30 Years Old, Oncotype Score 18 - To Chemo or Not?

BrittanyY · July 2016

Hello. I am 30 years old and recently underwent a lumpectomy last month which showed clear margins and no node involvement. My breast cancer is IDC, ER + (99%), PR+ (85%), Her2-, Ki-67 status 4%, and stage 1A, Grade 1, mitotic score 1. My tumor was 10 mm. I am BRCA 1 and 2 negative. However, my Oncotype score came back as an 18, and my oncologist says it's up to me whether or not to do chemo. I am at a complete loss. For someone my age, would you recommend chemo given my diagnosis, or simply radiation and Tamoxifen? Any personal experience, research, insight, etc. would be so deeply appreciated!

Englishmummy · July 2016

Hi, this is a tough call and I am so sorry you join us here - I will not proffer any advice but I will point you in the direction of a user in a similar predicament to yourself, she was almost 31 when she was diagnosed last year and had similar pathology. Her user name is Tshire. You can search her out on here and read her dilemma,the conclusion she came to and why. I am not sure if she still posts but I am sure she would be willing to chat if you liked?

Also, there is a thread for young women in their 30's - https://community.breastcancer.org/forum/27/topics...

Myself, I am 42 (I thought 41 was young:( mum of 3 and a year out from dx and I just want to let you know that it does get easier. Things fall back in to place. I wish you all the luck in the world with your decision. Big hugs, Laura x

Edited to add link.

Lisey · July 2016

Hi, your age is obviously the ONLY negative to all your stats but the oncotype. The fact your Ki67 was single digit is great and honestly, having a grade1 mitoesis rate of 1 means chemo willl not work on your tumor... so there is no point.

The only reason your onco was high was probably due to factoring your age in... If it were me, I'd not do Chemo as the risks would outweigh any benefits of a grade 1, mit. 1 tumor.

See, I have an Onco of 20, and mine is a grade 2 tumor, miteosis of 1, but my PR is much lower. I'm 41 and on the fence about chemo, so I'm doing the mammaprint to settle the issue... I'm actually quite hopeful I'll not do chemo either, most stage 1As don't have chemo with ER+/PR+/HER2- tumors. I think only grade 3s would.

keepthefaith · July 2016

brittany, grade 1 is a low grade. Chemo responds best to higher grade faster growing tumors than slower ones...for what it's worth. Good luck with your decision.

nash · July 2016

Given your stats, I would say no chemo.

I was oncotype 18 at age 38. I did chemo, but I had a larger tumor and an aggressive subtype. I recurred anyhow, while on Tamoxifen, so basically I flunked surgical excision, chemo, radiation and an extended course of Tamoxifen (I was going into year 8 of it). My point is not to scare you, but rather to point out that one can throw everything at the crap and it can still come back. So given your favorable stats (aside from your age), I'd say skip the chemo. The benefits won't outweigh the side effects and risks.

farmerjo · July 2016

Yes, Lisey! MammaPrint definitely settled the issue for me!

BrittanyY · July 2016

Thank you all for your support and feedback. I am going in for a second opinion at MD Anderson and hope that will offer me some clarity as to whether or not to do chemo. I hope you're all well, and I appreciate you sharing your insight with me!

Fallleaves · July 2016

Hi Brittany,

(Edited cause I didn't know what I was talking about) Anyway, I'm sure getting a second opinion will help you figure it all out! Good luck with your decision!

Anonymous · July 2016

Hi there,

I had a similar diagnosis... Mine was Stage 1 Grade 1 clean margins and no node involvement. ER+ 90% PR+ 75% HER2- ( Fish)

My oncotype was higher (25) and so was my Ki67....

I am also older than you at 58 years old.

I too agonized over the question about the benefits of chemo... When I met with my MO he told me that without chemo my odds of recurrence are 12% If I did chemo it would bring it down to 9%.. I did not feel that the 3% difference was worth the effects of chemo.. so I opted out of it... Maybe you can gt a percentage difference of no chemo vs chemo The MO said that was a reasonable decision given the fact that I was Stage 1 Grade 1 had clean margins and no lymph involvement. I only have 8 more radiation treatments left and i have been taking Femara for 3 months without any side effects.

I have made my decision and have chosen not to second guess myself and just move forward.....It is a crap shoot anyway so you have to make what decision you are comfortable with and not look back

Good luck in your treatment... Please keep us posted.

Diane

Totallytubular · July 2016

Hello Britney,

This is a very difficult decision. I had an oncotype score of 21 and opted for chemo.

Just finished. I got a second and third opinion. I think having the second opinion at MD Anderson

Is great. I appreciate a stronger point of view than.. Decide yourself. It feels very overwhelming.

Those second and third opinions make all the difference. Chemo is difficult and not without it' slide effects. but you can survive it if they think it's beneficial. Listen to the reasoning.. I hope you are able to do well without chemo. This period of shock and treatment will end and you will begin to feel better.

Best of luck to you,

Xo Mary

Totallytubular · July 2016