KI-67 test never done during biopsy and told no now when asked

Hi PSW. My first thought was the same as muska's: with such a large tumor, it seems chemo would be strongly encouraged.

My lab didn't do the test when I was first diagnosed four years ago. My MO believes the results are unreliable. When the lab started doing the test a year later he happily sent my tumor over for testing because I was curious, but I'd already had chemo and it wouldn't have changed my treatment.

My MO never ordered the Ki67 test. I was stage IIIA, triple positive, Grade 3, and bound for chemo anyways. Why do you think a Ki67 test would make a difference, given that your tumor is over 5 cm. and you have 5/10 nodes positive? Does it make a difference with ILC as opposed to IDC? I have IDC; can't really speak to ILC. Good luck!

When I asked my MO about Ki67, he said "well, that's the poor man's Onocotype score" implying that knowing my oncotype score meant no need for a ki67 score. He also said that it is not a reliable metric. So here is a question for the boards: are these scores, whether ki67 or Oncotype, etc. useful to have beyond a chemo decision? I think if I were in PSW's position, I would be frustrated to know that ki67 isn't done, and Oncotype testing isn't called for because chemo is a given. We all want as much info as possible. Would we maximize this information by having our genome or tumor sequenced? is that not too far into the future?

Oncotype test is for women with DCIS. They have started using it on women with IDC if only 1-3 nodes were positive. The jury is still out on how useful or accurate it is for women with IDCs. No oncotype is done for stage 3 - the cancer is already locally advanced.

Being stage 3 myself i have not had much interest in getting tests that do not matter for treatment decisions and are not very reliable to begin with. At one point, I asked my MO about CTC - circulating tumor cells - whether she can do it. She said she can but she doesn't do it because they don't know what to do about the results.

"The test is intended for use in all newly diagnosed patients with early-stage (stage I, II or IIIa), breast cancer who have node-negative or node-positive (1-3), estrogen receptor-positive (ER+), HER2-negative disease."

Source: http://www.genomichealth.com/en-US/oncotype_iq_products/oncotype_dx/oncotype_dx_breast_cancer

I for one am grateful for the Oncotype test. I dodged chemo because of my low score. A radiologist friend said it is very reliable and a lot of oncologists are using it as a guide for treatment. My oncologist said they had been over treating women for years so this test has been instrumental in determing the benefits/or not of chemo. It's not a perfect test - no test is. It also tells you the likelihood of a recurrence by percentages. Mine was 8%.

My BC is IDC, Stage 1b, Grade 1. My score was 11. I will be 5 years out August 22.

Diane

Excellent article kayb! That is one for the file!

The Oncotype test is only for those with 0-3 positive nodes. PSW had 5 positive nodes, therefore would not be eligible for the test.

PSW, my situation may be different since mine was nearly 4 years ago and maybe they didn't do these tests routinely, I don't know. But I never got the KI-67 test and I never got the OncotypeDX test. I knew nothing about these things at the time. It would not have occurred to me to ask for them later when I did learn about them. At the time of my surgery they found cancer in 3 nodes so that was it, I had to get chemo and rads. No test would've changed that. Likewise I never would have agreed to chemo if my nodes were clear, no test would change that either.

No one ever sent me, or gave me, any copies of any of my test results. The docs act like it's some kind of secret only they can read. I did eventually get a copy of my path report from surgery but I had to ask for it..... Persistently, as I recall.

jenn32214 your Oncologist would be the person to ask about the OncoDX test.

PSW my cancer was lobular and all low grade. My KI67 was less than 9%. I had one positive node. No LVI. My Onc did suggest the OncoDX but it's not covered be Medicare here in Australia and I didn't have a spare $4,000 to pay for the test. In the absence of an Onco score and although I knew that both Lobular and low grade cancers are less responsive to chemo I went ahead with 4 rounds of Taxotere/Cytoxin. Even with the 1 positive node radiation was not recommended for me. We make treatment decisions that we feel are best for us with the information that we have. Wishing you the very best. Donna.

My MO said she is ordering oncotype tests on all of her Stage III patients. I was Stage I, so didn't pursue it much, but she said it helps her understand how aggressive the cancer is. How she uses that information, I have no idea.