Do 2 positive LN always = chemo?

2 positive nodes do not always mean chemo. This is exactly where the Oncotype test would come into play.

But... the Oncotype test recurrence risks are based on the "average" patient. What this means is that if someone is far off the average, the recurrence risk estimate that is associated with their Oncotype score might not be all that accurate. This is why Genomic Health (the Oncotype people) make available to MOs a simple, quick computer model that allows them to adjust the recurrence risk based on addition factors - patient age, tumor size and tumor grade. This is called the Oncotype RSPC (Recurrence Score Pathology Clinical) model. I know that this model is available for those who are node negative who've received an Oncotype score & recurrence risk; I don't know if a version of the model exists for node-positive Oncotype scores. But the same principles would apply.

In your case, even without the model, it's clear your pathology & clinical factors would increase your risk. Your age, being 39, is much younger than the average - and this will increase risk. Your tumor size, being 3cm (according to your signature line) is much larger than the average - and this will increase your risk. So let's say you had a low Oncotype score of 10. From the reports I've seen on-line, this would confer a 12% 9-year recurrence risk, and a recommendation that chemo is not beneficial. But then if you factor in your age and your tumor size, that 12% recurrence risk (for the "average" patient) might jump up to 20% for you - and with a 20% risk, chemo would be recommended.

This I think is why the Oncotype test wasn't ordered - it would just muddy the water and possibly complicate the decision. But maybe your MO will order it. Honestly, however, for someone who is 39, and who has a 3cm cancer, and 2 positive nodes, I don't think any MO would not recommend chemo.

Hi--I was 43 at diagnosis, 2.5 cm, only had 1 node out but it had 8mm. I will tell you from my insurance perspective, they refused to pay for the oncotype because they saw my situation as automatic chemo. My oncologist (MO) argued this, I really wanted that piece of information, and we ordered one anyway.

While we were waiting for the test, I did a lot of research, understanding the SOFT trial, etc. I made a decision in my own mind that my oncotype had to be 1-10 for me to skip chemo. Wasn't sure what my MO was going to say.

So the test came back as a 10. My MO suggested no chemo with a 10, but wanted me in menopause and on an aromatase inhibitor. With that being said, I knew that I could get a second opinion that would suggest chemo. I knew that. But I was okay with the direction we took things. However, since I did not do chemo, I did a hyster/oopherectomy fairly quickly after radiation and got right on that aromatase inhibitor.

I guess in my situation it did kind of "complicate" things because without the test I would have automatically done chemo. No decision to be made. BUT...information is power. And even if you would do chemo no matter what....I would argue that that's ok. Get the test anyway. I feel like it's our right to know these test results (if we want them).

Additionally, it might even help you make treatment decisions in the future. Who knows. The future with cancer is tailoring it to your specific biology. I guess while the information might "complicate" things, I personally always err on the side of information.

The oncotype folks have been great with me. They are still fighting with my insurance company almost a year later. They said that if it doesn't work out in our favor they would work with me on a out of pocket price. Sorry for the wordiness....I thought all of this might help and give you a different persepctive. Good luck!

Kathabus,

I had similar experience, my insurance does not cover this, and I asked my MO this question, if there is no money issue, would you recommend it? He said, 100%, so I ordered it, I paid CAD$4100 for it, and it is worth it. Same as you, my situation is automatic chemo, and will be 8 dose dense ACT. My MO said, useless to do 4 AC, either no chemo or 8 dose dense ACT. Same as you, I also read lots of info, including NCCN guidelines, I also decided if under 11, I will skip chemo. With oncotype score 6, my MO said no chemo, but he prescribed me injection to end my period completely, and started arimidex immediately even before radiation. My radiation oncologist also said, no chemo. That is the best news I got after diagnosis, surgery pathology report brought me into deep darkness, thanks God I ordered oncotype test.

Hi Kathy, I was also looking for someone with same situation at that tough time, but cannot. I even prepared everything for chemo, only hold wig order cause it is too expensive. It is so lucky we got super low score, and we made the right decision. Oncotype test will work for more node positive cases gradually, my only one is 3mm, under 2mm is another category. My tumor is 2.1 cm, under 2cm is another category. Thanks God.