“Higher” Oncotype score & hormonal therapy only?

I think if mine had been grade 3 and larger size I would have thought more about it especially with the oncodx of 34. Also need to understand the risks associated with treatment.

With a score of 27 AND lymph vascular invasion AND a 7 point difference in recurrence rates I would have been comfortable taking the chemo. That said, it is always what YOU are comfortable with. Wishing you all the best in whatever decision you make!!!!

Does the Oncotype DX accurately predict the increased benefit of having chemo when one has a higher score? I read an article in Annals of Oncology, "Prediction of benefit from chemotherapy in ER-positive/Her2-negative breast cancer--a problem still to be solved" that would suggest that the inclusion of some Her2+ women in the NSABP-B20 and SWOG-8814 trials could affect the stated level of cheotherapy benefit. The authors state "We conclude that neither the RS nor any other currently used gene expression test has demonstrated its ability to predict a benefit from chemotherapy treatment in patients with ER-positive/HER2-negative tumors. Nevertheless, validated gene expression tests providing information incremental to established risk factors continue to be a valuable tool to identify patients with low risk of recurrence having low absolute benefit from chemotherapy."

My initial diagnosis on June 19 by needle biopsy as follow up for my suspicious mammo was IDC, Stage 1, grade 1. I had a partial mastectomy on July 12. My tumor was classified as pT1c N(sn)0. Although the margins were negative, focal DCIS grade II (Intermediate) was also found with no "xtensive intraductal component. Interesting that intermediate grade for DCIS is defined as "neither well-differentiated nor poorly differentiated," I had a close margin of <1 mm for the DCIS, and I elected to have a re-excision on August 16 to get a larger margin. Both surgeries were a piece of cake for me. i finally got the OncotypeDX score back on August 28. Result was 31, which puts me at the bottom of the high risk group.

I am 70, in very good health and and do not take prescription meds except an infrequent Ambien. I exercise very regularly (cardio and weight-bearing), limit alcohol to -4 drinks/week, have a good diet, and a good weight with BMI of 24. There is no history of breast cancer in maternal family (unknown paternal hx). I nursed 5 babies for a total time of almost 12 years, and had prior mammograms which said that I had a 4.5% lifetime risk of BC. Go figure.

Both MOs I have consulted with are recommending 4 cycles of T-C (Taxotere and cyclophosphamide.) One MO likes Tamoxifen and the other, an Aromatase Inhibitor with Zometa for my low bone density along with the chemo. I have deferred starting any treatment until after i return from a long awaited and already once-postponed trip to South America.

I am hoping that someone with a similar profile/experience will offer me their thoughts/outcomes/concerns about chemo and anti-estrogen therapy. I have not made up my mind which path I will take. Thank you for reading.

lact...the study you refer to is from 2014. Subsequently, the long awaited TAILORx study was presented this year. The results should be part of your discussion with your team. TAILORx was important because it tried to measure whether those patients with “intermediate Oncotype DX scores would benefit from chemo.

Here are the results:

https://www.oncotypeiq.com/en-US/announcements/TAILORx?gclid=EAIaIQobChMItv_zy4C03QIVxVmGCh1ZXwIiEAAYASAAEgLItPD_BwE

With the TAILORx study, we can now say that for certain cohorts of patients, the benefits of chemo outweigh the risks. Based on your score, you would see some benefit.

That said, you mention that you are relatively healthy. So are many of us. I was 53 when diagnosed. I exercised, ate well, have a BMI of 24, and like you, STILL got breast cancer. I wish I could say that lifestyle will keep a recurrence at bay. But, sadly, it didn't prevent you or me from getting it and I sincerely doubt it will keep us from recurring.

At 70, you are still young...and healthy. I hope you will read the TAILORx study and have a fruitful discussion with your team....good luck

You may want to do AI drugs if you are post menopausal, anastrozole works well for er+ and pr-.

Thank you Meow13. I am leaning toward doing just the endocrine therapy, even though both Tam and the AIs have SE's that are not to be underestimated. Perhaps I need a 3rd opinion to be the tie-breaker...

Voraciousreader. I had heard about the TailorX study and appreciated the link you provided. Thank you. A quote from the NCI press release about it:

"The findings suggest that chemotherapy may be considered for the remaining 30 percent of women with HR-positive, HER2-negative, node-negative breast cancer as in 'any age with a recurrence score of 26–100 (17 percent)"

Interesting that it says "may." I wish the ages of the trial participants who made up this % were part of the report.

Another point to consider for me. Wouldn't younger women have more of a chance of returning to a similar functional status that they had before chemo than older women? This is what worries me most about chemo. Yes I might live longer with chemo, but at what cost to being able to fully appreciate life in the here and now, and continue to do all things I do now for as long as I can?

Still considering options, but luckily I have another month and a half before I have to come to a decision. Thank you for reading.

Lactcondoula: I'm guessing the Grade 1 IDC was Oncotyped and found to be a 31?! Both MOs are probably recommending TCX4 because of your Oncotype score and your overall good health.

Here is an interesting article about treatment options and explanations for 70 yo ladies with your type of BC.

https://www.cancernetwork.com/adjuvant-therapy-bre...

Ahh, I missed the PR-. That would explain the RS 31.