Young and Oncotype score

I was 40 when diagnosed with a 20 score. I got a Mammaprint as a second opinion and it said 'low risk' so no chemo for me. The TailorX study is now showing that even younger women can safely skip chemo if lower than a 25 score. I'm glad I didn't do chemo, I'm saving it for if/when BC ever comes back. With that, I'm on Tamoxifen for 10 years. I'm 3.5 years in.

My Oncotype was 32. I did do chemo.

If it looks like you need to do chemo, ask your MO about possibly adding ovarian suppression during chemo - it helps protect your ovaries, but also might help chemo to be more effective because the cancer is not being simultaneously fed by estrogen.

Best wishes to you. It's a hard situation at any age, but especially when we are supposed to be in our "prime."

Mine score was 19 (12% risk of recurrence with or without chemo). Did chemo for my age (36), size & grade of tumor plus one positive lymph node. Hope you get a low score. I was 90% ER and 90% PR plus grade 3

I have a similar diagnosis-grade 3, ER/PR+, Her 2- and am 43. I have nodal involvement and my team actually put me on neo-adjuvant chemo therapy and in a clinical trial (adding in immunotherapy or placebo) because the high grade makes it both higher risk and more responsive to chemo. I just got my last dose of chemo and don’t regret my decision

Hi PoojaMG,

We are sorry you find yourself here, but glad you found this community.

The numbers can be difficult to understand. Here is a something we've written that may help make more sense of it: Oncotype DX: Genomic Test to inform breast cancer treatment. What is your treatment team suggesting for you?

Thinking of all of you! Keep us posted!

I think people should be very careful of assuming that TAILORx says that people with scores under 25 can skip chemo.

The latest results also show that women under 50 who have high clinical risk tumors who score in the intermediate oncotype range (16-25) have a definite chemo benefit.

The likelihood of distant recurrence and absolute chemo benefit that are printed on the oncotype score will NOT apply to these people.

Ask for the RSPC score (part of oncotype).

Lisey, your results were pre-TAILORx. The results were not broken out by age then.

This is the current Oncotype recurrence risk chart for Intermediate scores, taken from the TAILORx study and specifically for women aged 50 and under:

Additionally, to OnTarget's comment, Oncotype make available to MOs the RSPC (Recurrence Score Pathology Clinical) computer program, which takes an Oncotype score and refines the recurrence risk even further by incorporating the patient's age, tumor size and tumor grade. In some cases this recalculation of the recurrence risk doesn't change things much, but if the patient is older or younger than average, if the tumor is much smaller or larger than average, and if the grade of the tumor is a 1or a 3, the estimated recurrence risk associated with the patient's Oncotype score might either increase (younger age, larger tumor, grade 3) or decrease (older age, smaller tumor, grade 1) substantially. This means that someone in her 30s or even early 40s might have a higher metastatic risk and get even more benefit from chemo than the chart shows.

Lisey, I think there is a difference between what your MO told you based on the previous Oncotype results and the results in the TAILORx study. Maybe it comes down to the assumption on chemo side effects and the point at which an overall benefit from chemo kicks in. Because the Oncotype results are now separating out younger women, and because it is well established that younger women do not experience the same degree of serious side effects from chemo as older women, the recommendation from the TAILORx study is that for women aged 50 and under, those with intermediate scores in the 16 to 25 range should consider chemo (i.e. not a definite recommendation but a consideration based on other patient factors such as age and comorbidities).

This has also been incorporated into the NCCN Treatment Guidelines:

This is the table with the Age 50 and under results from the TAILORx study, showing both recurrence rates and survival at 5 years and 9 years:

I am one who would get a different recommendation in 2020 than I got in 2011. I was premenopausal (under 50) and had an Oncotype score of 16. Back then, I was told no chemo, not even ovarian suppression and aromatase inhibitor, just tamoxifen. Now with the TAILORx results, for premenopausal (under 50) with an Oncotype score of 16, I would fall into the “consider chemo" group. And I certainly would have done chemo or at least OS + AI. There were several details about my case that worried me but not the oncologists. I did not know about Mammaprint or the RSPC. My “stats" below tell my story.

I think there is a disconnect with women knowing the initial results from the TailorX study, which did state what Beesie said, but not the subsequent studies that dug deeper and found that women who are younger can safely avoid chemo with scores from 16-20. (I'm a 20). The NCCN guidelines is always slightly behind, and with the deeper dive TailorX has now done, I think it does a disservice to new members to state old info and scare younger women into chemo when they are low risk.

Now I'm not saying Pooja's score of 66 is low risk, I would highly urge her to consider chemo and get a second opinion. But younger women who are low risk and have a score of 16-20 can feel better having skipped chemo based on the TailorX.

Bottom line, TailorX has modified their results based on new studies as of 2019-2020 and is finding, more and more, that women can safely avoid chemo. I'm certainly glad I did.

Lisey, there is no disconnect or inconsistency. The subsequent analysis that you've linked builds upon and supplements the TAILORx study - it does not over-ride the previous conclusions. It is in fact not a new study but simply reflects further analysis of the TAILORx data.

TAILORx concluded that patients who are age 50 and younger with Oncotype scores of 16 to 25 should consider chemo. This remains true. In considering chemo, patients and their doctors should review other factors related to the cancer itself and the patient herself. In some cases the decision will be made that chemo is an appropriate and beneficial treatment and in other cases it will be decided that chemo is not necessary / would not be beneficial.

The addition analysis of the TAILORx results provides guidance on this decision. Specifically, it shows that women with 16-25 scores who have low clinical risk gain no benefit from chemo. This is not surprising and is quite consistent with how most MOs and patients have been making this decision since the TAILORx results were released in 2018. It is also in effect the same as applying the Oncotype RSPC model, which I mentioned/suggested in one of my posts above.

Here is the actual ASCO Post article: https://www.ascopost.com/News/60141

And here is the concluding paragraph:

"The authors concluded, "Clinical risk stratification provides additional prognostic information to the 21-gene recurrence score, but not prediction of chemotherapy benefit in the overall TAILORx population or those > 50 years, and facilitates more refined estimates of absolute chemotherapy benefit for women ≤ 50 years with a recurrence score [of] 16–25.""

Shetland, I totally agree with you that ILC is a different animal entirely. The ovary suppression that chemo does seems to be what is advantageous, not the chemo itself, which means women should look more to that when considering options.

JoJo, yes I was low risk per the mammaprint though my ki was rather high and I had grade 2 (thus the second opinion).

Beesie, I posted that at a 20 score, I only got a 3% bump from Chemo.. and the risks of Chemo were about 3% so a net zero. you then posted DIRECTLY at my statement saying I had old info. and the Tailorx said younger women in the 16-20 should consider chemo. When in fact it was saying that younger women 16-20 can be more assured chemo isn't necessary for most - which is EXACTLY what I had been saying before you tried to negate my info. My results and MO were correct that not outdated, and the science is showing how little chemo helps for even younger women in the 16-20 category and most who have grade 1 and 2 tumors, can safely avoid it.

In thinking about Pooja's score, maybe there is confusion and she got a DCIS score which usually is much higher than a typical score? A 66 on a typical score would be mandatory chemo, but not necessarily on a DCIS score... Looks like a 57 Score for DCIS is only 13% recurrence rate, which is nearly the same as my score of 20.

https://www.oncotypeiq.com/en-US/breast-cancer/healthcare-professionals/oncotype-dx-breast-dcis-score/about-the-test

The Oncotype test for DCIS is a different test than the Oncotype test for IDC - fewer genes are analyzed and the recommendation for those with high scores is that they have radiation after a lumpectomy. Chemo is never a consideration for DCIS so a high DCIS Oncotype score would never come with a recommendation to do chemo. The DCIS Oncotype is also not used for patients who have both DCIS and invasive breast cancer, not even if it's just a microinvasion.

Pooja, I agree too that asking for a Mammaprint test seems like a good idea.

Lisey, to your comment directed at me, the differences in what we are saying are subtle but I think they are important.

You have made definitive statements that are only partially correct and therefore could bemisleading ("Please explain this article recently updated showing the TailorX study does NOT say those 16-26 younger women should consider chemo. Not at all".... "the subsequent studies that dug deeper and found that women who are younger can safely avoid chemo with scores from 16-20"). You have been adding in the critical contingency ("younger women who are low risk") only some of the time.

If the TAILORx guidance to younger women in the 16 - 20 group was that they could safely skip chemo, then none of the patients in this group would even consider the need for chemo, and those who are high clinical risk - who would benefit from chemo and for whom chemo is recommended, based on the TAILORx results - would not get it. This is why TAILORx does recommend that younger women in the 16 - 20 range consider chemo. Then as part of the consideration, those in this group who have low clinical risk can relatively safely choose to not have chemo.

This back and forth is getting tiresome. Lisey, I am not challenging your decision. It's the same decision I would have made with the information you were given and the same decision I would make today, with the information from TAILORx. I simply want to ensure that those reading get all the information necessary for their discussions with their MOs so that everyone can make the best decision for themselves, based on their Oncotype score, clinical risk, personal risk factors (relative to cancer and chemo) and risk tolerance. I'm sure at this point anyone reading can figure it out.