 

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Jan 2014 Breast Cancer  2 Positive nodes.  Very small tumor not agreesive hormone receptive.  OC suggested the   oncotype test.  Score was a 9. I was age 59 at that time.  OC said I could do the chemo if I wanted might up the reaccurance score 1.5 or 2 points.  He said he was ok with me doing chemo or not.   I did not choose to do chemo.  I take letrozle.  I had a right mastectomy.  1 year out.  Any one like this?  

Yes forida2015.  But with that said not as bad as the arimidex.  I have hot flashes, and some stiff joints with the letrozole, but not as bad as with the arimidex.  I had stage 2B.  I had two positive nodes, low grade, not aggressive.  My onocotype score was a 9.  My OC said he was ok with me not doing chemo.  I choose not to do the chemo.  What about you?