The oncotype dx score does not take radiation treatment into account. As you have said it does assume tamoxifen treatment. Tamoxifen reduces your distal recurrence rate by a little less than 50% so you can calculate your distal recurrence rate without tamoxifen.

The oncotype dx test you are looking at the risk of metastatic disease (distal recurrence.)

The assessed biology (ER, PR status, Ki67 among other things) is "baked into" the oncotype dx test score. It is taken onto account. (The final oncotype test result is calculated by pluging the numerical results of individual real time PCR tests into a formula (model) to give the final oncotype dx score. The individual real time PCR test results measure the kinds and amounts of specific mRNA the bc cells are making .)

Thank you BarredOwl - You have done a better job of explaining this - what groups of patients the test is validated for.

Hi:

Another question might be how well are 84-yr olds represented in these studies? For example, TailorX only included women 18 to 75 yrs old. Sometimes, the data is just not there for unique or unusual presentations, which can be frustrating and worrying.

I note that while the J Clin Oncol paper does discuss loco-regional recurrence (LRR), the conclusion emphasized in the discussion is with respect to tamoxifen-treated patients, and it characterizes the result regarding loco-regional recurrence as "hypothesis generating" (see paragraph 1 of the Discussion). Again, those receiving BCT in this study, also received radiation. I do not know whether other studies speak to this or not.

A risk/benefit analysis is a very personalized assessment. Traditional clinico-pathologic features are weighed (e.g., margin sizes, grade, age), co-morbidities, risk factors, life expectancy, and patient preference. The risk/benefit analysis is a very personal one, and patients will often come to different conclusions under similar circumstances, because of their different personal risk tolerances. For example, one person may want to reduce risk as much as possible no matter what, while another may feel the benefit (risk reduction) achieved does not significantly outweigh the risks (of serious side effects).

Because you/your relative are unsure, and because the case is somewhat specialized due to her age, I would recommend that you seek a second opinion. As part of that process, you will receive additional expert input and discussion of the magnitude of the estimated risks of local and distant recurrence and the potential benefits and risks of radiation and/or endocrine therapy. You can ask about the import of studies (outside of the Oncotype context) that did look at breast conserving treatment with or without radiation and studies of endocrine therapy, and whether they might inform decision-making (or not).

BarredOwl