MY BS doesnt do Onco test - 1 pos node and straight to chemo!!!

I would want the oncotype test done. Latest studies are showing it to be accurate for women with 1-3 positive nodes. Both breast centers I consulted for treatment told me a low oncotype score trumps one positive node and neither recommended chemo for me despite that positive node and neither center's oncologists would even make a recommendation about chemo one way or another w/o knowing my oncotype score. They rely that heavily upon it. IMO, the more they know about the make-up of your tumor the better and while it used to be a positive node meant chemo automatically, that is not the case today. Try to get a second opinion from another oncologist not affiliated with the first. I don't remember exactly how long it took to get my oncotype test back, but not more than a few weeks. In my case, they used tissue from my core needle biopsy, so I knew the results before I even had surgery, but from reading on here most women don't seem to have it done until after they have surgery using samples from their lumpectomy or mastectomy.

You can safely use oncotype for up to 3 nodes I believe. I had a consult with an MO before my surgery and we agreed we would send for oncotype with one or two positive nodes. The sample wasn't sent for testing until about 10 days after my surgery, and it took about 2-3 weeks after that to get results. Besides, you wouldn't want to start any kind of treatment for a month after surgery until you're all healed. Hugs.

Another point to consider is that ILC doesn't always respond as well to chemo as IDC. especially if not Grade 3.

You’ve yet to have surgery and SNB, right? Unless you had a pretty good-size tissue sample from your biopsy, it’s highly unusual (though not unheard-of, since labelle had it) to do OncotypeDX before surgery has removed the entire tumor and its margins. Until surgery, they can’t be sure that you have pure ILC, they don’t know for sure your stage--how many positive nodes you have and the actual size of the tumor--and they usually don’t have enough of a sample to send off for Oncotype testing. All these factors will determine whether your cancer is obviously aggressive enough for chemo, obviously non-aggressive and highly unlikely to respond, or in that “gray area” for which OncotypeDX was developed. (Mine, though ER+/PR+/HER2-, no LVI, and staged as IA, would have been a slam-dunk for no chemo, but for its size--1.3cm, nearly twice what the ultrasound indicated--so the BS suggested to the MO that she order the test even before my first MO appointment). It’s not an inexpensive test, and some insurers might balk at paying for it if the tumor doesn’t fall into that “gray area."

No it doesn't sound right get all the info you can on your tumor and then YOU make your treatment decision.

This was the standard of care but Oncotype testing has become available to identify patients who would/would not benefit from chemo. The one size fits all for a positive node is old school IMO. I would not allow any doctor to deny me this valuable information even if you still do need chemo.

http://health.usnews.com/health-news/articles/2016...

Hi Warrior, as SpecialK pointed above your post-surgery care falls under the control of medical oncologist. (s)he will need surgical pathology results to assess whether oncotype is useful in making your treatment decisions or not. You will need to discuss with him/her. Insurance will not cover the test if you don't fit prescription requirements. There is one thing I would like to mention here: your MO is much better equipped to make this decision than anybody on this board. You need to trust your oncologist is working in your best interest. If you have questions about these decisions by all means bring them up and listen to what (s)he has to say, get a second opinion if you disagree. And always remember oncotype is just a test that assesses the risks based on currently available genes data and low oncotype is not a guarantee of no-recurrence.

I very much hope you will fall into the group for which oncotype is prescribed, i.e. up to 1 -3 positive nodes and no other complicating factors. In my case, I went into the operating room expecting to be stage 1 and woke up stage 3. When I asked my MO why she didn't order oncotype I was told I needed chemo no matter oncotype score.

Good luck with your surgeries!

HI there, the Oncotype dx, is now standard of care even with lymph node positive cancer. You may want to request the doctor order it. Now that its standard of care most insurance cove the cost and if yours doesn't the genomic health folks work with you and I had the remaining balnce waived even with a 6 figure income. They're keen on the testing and will work with you and your insurance as this costs way less than chemo and in 25% (?) of cases changes treatment decisions.

Good luck to you and what you decide to persue.

Hi:

It sounds like your node status is currently unknown, and you could still be node-negative.

To expedite matters, you can certainly look for an MO now, and set up an appointment at a time post-surgery when your full surgical pathology and associated test results (ER, PR, HER2 status) will be likely complete, and be made available for review by the MO.

The test is usually run on surgical samples, as explained here:

Timing: http://breast-cancer.oncotypedx.com/en-US/Patient-...

Surgical samples are more likely to be available in sufficient quantity and quality for conducting the test. With respect to quality, samples submitted must be suitably prepared and should be sufficiently "representative." As you can appreciate, the submission of "representative" tissues is best made with full surgical pathology available. For example, the submission form states: "List the most representative specimen (i.e. the highest grade and largest tumor) on line one."

Since nodal status is a factor for eligibility, axillary staging should typically be completed when eligibility is determined. This is another reason why eligibility is usually determined post-surgery.

Minimally invasive biopsies are not always representative of what is found post-surgery. Thus, as noted above, ER, PR and HER2 status will again be determined on surgical samples, and this information, together with your nodal status will determine your "formal eligibility" for the test. Here is a link to the professional page with current "formal eligibility":

Formal eligibility: http://breast-cancer.oncotypedx.com/en-US/Professi...

As with any such test, there may be considerations other than formal eligibility, such as the scope and quality of clinical validation of the test as it pertains to you personally.

Consensus guidelines are a useful starting point for information gathering. Consensus guidelines treat the Oncotype test quite differently in the node-negative versus node-positive settings. For example, the NCCN guidelines prominently feature the test in node-negative patients (See NCCN guidelines for Breast Cancer, Professional Version, 1.2016, Chart BINV-6, at page 18, available for free with registration at www.nccn.org).

In contrast, on Chart BINV-6, at page 18, the NCCN guidelines refer to the test in a footnote for node-positive patients, saying it can be "considered" in select patients with 1–3 involved ipsilateral axillary lymph nodes. See also, the discussion section in the paragraph bridging pages MS-24 and MS-25 (under revision).

In addition, in February, 2016, ASCO issued the following guideline regarding Oncotype for invasive disease and other tests:

"Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline"

2016 ASCO Guideline Main Page (see "Full Text" at right): http://www.instituteforquality.org/use-biomarkers-...//www.asco.org/guidelines/adjuvantbreastmarkers

2016 ASCO Guideline Document: http://jco.ascopubs.org/content/early/2016/02/05/JCO.2015.65.2289.full

Please see Recommendation 1.2 regarding node-positive disease and the Clinical interpretation of literature review and additional remarks in the Data Supplement.

This guideline includes a discussion of analytical validity, clinical validity and clinical utility, and the criteria for determining these, including an assessment of the quality of the evidence based on the types of studies then available.

Since the ASCO guideline came out, new evidence from a prospective trial became available for certain node-positive patients, and more may become available. Thus it is critical to seek accurate, current, case-specific expert professional medical advice from a medical oncologist regarding the potential value of the test in your specific case in light of currently available clinical evidence.

For this or any other test described, patients interested in any test should not hesitate to inquire about the information in the 2016 ASCO guideline and what it means (in light of other relevant guidelines and recent studies), regarding the use of the test in their specific case, appropriate uses of various test outputs, and the scope and quality of validation in patients like them (e.g., node-positive, ILC).

BarredOwl

[Edited to add: Because of the above, as of this date, I do not think it would be accurate/complete to say that "the Oncotype dx, is now standard of care even with lymph node positive cancer." Use of the test in the node-positive setting may be within "standard of care" and within NCCN guidelines in the appropriate case, but not using it in the node-positive setting is within both NCCN guidelines and ASCO guidelines.]

[Edit 3/23/16: Add working link direct to 2016 ASCO Guideline document]

I spoke to a woman recently who was diagnosed 6 months ago with BC. She didn't do chemo or rads even though she told me she had 2 nodes positive. I didn't want to press because we met officially for the first time after her 20 year old daughter died in a hit run with a drunk driver. I'm concerned for her. Since some or most of you know a lot about how they decide who get chemo when it falls in a gray area, I thought I'd ask why that would be the case for her? My BS told me that with IDC that I would at a minimum get rads and chemo if in my nodes. If it's in your nodes it has to be invasive!

Hi HomeMom:

It may be a reasonable treatment choice for her, and may be within treatment guidelines. All "IDC" is "invasive", whether it is node-positive or node-negative. Node involvement is evidence of loco-regional spread, but there are differing degrees of involvement, with different prognostic significance and implications for treatment.

There is little information here about her actual diagnosis, co-morbidities, and treatments, so one can only speculate. Perhaps she did not receive radiation because she had a mastectomy?

Perhaps her tumor was smallish and her nodal involvement was quite limited (e.g., pN1mi Micrometastases (greater than 0.2 mm and/or more than 200 cells, but none greater than 2.0 mm)), for example, Stage IB disease? Depending on the type of cancer and clinico-pathologic features, for pN1mi (≤2 mm axillary node metastasis), chemotherapy is optional in some cases under the NCCN guidelines.

Perhaps she is hormone receptor-positive, HER2-negative and with 2 positive nodes, was formally eligible for the OncotypeDX test, and got a very low Recurrence Score, such that her MO felt that in her particular case, she could reasonably choose to decline chemotherapy and rely upon endocrine therapy alone. Other favorable prognostic factors, co-morbidities (risk/benefit), or considerations like age > 70 may have affected the decision. Other scenarios are possible.

I wrote in detail above about how current guidelines treat the use of OncotypeDX in the node-positive setting, but guidelines are a snap-shot in time, and treatments are individualized.

BarredOwl

Hi HomeMom:

Sometimes patients receive axillary node dissection instead.

http://meetinglibrary.asco.org/content/109779-132

BarredOwl