No endocrine therapy for low Oncotype scores?

farmerlucy · March 2019

Wait. What? Is this doctor saying no endocrine therapy for low Oncotype scores? Anyone hear of this?

https://podcasts.hopkinsmedicine.org/2018/07/06/july-11-2018-breast-ca-and-genes/

Meow13 · March 2019

I am thinking wow maybe I should not have done any medication just surgery.

SummerAngel · March 2019

It does seem like he's saying that but I've never seen anything saying the same. My low score at least part of the reason my oncologist was okay with me stopping, though.

applejuice · March 2019

I have seen this discussed in more detail in another article, I believe no chemo for Oncotype lower than 10, early stages, (HR)-positive, HER2-negative, node-negative breast cancer.

https://www.cancernetwork.com/breast-cancer/women-can-safely-skip-chemotherapy-some-early-stage-breast-cancers

JoE777 · March 2019

Never heard of that. Low onco score can rule out efficacy of chemo

Salamandra · March 2019

Is your link meant to go somewhere else? The page it's pointing to now only mentions avoiding chemotherapy.

AliceBastable · March 2019

applejuice, under 10? Mine was 17 and considered in the low range, even with a micromet in the one node.

farmerlucy · March 2019

Salamandra - I tried to circle my area of question. I guess the entire discussion is from a PodCast@johnshopkins.

It first turned up on my Facebook page since I follow them, and I have asked this same question there.

The cow is long out of the barn for me, since I quit at 4 year, but we always grasp for reassurance.

Salamandra · March 2019

farmerlucy, thanks for pointing that out! Somehow my mind skipped over it not once but twice.

That is fascinating! I've also never heard of that. I wonder if he's just alluding to the fact that the absolute benefit for low risk cases is low, and statistically most low risk women do well without the endocrine therapy, they just do a little better with it. Did you listen to it out loud? I just read the quote. Maybe from context it would be easier to tell whether he's being descriptive or prescriptive.

farmerlucy · March 2019

I did listen to it, but it is just the text spoken. 🤷🏼♀️ Their “ask the expert” site is disabled and they said to post questions on their Facebook page. I’ll see if I get a response.

When I was protesting taking HT based on my low Oncotype, my onc used the argument of “that’s a lot of faith to put in that one number.”

I’ll let you know if I find out anything more.

applejuice · March 2019

AliceBastable see the article in the link i posted above, that's my understanding. My oncotype is 12 so I want to discuss this study with my MO next time will meet.

AliceBastable · March 2019

Reading the results from the TailorX studies, it seems to depend a lot on age. I was 68 when I had surgery, so that put me in a safer category at a higher number. I think my oncologist only discussed the number breakdown for my age group.

https://www.cancer.gov/news-events/press-releases/2018/tailorx-breast-cancer-chemotherapy

farmerlucy · March 2019

https://www.medscape.com/viewarticle/882554

I did find this article. But here “ultra low risk”is determined by the use of the mammaprint test.

bcincolorado · March 2019

I had a 17 Onco score and my MO said the risk of chemo did not outweigh benefits for me and would only reduce my recurrence by 2%.

farmerlucy · March 2019

https://www.npr.org/sections/health-shots/2017/06/29/534882955/tumor-test-helps-identify-which-breast-cancers-dont-require-extra-treatment

Here is the NPR article referenced in the medscape article. Their wise take is that there may be ultra low risk tumors, defined by the mammaprint test in this study, but that recommending no therapy is a bold move which needs further study.

SummerAngel · March 2019

Everyone, we're not talking about chemo, we're talking about endocrine therapy.

Based on the recent posts I'm curious what a Mammaprint would have said for my tumors!

farmerlucy · March 2019

One more post. I guess this is a thing. I was premenopausal though. These studies were done on postmenopausal women. Anyway this is definitely interesting.

https://www.medicalnewstoday.com/articles/318197.php

farmerlucy · March 2019

Johns Hopkins responded to my question. Not surprising their expert said endocrine therapy for low Oncotype scores. I imagine few doctors are going to stick their necks out and say no endocrine therapy for lowest of scores.

Meow13 · March 2019

Yes pretty generic response.

SummerAngel · March 2019

From the response I would guess they didn't even really look at it. How annoying.

kec1972 · March 2019

I don't think any doctor would ever say no hormone therapy. They don't want the liability. For me personally, if my Oncotype score had been under 10(it was 21), I definitely wouldn't take any meds

Cherryi3 · March 2019

Myoncotype was 4 and my MO is pushing me to stay on AI. I’m 52 and have degenerative disk disease in cervical spine. The arimadex gave me night sweats, daily migraine, diarrhea and brain fog. I literally told the nurse “fuck it” when she said doc wants me to try letrozole. She said, “oh Dr would not agree”. In the end I am too chicken to not try. I have a healthy BMI and lifestyle and I’m really pissed about the whole thing. Just trying to get my career back on track and put this behind me but it’s just not happening with still more appointments for BC and also my disk problem. I want my old life back! Sorry for the rant. I should be more grateful it wasn’t worse.

SummerAngel · March 2019

Cherryi3, I understand. I had horrible side effects on Tamoxifen, which surprised me since I typically do well on medications. I tried a reduced dose but still couldn't function very well. My MO gave his blessing for me to quit due to my low risk of recurrence. It's up to you to decide what you want to do and what level of risk of recurrence you're willing to take.

farmerlucy · March 2019

Cherryi3- Tamoxifen was easier for me and taking it satisfied my onc. After four years I stopped altogether.

Cherryi3 · March 2019

Thanks Summer and Farmer. Tamoxifen won’t be an option because of uterine issues so I started the letrozole. I think these meds mess up my mood too because I don’t normally have such a nasty attitude. The nurse navigator called today to make sure I was taking it. I’m nervous about arthritis and the disk degeneration getting worse. Add to that very high liver enzymes and high cholesterol! Sheesh! Those were issues before the BC. My MO knows this but seems completely uninterested and just repeats “standard of care” and “studies have proven”.

No endocrine therapy for low Oncotype scores?

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