Oncologist said OncotypeDX unnecessary - really???

The oncotype test is an analysis of your specific tumor (different from genetic testing for known genetic markers). My surgeon submitted the tissue for mine, not my oncologist. I would get a second opinion if it were me. My test came back with low likelihood of recurrence and if not for the # of lymph nodes with cancer, I would have been a candidate to skip chemo. But my numbers did lead my oncologist to order less chemo than if my scores had indicated a higher likelihood of recurrence.

I would certainly get the test done. Knowledge is power, the more the better.

Some oncologist are really aggressive when you have that positive lymph node. Is there any chance your cells are grade 3?

I was stage IIA and grade 2 with one lymph node positive. My oncologist ordered a Mammoprint and said the chemo decision would be based on that. It came back "high risk" and I did have chemo. The point is that if lymph node involvement alone were the deciding factor, she would not have ordered the Mammoprint which showed if my particular tumor would respond to chemo. I read an article recently that said underarm lymph node involvement is an indication of risk but that the possibility of distant mets is not determined by underarm lymph node involvement. He described it as having a speeding car and removing the speedometer: removal won't slow the car down. I believe it used to be that the Oncotype test was not used if even one lymph node was positive but that has changed and the test is used even if a lymph node is positive but I do know that Mammoprint test is used with lymph involvement. If on the other hand you are grade 3, that alone might warrant chemo without further testing. So I agree with the advice above to get a second option from an oncologist.

Thank you, DTR808, for starting this topic. I am just about a week out of my lumpectomy and sentinel node biopsy (clean margins, clean nodes). I have IDC, ER+, PR-, HER2-. And I too want to have the oncotype testing done. My surgeon had indicate that it would be the medical oncologist who would order the test. (I meet with surgeon, med onco, and radiation onco in a couple of days.) I REALLY want to have this additional piece of information about recurrence.

But I'm not sure how hard I can push for the testing or if I can insist on it. I'm the customer, right?

Dtr808- My onc also did not run the Oncotype for me, she said because I was young with a positive node, chemo was a given. I got a second opinion at Dana Farber and they were the ones who sent it out for testing. It came back low, so I chose to skip chemo, but I did have to do rads because of the positive node. You don’t mention your age, but that may also play a role. There are some docs who don’t put a lot of faith in the Oncotype either, so it could be that

I asked for an oncotypeDX for my second b.c....7mm and grade 3 but my oncologist said my treatment recommendation would be the same....no chemo, no rads, and I had a mastectomy....no nodes, no LVI. I always worry about the grade 3 bit myself. But it is done and over. So I worry not so much so it doesn't ruin my life that has been saved. I agree that you should always be your own advocate, as much as many doctors dislike this. As long as you are using reliable sources for information, it should be a welcome addition to a doctor's recommendations.

I am not sure why my MO ordered a Mammaprint instead of Oncotype. I have read that some doctors consider Oncotype unreliable but I was satisfied with the Mammaprint recommendation and didn't ask my doctor why she chose that. Sometimes doctors may not recommend something because they know your insurance won't cover it so I sometimes ask if that is a factor in whatever decision is being made for me but didn't about this test. ( I am on Medicare and AARP United Healthcare Ins.) Mammaprint gives you a high risk or a low risk rating -- no in-betweens. I understand that one reason some doctors do not order Oncotype is that there is a range in the middle of the numbers where the effect of chemo is unclear and Mammaprint was developed to remove that issue. I don't know. My risk although "'high", was 14 on a scale of 1 to 100 so consider it "low" high risk if you see what I mean. But if I had been "low risk" with a score of 99 on a scale of 1 to 100 low risk (with 1 being the lowest) and was thus "high" low risk, I might have worried about skipping chemo. It is confusing for sure.

DTR808: to answer your question about how I am doing, just had my one year post diagnosis mammogram and there was a questionable "spot" but likely just a benign bit of scar tissue. Will have a 6 month recheck. So doing okay at this point. Thanks for asking. Polly

Polly, i understand what you are saying about the high low thing, it is confusing! There is a gray area in the oncotype. The tailor x study results come out very soon. In that study, I believe, but not certain that 26 is considered high. It did make my decision (27..so "high" intermediate range ) to be a little easier than had I fallen in the lower 20 range. Confusing for sure!