Low Oncotype, Grade 3, Node-positive - chemo or not?

For me , the grade and node involvement would push me to chemo. I was lucky and didn't have to have it. Onco score of 15 but now I'm metastatic at 69. Good luck.

Dear KF2018,

Welcome to the BCO community. We are sorry for your diagnosis and the decisions that you face but we are glad that you have reached out and find the community to be of help. We are certain that you will discover support and helpful information here to ease your path. While you are working on decisions you may want to review the information on Oncotype on our website. Let us know if there is anything we can do to help you along the way. The MOds

with positive node. Grade 3 and LVI i would have done chemo. No question..my onocotpye was 15. My stats are below. I got 3 opinions. Not one suggested chemo to me.

also just because someone does chemo doesnt mean they are going to be cancer free. Cancer can come back regardless. Ask the doctor how much chemo improves your reoccurrence rate. The oncotype papers will tell you.

I understand your position. Your oncodx score is not convincing on its own. I was in an opposite position my grade was low mitotic score low. Tumors were isolated no lymph nodes involved yet my oncodx score was 34.

My oncologist put a lot of faith in the oncodx. The more I looked at the statistics the less convinced I became especially since I was going to take AI drugs not tamoxifen. I chose no chemo, now 7 years no cancer.

Grade 3 and in the lymph nodes suggest chemo might get a bunch of fast growing cancer cells. My question would be "What evidence is there that chemo would kill more cancer cells potentially keeping you NED".

If you feel like you will benefit then do the chemo.

Hi KF2018, sorry that you find yourself in this position. If I may weigh in, the size, micromets and grade would push me to chemo. My Oncotype was 12 so I didn't do Chemo but sometimes I wonder about it. Cpeachymom is spot on. Oncotype means something if you are on hormonal for 5 years otherwise means nothing.

KF218 Were you told that you have a positive node? I don't think a node with mircromets is considered a positive node. Below 3mm its micromets and only 3mm or larger is a positive node. If I am right you can forget worrying about the node reference on your pathology report. Some people who, unlike you, have a positive node are not urged to have chemo depending on other characteristics. I was grade 2 with a 7mm tumor (i.e, less than 1cm) and 1 positive node but my oncologist did not recommend chemo until the mammoprint came back "high risk". Even then I was told by her and another MO that the hormone therapy was more important for me than chemo. I chose both.) Good luck with your choice. Polly

Up to three positive nodes, yes - I had one and my oncotype was 17, so no chemo. But it's the size (over 2cm) and grade 3 that I thought made this one not fall into the oncotype test category.

KF2018- I will share my situation. I had BMX and they took out 4 sentinel nodes. Post surgical pathology showed 2 of the 4 nodes had just micromets which is less than 2 mm per node. My oncologist ordered Oncotype. My tumor was 3 cm's and I had LVI invasion also. While waiting for the Oncotype to come back I kept asking my surgeon and oncologist how do we know it hasn't spread to further nodes? They both told me with just micromets odds are slim to none that it has spread to other nodes. Not good enough for me and I pushed for ALND. My surgeon went back in and took out 14 more nodes 2 of which were fully positive (4 mm's of cancer each) so even more so than the sentinel nodes. My MO said chemo now regardless of Oncotype result. He set me up for AC+T chemo and I was ready to start when my Oncotype came back and it was a very low 3. Based on the 3 score he adjusted chemo to TC four rounds as he thought now the Adriamyacin heart risk was not worth it. So I did 4 rounds of TC and yes it's not fun but it was doable. Looking back if I had not pushed for ALND and found those 2 positive nodes, my Oncotype would've come back the 3 and I would not have had any chemo based on this very low score and I would've skipped radiation as I had the BMX and my positive nodes would still be there and I wouldn't have had any treatment at all. The thought of that still makes me nauseous. It's just what happened to me but I wanted you to be able to see that different scenarios exist. Not everyone is textbook. Best of luck in your decision.

Just chiming in to say that if on the fence about chemo... I found TC to be brutal. I never got my hair back after Taxotere - that was 7 years ago ...and I have crippling neuropathy in my feet, where I can not wear closed toed shoes any more or stand on my feet for any length of time. If you do decide for chemo, you may want to ask for a gentler version like CMF or even Taxol. Not meant to scare you, but offering my experience.. Tough decision you have!

Meow13 - I couldn’t agree more.

KF2018 - I’m so sorry you have to make this decision. Obviously for me chemo is a no-brainer and there was no point in running an Oncotype, but another factor you may want to consider is age. They often suggest stronger treatment if you’re young, esp 40 or under, in part because the cancers in younger women are often more aggressive but also you potentially have more years in which the cancer could recur.

Also my MO used to the nhs predict tool when he thought he had to talk me into chemo. It can be useful to get a sense of the statistical impact of different treatments at 5,10 and 15 year intervals.

https://www.predict.nhs.uk/tool

Good luck with whatever you decide. It is entirely your choice and the most important thing as others have said is that you can live with it.

Meow13....yes! We need better treatment options! My dear cousin passed away from metastatic BC 30 years ago at the age of 38. She lived a miserable 10 years with it. Her treatment was exactly the same as it is today except she had a radical BMX. Where is all the money for research going? I just do not understand.