later oncotype test

Hodgy,

My MO didn't order the Oncotype for me "because I think it will be between 4 and7".  I would rather see the number for myself so I called the MO's office and had them order it anyway.  You might try calling the office to see if it can be done.I will still be in rads when the results come in.

I would call my ONC and order the test. I'm like you I would want to see for myself. It's too big a gamble to just accept what the Dr thinks. BC is a crapshoot. Don't play Russian roulette with your life. And thenthere's he could be wrong.

Btw I had the test and glad I did. Low score and dodged chemo as a result. No guarantees but eased my mind a bit. Radiologists and oncologists both trust the test.

Good luck!

Diane

The problem with ordering the Oncotype Dx test this late is that the information it provides is unlikely to provide any substantive change to your treatment choices. The purpose of Oncotype testing is to determine whether adding chemotherapy to hormonal therapy is likely to provide benefit. Since the optimal window for chemo has passed the information will have less bearing, and your insurance is highly unlikely to pay for this expensive test knowing it provides little information that can be acted upon. You have had surgery and radiation, which were appropriate choices for your situation, and you are on hormonal therapy now, which is hopefully providing you protection for the future. I think the question you have to ask yourself is whether knowing that you had a higher Oncotype score than your oncologist thought you might, would you change anything you are currently doing - and what would that be, or would this knowledge just worry you more than you might otherwise be? It is unfortunate that we all have concern about whether our treatment did what it was supposed to, or whether we will recur or progress - it is the nature of the beast.

Hi Hodgy:

I don't really know, but SpecialK raises a good question about whether or not chemotherapy would be beneficial and indicated six months out from surgery, a point you could take up with your providers.

I note from above the invasive component is stated as 5 millimeters. I think you are saying you had DCIS (1.2 cms) with an invasive component (IDC) that was 5 millimeters. The size of IDC controls this decision. It may help you to know that for Hormone receptor-positive, HER2-negative invasive ductal carcinoma, which is pN0 (node negative), for a Tumor ≤0.5 cm, the National Comprehensive Cancer Center (NCCN) Guidelines (Version 3.2015) provide:

"Consider adjuvant endocrine therapy"

So for 0.5 centimeters or less of this type of IDC, neither an Oncotype DX test nor chemotherapy are recommended under the guideline.

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It may also help you to know that under the current NCCN Guidelines (Version 3.2015), for Hormone receptor-positive, HER2-negative invasive ductal carcinoma, pT1, pT2 or pT3, node negative disease, with a tumor >0.5 cm, it says (emphasis added by me):

"Consider 21-gene RT PCR Assay"

This is a reference to the Oncotype DX test, and as SpecialK notes, it is not a blood test per the Guidelines: "The 21-gene assay using reverse transcription polymerase chain reaction (RT-PCR) on RNA isolated from paraffin-embedded breast cancer tissue (Oncotype DX) is among the best-validated prognostic assays. . ."

Note that the Guidelines use the word "consider" indicating it is also within the guidelines to NOT perform an Oncotype DX test even when >0.5 cm. In this case, when the Oncotype DX test is not performed, the Guidelines further provide the following information regarding treatment:

"Adjuvant endocrine therapy ± adjuvant chemotherapy"

Thus, the Guidelines include a chemotherapy decision based on the usual traditional factors even for >0.5 cm (with the stated features).

BarredOwl