Oncotype dx

I agree with Lisey. My ODX score was 16—and my MO told me the benefit of adding chemo to my rads & AI therapy would confer a very negligible longevity benefit at my age (64 at the time); and chemo would pose greater risks that heart (strong family history) or lung (I have asthma) disease or drug-resistant-bacterial infection (I am allergic to the three major classes of antibiotics) would kill me long before they’d be expected to without chemo. (Statistically, I am at greater risk that my heart, lungs or a bug will get me before bc would). Then there’s that incalculable factor of quality-of-life.

A low ODX score means that your tumor was comprised of slower-growing cells that would not be vulnerable to chemo but would be vulnerable to estrogen-deprivation.

So far, all we know about your situation is that you may have IDC (inferred from posting in the IDC Forum) and that your Recurrence Score (presumably with the OncotypeDX test for invasive disease) was 14 (in the standard "Low Risk" category of 0 to 17).

As discussed above, the question of added chemotherapy entails a risk / benefit analysis. However, this analysis should be based on all relevant clinical and pathologic information available, and not on tumor histology and Recurrence Score alone.

Based on usage studies and recent medical advice provided to members here, it appears that a person might receive different medical advice on these same limited facts, in light of other clinical and pathologic factors, including patient presentation (e.g., age and co-morbidities). For example, lymph node positive status, young age, personal risk tolerance, etcetera.

Re: "wondering if I should still discuss some chemo therapy with my oncologist"

It is not clear to me whether you have already met with a medical oncologist ("MO") or not. If you already met with your MO, please do not hesitate to request an additional appointment to ask more questions, obtain further discussion of the information provided in your Oncotype report, and the basis for advice.

On the other hand, if you received the Oncotype test for invasive disease, but have not yet met with an MO, please be certain to request a referral to a medical oncologist to discuss the question of adding chemotherapy to endocrine therapy. This is to ensure active and case-specific consideration of this question (and of the recommended endocrine therapy regimen), in light of all relevant factors by a professional with the relevant medical expertise (i.e., a medical oncologist).

In either case, you can request a summary of the specific factors that support the advice you receive(d), and ask about the strength of the recommendation. (You can write these down and read them back to your MO to ensure accurate understanding.) This should help you to understand they "why" of the advice, and to gain more comfort in the recommended treatment plan. After that, if you are still in doubt, you may wish to seek a second opinion.

Also, if you have not already done so, be sure to obtain a copy of your OncotypeDX test report.

BarredOwl

If you feel that you'd be more reassured by a second opinion you should get one. Lots of us have.

That said, your stats all point to an early stage slow-moving cancer that would be responsive to anti-hormonal and radiation. Lucky you!

Just going off your stats. If you are a 2cm, you can see what the staging says... I'm totally fine with my treatment, When you mention your age to newbies being the factor - you may want to also mention you were node positive. That makes a world of difference in chemo land.

Hi Amapola36:

The statement "my .07mm micromet" and the "pN1mi" status indicated in the shot from your pathology report are not consistent.

Per the summary from AJCC regarding the 7th Edition, the definition of "pN1mi" is:

https://cancerstaging.org/references-tools/quickreferences/Documents/BreastMedium.pdf

"pN1mi Micrometastases (greater than 0.2 mm and/or more than 200 cells, but none greater than 2.0 mm)"

A nodal deposit of 0.07 mm does not appear to meet the AJCC 7th edition size criteria above for a "micromet". Is it possible that the actual size of the "micrometastasis" was 0.7 mm?

Secondly, a person cannot be both "N0" and "N1mi" simultaneously, because these are mutually exclusive categories. If your path report indicates "pN1mi" according to AJCC criteria (7th Edition), this would indicate that a micromet was present.

It is my layperson's understanding that any "pN1" status, including "pN1mi" is considered node positive (as opposed to "N0"), although there are different degrees of positivity, per page 2 of the summary above:

pN1 - Micrometastases; or metastases in 1–3 axillary lymph nodes; and/or in internal mammary nodes with metastases detected by sentinel lymph node biopsy but not clinically detected***

pN1mi Micrometastases (greater than 0.2 mm and/or more than 200 cells, but none greater than 2.0 mm)

pN1a Metastases in 1–3 axillary lymph nodes, at least one metastasis greater than 2.0 mm

pN1b Metastases in internal mammary nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected***

pN1c Metastases in 1–3 axillary lymph nodes and in internal mammary lymph nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected

As further explained here:

http://annonc.oxfordjournals.org/content/24/11/2794.long

"Axillary nodes with ITC [isolated tumor cells] are considered to be cancer-negative and coded as pN0i+. Micrometastases are slightly larger with a diameter between 0.2 and 2.0 mm and are considered node positive and coded as pN1mi."

Please confirm it with your team.

BarredOwl

I have been in this oncotype game for a while. Over the years the score has become more of a deciding factor and the size and node status somewhat less. When you get to the low scores, remember to also consider the rate of complications from chemo.