How many percent reduction in 10yrs recurrence shall do chemo?

Cathy, I actually did radiation first because they didn't think that I would need chemo. The Med Onc almost stopped the radiation the day of my first treatment since I didn't have oncotype results yet, but then said I could do chemo after radiation if needed. My score was 29 and I am 61 years old, so they did recommend chemo following radiation. I did opt to decline chemo - seen next paragraph.

The decision about how many percent reduction makes chemo "worth it" really is a personal decision based on a lot of factors. Some people who are married and / or have children are willing to do chemo even if the reduction is only 1% or 2% because stopping recurrence / death is that important to them.

In my case, I am 61, single, no children. The reduction for me is between 3% and 7% depending on how I figure it out. The Predict program says 5% (I think that is mortality benefit, not recurrence?) in 15 years. For me, I decided that the current quality of life was more important to me than doing chemo to have a 5% greater chance in 15 years.

Cathy, Once you get your oncotype results, a few things that will be helpful:

1) The actual report (assuming it is the same as the US) does not really give you an accurate chemotherapy benefit. The report will have three big numbers. First is your Distant Recurrence Score (RS) - mine is 29. Second is the Distant Recurrence Risk at 9 years if you do hormone therapy. Mine is 18%. I don't have any reason to believe that those two numbers are not accurate.

The third number is the one I don't like being shown as it is. Mine (over age 50 with RS score over 26) says that the Absolute Chemotherapy Benefit is > 15%. This makes it seem like it would make a HUGE difference if I do chemo. However, if you read the second page of the report carefully, you will find that they usee one study to determine benefit for those with a score of 25 or under and a different study to determine the benefit for those with a score greater than 25. In looking at the study for those with a score of 26 or higher, it says "The magnitude of the absolute benefit of chemotherapy was ~6% at RS 26, and increased as the RS results increased from 26-100, with an average absolute benefit of ~24% and a conservative group estimate of >15% based on the width of the confidence intervals." So, if my score were 26, the front page of the report would say that my benefit would be >15% while based on the study, it would really be closer to 6% (+ or - a confidence interval).

After realizing this, I spent a long time trying to find the details to see how much the study would show the actual benefit would be with my score of 29. Finally found it . . .

2) I found two good sources on the Oncotype website.

https://www.oncotypeiq.com/en-US/breast-cancer/hea... you can scroll down and click on Node Negative Predictive Clinical Trial Results to got more info also. I also found this:

https://www.oncotypeiq.com/en-GB/breast-cancer/hea... if you click that you are a health care professional, then select node-negative to download the information, you will find a graph that shows the possible range of benefit from chemo based on your RS score.

Based on these, my absolute chemo benefit is way under 15%.

3) Beesie frequently lets people know that there is another test available to medical oncologists called the Oncotype RSPC which gives even better info. My Med Onc wouldn't do it for me, but yours might.

4) There are also two on-line estimators which aren't as personalized (so likely not as accurate) as the RSPC. (of course, remember, even with only a 1% recurrence rate, someone has to be the 1%) I couldn't find the best, most recent thread on them, but did find this: https://community.breastcancer.org/forum/78/topics/870921?page=1#post_5384034 scroll down to SpecialK's post on April 9th and read from there.

Oh - and I lubricated very well starting several days before radiation and until several days after. I got very red and had some discomfort, but no raw skin, etc. I also drank as much water as I could.

Cathy,

My chemo started late because after I had my bilateral mastectomy I had an area on my left breast that wouldn't heal. I ended up having two more surgeries to address this issue.

I thought I wouldn't need chemo but my MammaPrint came back high risk on one tumor. I had two tumor's. 29% if left untreated and also Luminal B.

Cathy,

1) the Oncotype report says 18% chance of distant recurrence in 9 years if I did hormone therapy for 5 years. It doesn't give chance of recurrence if I do not do hormone therapy.

2) the Oncotype website pdf for HR+, HER2-, node-negative, early-stage, invasive breast cancer pdf has a graph showing approx 14% chance of distant recurrence with hormonal therapy alone and approx 8% chance of distant recurrence with hormonal therapy and chemo so the chemo benefit would be about 6%

3) predict breast cancer tool for my info shows that in the next 10 years: 76% of those treated w/ surgery alone would still be alive. An extra 5 people would be alive due to doing hormone therapy (so 5% benefit). With chemo and hormone therapy, another 4 people would be alive (so 4% benefit). 9 people would die from other causes. I believe that leaves 6% who would be dead even with chemo and hormone therapy. So, since I'm skipping chemo, there is a 10% chance that I could be dead due to cancer in 10 years. However the 4% benefit of doing chemo isn't worth it for me.

4) lifemath results show that in the next 15 years, 61% would be alive with surgery only; 18 - 20% would have died from other causes (more die from other causes if they don't die from cancer ); taking only tamoxifen would benefit me 6%. If I also added chemo, I would have an additional 3% benefit (not worth it to me). So, skipping chemo, there is a 14% chance that I could be dead due to cancer in 15 years.

So, benefit of chemo to me is probably between 3% and 6%. The benefit of tamoxifen to me is probably between 5% and 6% based on predict and lifemath. Oncotype doesn't show benefit of hormonal therapy, but shows 14% - 18% chance of distant recurrence which is sort of in line with the predict and lifemath chance of death in 10 / 15 years.

DorothyB, do not increase your dose of tamoxifin. You may be setting yourself up for a very toxic reaction. Repeat...don not increase. Sorry to be so sharp but I am quite concerned for you.

I also was dx as stage 2b-had my lump been 3 mm smaller in one dimension- would be 1b-had 2/2 positive sentinel nodes-given choice of 4 rounds of TC or 8 rounds of ACTdense dose- my onco type was 45- so high risk for recurrence. Tc considered about 3% less effective that act ,but still effective--I researched both protocols==I was 68 at dx and have a 15 y hx of hypertension which upped my risk of cardiac myopathy with ACT. I chose the tc-and accept it may not have helped as much as the ACt--had I been 50 years old I may have chosen differently--

also had 33 rads treatments

I used cold capping--Penguin brand and saved 75-80 percent of my hair -I likely would not have had as good results with act-A is very hard on hair,. I have been on letrozole almost 2 years and am doing fine at 2.5 years out

We all have to make our own choices-I am at peace with mine

I might suggest you get a second opinion once all your tests are back-there are many treatment paths--hugs,K

Cowgirl, I am surprised that you are so strongly against increasing the tamoxifen dosage. Curious as to why?

I did decide earlier today to go back down to the 10 mg / day instead of increasing or staying the same.

Cathy, you could get a second opinion from another oncologist.

Kaaadams, maybe a second opinion also?

The decision about what to do is so individual so I'm not about to advise others. I know some have chosen chemo with just a 3% benefit and that is fine for them. It seems like the predictor's 8% benefit is really close to your doctor's 10%. You need to decide if you want do do chemo with a 6% chance that it will stop recurrence with no side effects and a 3% chance that you will get the CIPN along with no recurrence.

I opted out of chemo, so haven't researched side effects, %s, etc at all.