Oncotype DX score 31. chemo or not?

We have very similar BC stats and my MO did not think it was a choice on whether I should do chemo. My Onco DX was 38, so I did four rounds of TC and am now on Tamoxifen. It was all very "doable" and I continued to work throughout treatment. My risk of recurrence is now between 8-14%.

Do it and rock the bald look!🎀💪

Didn’t realize they give chemo for node-negative pure DCIS. Isn’t the OncotypeDX for DCIS score supposed to determine the need for radiation, not chemo?

Assuming the OP meant invasive cancer, I'm still surprised the tumor was sent off for Oncotype testing, as the NCCN guidelines don't typically recommend chemo for tumors <5mm.

A high Oncotype of 31 would make more sense for pure DCIS, as the DCIS ODX scores are much higher than for those with invasive disease, but as pointed out above are used to determine the need for radiation, not chemotherapy.

Please make sure whether you have DCIS or IDC. A score of 31 indicates quite different things for each of these. The former whether to have radiation or not and the latter to have chemo.

I had IDC and a score of 30, the highest Intermediate score. I went forward with TC chemo. 31 is the lowest high risk score for the Oncotype for IDC. Except for unusual circumstances and maybe a very small tumor, chemo is usually recommended.

My hair started to fall out about two weeks after my first chemo treatment of taxotere/cytoxan. I chose not to get a wig and just wore hats - my treatment stated in October and lasted until January and it was cold so I would have had a hat on anyway. Chemo wasn't bad but the Neulasta was horrible. It was like I had the worst flu. But I got through it and it is al behind me!. My oncotype dx score was 25 and my MO said he felt I needed chemo and I trust his judgement. I was told from the beginning diagnosis that I would have to have radiation. My cancer had spread to the lymph nodes. I had 12 weeks of chemo and 6 weeks of daily radiation.

sandyp11, Your latest post said that your are DCIS, Stage I and that it is invasive. That is confusing because DCIS (contained within the duct and not invasive) is Stage O and the Stages 1-IV are used with IDC, which IS invasive.

I am wondering is you are confusing Stage with Grade?

If your tiny tumor had a bit of microinvasion happening, that is what the radiation was supposed to address. Even with an Onco score of 31, I am not at all clear why chemo would need to be considered.

If that risk of recurrence percentage is coming from the Oncotype report, maybe you could ask for it to be presented in another way. A lot of doctors use a program called Adjuvant Online. In fact, you can check that out online yourself...but you have to be a "doctor" to do it.

Sandy,

Do you have a copy of the Oncotype DX report? If so it will specify whether the sample tested was DCIS (and your score reflects need for radiation) or IDC (and your score reflects efficacy of chemo AND Tamoxifrn/AI). The scores are NOT comparable; the DCIS scores (which are historically higher than the invasive Oncotype scores) cannot be also used to determine the need for chemo. Two totally different tests with different scores and different uses. You really need clarification on this point before deciding on chemo.

I understand a bit better now that you have given more details. Maybe still find out what the Grade was? If you have Grade 2 or 3, that level of aggressiveness may be behind your Onco score of 31. What I mean is, even tho' it was only microinvasion, it may have aggressive growth features. That is a factor to consider when thinking about doing chemo or not.

sandyp11,

You must have the Oncotype paperwork from the IDC. My IDC score was 30 and the recurrence risk after Tamoxifen was 20%. A report on DCIS would not have mentioned risk of distant recurrence.

So the difficult question for you is whether or not to do chemo for a tumor that is small. Mine was considerably larger, 1.5 cm. I'd suggest getting a 2nd or 3rd opinion from MOs not associated with your current one's practice, if at all possible.

I managed TC ok and worked throughout treatment. Still I had a serious SE that would have been life threatening if not treated immediately. Chemo is not w/o risk of serious complications, yet has real benefits for some. Unfortunately we don't know who in the lower stages really needed it. It should be considered with care from both angles.

Sandy, I'm not amazing. I have bills to pay and I'm a desk jockey. I do chemo on Wednesdays so my high fatigue days happen on the weekend. I have had to use a couple of personal days here and there but I had saved them for just this reason when I was first diagnosed.

Biology trumps stage. In other words, the Oncotype score is more important than the size of the tumor.