Oncotype and Pam 50 are both intermediate! Help!!!

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Sunflower64
Sunflower64 Member Posts: 166
edited September 2016 in Second or Third Breast Cancer

Ladies!

My Oncotype and Pam 50 test came back intermediate!!! Idk if my insurance will pay for another test if I want to get a Mammaprint test done! I wish my Dr would of ran that instead but I didn't know about it!! What should I do

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  • keepthefaith
    keepthefaith Member Posts: 2,156
    edited September 2016

    SF, Idk what the PAM 50 is, but I believe that the mamma-print is ordered if you have an intermediate onco score. I was a 21 and my MO offered it, but I chose not to do it bc of the wait. Just wanted to get started on my TX. Good luck!


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  • SpecialK
    SpecialK Member Posts: 16,486
    edited September 2016

    I believe if your insurance company refuses payment for a Mammaprint, or you wish to go self-pay, the cost is $500 for the patient. You might PM the member Lisey, she sought Mammaprint after an intermediate Oncotype Dx, and I believe that was her out of pocket cost.

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  • KBeee
    KBeee Member Posts: 5,109
    edited September 2016

    Your choices now are to get a second and/or third opinion, see if you can get mammaprint, or make a decision. I know these are hard decisions; it would be so much easier if we had a crystal ball to know what our future holds. I find that making a list of paper of the pros and cons of my choices helps to make it clearer for me. Best wishes. Keep us posted.

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  • BarredOwl
    BarredOwl Member Posts: 2,433
    edited September 2016

    Hi Sunflower64:

    Please discuss the meaning of this latest result with your MO. Possible questions include:

    (1) Why was this test selected in my particular case versus another test, such as MammaPrint? Are there possible advantages, for example based on the output, patient populations in which the test was validated, or other factors?

    (2) Was the test conducted the Prosigna version of PAM50? (i.e., Prosigna Breast Cancer Prognostic Gene Signature Assay; NanoString Technologies, Seattle, WA) Please obtain a complete copy of the test report for your review and records.

    (3) What was my ROR score? What is the risk of recurrence associated with this score? What type of risk estimate is that (e.g., 5 year? 10 year? Distant? other?)

    (4) Does the test result also provide information about "intrinsic subtype" (e.g., Luminal A, Luminal B, others)? If so, what are the implications of having this subtype?

    (5) In light of relevant clinco-pathologic features, the Oncotype RS, PAM50 ROR, and intrinsic subtype information (if applicable), what is your recommendation regarding adding chemotherapy?

    You mentioned in another thread that your Oncotype Score is 27. I am still not clear on your actual lymph node status (N0 or N1mi). If you are not sure, please check your pathology report for stage or TNM information (e.g., pT1 NX MX) or ask your MO to explain your exact stage and lymph node status.

    If you are purely node-negative "N0", please see this discussion of intermediate Oncotype scores:

    https://community.breastcancer.org/forum/147/topics/842209?page=3#post_4768276

    The above post includes a link to this page with a graph based on the node-negative ("N0") studies of Paik (2004) and Paik (2006), and which you should discuss with your MO or a second opinion MO:

    http://intermediate.oncotypedx.com/en-US/The-Recurrence-Score-Result/How-An-Intermediate-Recurrence-Score.aspx

    Please understand that these tests are based on comparisons of groups of patients. They can provide population-based "prognostic" (e.g., recurrence risk) information and may sometimes provide population-based "predictive" information (regarding benefit of added chemotherapy), that can assist in decision-making. However, such tests do not predict individual outcomes.

    BarredOwl

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