http://www.practiceupdate.com/c/43073/1/1/?elsca1=...

Rate of Distant Metastases in Women With Breast Carcinoma and an Oncotype DX Recurrence Score <18

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• This was a single-center, retrospective study. The authors assessed the rate of development of distant metastases in 1406 women with early-stage ER-positive, HER2-negative breast cancer who had low recurrence scores on Oncotype DX testing. Overall, 1361 patients (97%) received endocrine therapy and 170 patients (12%) received chemotherapy. Only 6 patients (0.4%) developed distant metastases over a median follow-up of 46 months. The absolute rate of distant metastases among patients aged <40 years was 7.1% (3 of 42 patients) versus 0.2% among patients aged ≥40 years.
• The rate of distant metastases over 5 years in women with early-stage ER+/HER2− breast cancer and low recurrence scores is 0.4%, although younger women have a higher rate of distant metastases.– Jeremy Jones, MD

Going back to Doc's wages etc. and slightly off topic but, this is a website where you can see if your Doc receives payments from Pharmaceutical or medical device companies - a nice supplement to their annual. Perhaps good information (or perhaps not for those with a 'suspicious' mind? Just be aware that even the lunches that the reps bring in count towards the total.....

https://projects.propublica.org/docdollars/

Thank for the info on dose dence ac+t. 6dd was what I received two yrs.ago. I still have problem with neuropathy in hand and feet.

labelle....most hospitals only receive a fraction of what they bill. My message is simple. We all need to avoid generalizations and simplications. And , my best advice is to first look at pubmed, the NIH's clearinghouse for journal studies.

BosumBlues I have talked to breast cancer survivors that need to exercise that live in tough inner city hoods. Sure there are parks and malls but they are all too dangerous to even powerwalk. I know I wouldn't want my kids (if I had kids) playing in those areas. Their lives are in danger Chicago Tribune Linky

Doctors also receive a fraction of what they bill unless you are paying cash. If they have Medicare mostly pts or worse Medicaid/Cal then it's really not much when you think of all their education, malpractice insurances.. Insurance has caps on what they get called allowable. I worked for a high end popular surgeon who was one of the pioneers in minimally invasive knee and hip replacement surgeries for 10 years. Medicare allows roughly $1500 a joint. But he bills much more so he can get the maximum allowable by insurance. He's doing better now that he is out of network with majority of PPOs but you'd think this guy would be richer than he is, and he deserves it having worked hard studied hard. And ever wonder why they are overbooked? That's why. To make up some for what insurance puts a cap on. And he gets no money from pharma. As with all professions, there are dirty people in all. Who they are you don't always know but to group them all together is simply wrong. Just like saying all cops are dirty every time someone was shot by cop where's there's a question about it..

Also just to add, when the economy sucks docs like dermatologist and plastic surgeons are hit. People don't go to the doc if they are hit hard unless it's necessary. Hence why certain specialists do well years round like my surgeon because you can't put off bad knees/hips once the pain and mobility has gotten unlivable.

BCO recently retweeted this infographic on Twitter.

cp418, your article at the top of this page is for patients with an oncotype of less than 18 so that headline is really skewed. There are also tens of thousands of patients that don't even get an oncotype. It's those kind of articles that make lay people think it's rare to metastasize.

bosumblues,

This dedicated teacher thanks you. I am so lucky to go to work and do what I love everyday

Molly50..honesty I've read sooooo much that I didn't keep track but most of what I see is that it's not a great thing and can affect prognosis...I see that it should be considered in young mode negative patients. Bottom line is one needs to decide whatever happens in the future..you need to be comfortable with your decision now if it is left to us. That's what I am going with. There is no black/white answer for this.

Thanks Minus Two amd Bosum Blues!!

lmencken, It is such a hard decision and no matter which you make, know you made the best decision you could with the information you had at the time.

I think second opinions are good from NCI centers, but my experience at a really good one is that their recommendations will be purely numbers based. When I had my recurrence, the doc at a very well known, well respected cancer center told me it was just a simple local recurrence because my surgeons must have left some behind. He disregarded the pathology change, time to recurrence, would do no further testing and simply recommended radiation and an AI. My gut told me otherwise, and my gut has never been wrong. My local doc told me I am an individual, not a number, and we need to look at my unique case. He told me he felt that my cancer was absolutely not behaving as it should, recurred quickly, recurred in multiple places, etc. He strongly recommended chemo which was my preference and did oncotype to help confirm. It was 40! When I messaged that info to the doc at the big cancer center, he agreed with our decision to do chemo. So my take is that a second opinion is important, but use the information from both doctors to make the decision that is best for you. Ask them what specifically about your unique case makes them recommend chemo or no chemo. If they say. "Research shows xxxx" then ask if their personal experience supports the research because you are a person, not a number. Specifically ask them whether the LVI will be adequately addressed with radiation, and how much risk it poses. Best wishes. I know it is a hard decision

kayb I too agree MDs work hard for every dollar…and they don't make as much as they used to. You want to make money better luck in the financial industry.

Lmencken, also keep in mind my tumor was strongly ER and PR positive and I had mastectomy plus a lot of radiation to make sure that the cells were killed.

I dunno.. I can dig it out, but I've read that some chemo actually makes room for the cancer stem cells to flourish. My gut tells me (as a 41 year old) that if I chose chemo, I'd end up with a more aggressive cancer than if I chose hormonals only. KBee, I can't say that is or isn't what happened to you. Perhaps that early chemo you did simply made it come back sooner and more aggressive. I disagree that because you are young, you should go the chemo route. it ALL depends on your type of cancer/tumor.. and what your heart is telling you.

KBeee...wow..I wish I had your gut! So glad you pushed on! I originally had a good gut when an OB- Gyno told me my lump was a muscle pull or defect..my lump was high near pectoral..and I then went to my regular Doc who sent me right over for a stat mammo.

Now my gut is waffling back and forth. I will take your advice with me when I talk again to MO Wednesday. I just hope I can make a decision then. I am notoriously bad at it. He did tell me that chemo was like a bunch of knives waving around everywhere and the hormone pill was like a gun. He said don't take the hormone meds lightly..it's still a beefy treatment.