chemo no chemo

Hi marge and gentle hugs to you. I think it is good to get a second opinion. Your recurrence score of 26 is intermediate so having another opinion would be helpful. I was also expecting to skip chemo, but when I got a score of 24 and my oncologist recommended chemo, I decided to do so. I had already done research and knew that I would probably have an intermediate score because I am PR-. I was also aware of the risk reduction I would get with each score, so I had already decided that if my score was 21 or lower....no chemo....above 21 chemo. Sadly, there are no guarantees that chemo will prevent a local or distant recurrence. There are also risks that come with chemo that have to be considered. I am a healthy, active person, so I felt confident that I would make it through chemo and I was right. I was able to work through surgery, chemo and radiation with minimal down time. I even had fun and was able to schedule travel. Chemo, fun? Nope, but most of us make it through just fine. My advice to you is to ask the most important questions of your 1st and 2nd opinion oncologists. If they are or are not recommending chemo, make sure they tell you why. My oncologist's reasons for recommending chemo were specific for me....1)My oncotype score was in the gray zone, but not at the bottom, 2) I would reduce my recurrence risk % from 16% to 12% 3) My ER+ cancer was more aggressive because I was PR- and my HER 2 was - but not 0, despite being node negative 4) I was healthy and could tolerate chemo 5) BC has no cure....this was my shot at a cure.

Do not skip chemo or do chemo because it is that doctor's cookie cutter approach.

Good luck and once you make your decision, don't look back.
MsP

Hi Marge, I was 53 when I was diagnosed. I had a lumpectomy and clear nodes, so expected that I would go right to radiation, and was very unhappy when my oncologist recommended chemo (this was in 2007 before the oncotype was being done). After a lot of soul searching and a long talk with my beloved general practitioner, I did the chemo. The reason for me doing chemo was that I had a big (4 cm) grade III tumor which came up from nowhere 6 months after a clear mammo.....so, even though it hadn't shown up in my nodes, I knew it was aggressive (there was a 50/50 chance, in my case, that micro-cells had already escaped undetected into my body)..... so I decided that I needed to do everything I could THEN to reduce the chance of ever having to go through it again. Chemo for me wasn't as bad as I had expected. I felt 'off' but worked full time, did everything that I had to do, and most of the things I wanted to do too. Remember, chemo is not the enemy; cancer is; and, if it is warranted, the chemo is working FOR you. Best of luck in making your decisions. This is the worst part. Once you have a plan in place, then you just do it and get it over with.

Annzie50 -- welcome to you as well to Breastcancer.org! We're thinking of you -- please continue to check back in and let us know how your score comes back and the treatment you decide on. We're all here for you!

--The Mods

My dear fellow travelors here,

I finished radiation 4/20/16 (yay! what a couple/three weeks of burning/itchy hell!) and see my Onc first time in a couple of weeks since initial consultation a couple of months ago. I must say I am perplexed by the variation of treatments: chemo, even for low grade small cancers, E, P + as I am. Why not rad and hormone inhibitors only? I do not have an onco score; suppose I will ask for that at my visit coming up. My DCI was 5mm, no nodes stage and grade 1a, clean margins. My question is: others I read here are in the same boat (no HER) just E+ and possibly P+ but assigned chemo. Can someone please enlighten me on why? and perhaps prep me on what to ask my Onc at first f/u visit. Oh, and is it possible my tumor was/is too small to oncotype? I think I've read that here as well. Thank you friends; so relieved and happy I found this site!

Age 63 dx DCI 5mm E+ P+ node-sentinal removed - clear

lumpectomy and rads 21 treatments

Upcoming disc. re: AI

I had the same decision to make my Oncotype score is 24. Having chemo would reduce my risk of recurrence by 4%. I decided the risks of side effects was greater than the benefit and am having radiation and will do adjuvant therapy. The hardest part is being at peace with your decision and I am hoping that if it does come back it will be many years and that there will be a cure. Good luck everyone.

Hello, wondering if your MO used the Oncotype calculator to find your new lower % risk score? Mine has not mentioned it at all. And did that change the recommendation? Thank you.

https://breast-cancer.oncotypedx.com/en-US/Professional-Invasive/Resources/ODX-Tools-RSPC.aspx

Hi Marge. Sorry you have to be here but you're part of a great community. I guess I could say I was in a similar place like you, that grey area of "should I do chemo or should I not". For me, my oncologist originally wanted me to do TCx4 because of one positive node (4mm). I was devastated and a mess in the office. But she mentioned the oncotype test and said it might make the decision easier for me, even though she would still recommend standard chemo treatment. I had the test ordered, and a couple weeks later I found out the score was 15. Low risk! I still went to a second opinion at a Breast cancer center, and they still recommended standard treatment, but said that skipping chemo is perfectly reasonable and might end up becoming standard of care for low risk scores after the RxPonder trial results come out. I agree with another member who mentioned the Mammaprint test. If it's low risk, you might feel much better with skipping chemo. If it's high risk, at least you knew you made the right choice.

There are also things like Grade, LVI, extracapsular extension, and DCIS component that might affect a doctor's recommendation. I had a slow growing tumor, no LVI or extracapsular extension and 30% of my tumor was DCIS. Those things plus the oncotype helped me A LOT with my decision. Wishing you clarity and peace going forward! Hugs.

Dear Marge50:

It is important to understand that your situation ("IDC stage 2A tumor 1.5cm 2 nodes positive"; age 50) is quite different from that of a person with negative nodes (node-negative).

It is my layperson's understanding that a Recurrence Score of 26 for a node-negative patient is not associated with the same level of risk as a Recurrence Score of 26 for a node-positive patient (1 to 3 positive nodes).

Completely different clinical trials, with different patient populations and clinical endpoints for determining risk were used to determine the relationship between Recurrence Score and risk:

(a) Trial NSABP B-14 for node-negative

(b) Trial SWOG-8814 for node-positive

For example, GenomicHealth (the provider of test) web site provides different recurrence risk information for a Recurrence Score of "6" in node-negative patients versus Recurrence Score of "6" in node-positive (1-3 nodes) patients:

Example report for NODE-NEGATIVE, RS = 6 (six)

See the first chart entitled and text to the left of the chart: Prognosis: 10-year Risk of Distant Recurrence after 5 Years of Tam, Based on the Recurrence Score Result (from NSABP B-14)

http://breast-cancer.oncotypedx.com/en-US/Professional-Invasive/Ordering/ReadingTheReports/Node-NegativeReport.aspx

With Tamoxifen Alone: 10-year risk of distant recurrence is: 5% (95% CI: 3% -7%)

Example report for NODE-POSITIVE, RS = 6 (six)

See the first chart entitled and text to the left of the chart: 5-Year Risk of Recurrence or Mortality after 5 Years of Tam, Based on the Recurrence Score Result

http://breast-cancer.oncotypedx.com/en-US/Professional-Invasive/Ordering/ReadingTheReports/Node-Positive1-3Report.aspx

With Tamoxifen Alone: 5-year risk of recurrence or mortality is: 8% (9% CI: 4% - 15%)

The magnitudes and nature of the risk are not the same.

The node-negative information is a 10-year risk of distant recurrence (5%).

The node-positive information is 5-year risk of recurrence or mortality (death) (8%).

These are quite different kinds of risk estimates. Please consult your personal Oncotype report to confirm the magnitude and nature of the risks in your report.

I am glad you are seeking a second opinion, which will provide further opportunity for discussion of the information content of your results re risk, whether other clinico-pathologic features should also be considered.

I note that consensus guidelines from the NCCN and ASCO treat the Oncotype test for invasive disease quite differently in the node-negative setting versus the node-positive setting. This could be a point of discussion with your medical oncologist. Clinicians may be less willing to rely solely upon the recurrence score in the intermediate range with node-positive disease, and may consider additional clinico-pathologic in their advice.

I am a layperson with no medical training, so any information above should be confirmed with your medical oncologist to ensure receipt of accurate, current, case-specific expert professional medical advice.

Best,

BarredOwl

I was a 22 and did not do chemo with a positive node in 2009. At that time I was living on the edge, now there are lots of women with the same scores making that choice. At 26 it's really grey, but there is not great proof that chemo helps intermediates, though the case gets better the higher above 21. It comes down to a hunch. Literally you could flip a coin and the decision would be ok.

Marge

With a positive node, and an oncotype 26, I would have done exactly what you decided; get a 2nd opinion and go for it. You will be OK. God Bless! Everyone in the peanut gallery is rooting for you

Prayers for you both annzie50 and Marge. I am happy you both made a decision and have confidence that it will be a great one.

Hi everyone. Just another story...I was 62 at my diagnosis of Stage 1. My oncotype was 27 and both my docs and I decided on no chemo. I already have an autoimmune neuropathy and we all felt the risks were too great. I also would recommend getting the Mammoprint. I didn't because it wouldn't have changed my mind no matter what but all situations are different. Good luck to all.