Genetic testing and Oncotype

Yes, that's right. There's genetic testing and genomic testing.

Genetic testing tests your genes for the presence of mutations that makes cancer more likely (like BRCA but there are many more). Not everyone is recommended for genetic testing. Your oncologist should explain why they recommend it or not.

Oncotype test is a type of genomic test & it looks at the tumor and assesses the risk of reocurrence and esimates a benefit from chemo.

if you go to this page and look down the left side you will see a section for Genomic testing and a section for BRCA and other genetic tests which explains it all https://www.breastcancer.org/symptoms/diagnosis

Re the surgery, if there are cancer cells found in your lymph nodes, then you would likely need radiation even if you did have a mastectomy and you need to know that recent studies have shown better overal survival post lumpectomy + radiation. Your surgeon should go all over all these details with you. https://www.breastcancer.org/research-news/lumpect...

I think it's fine to seek out a second opinion but probably too early. I'd wait and see what the surgeon has to say. I think you're still in the early info gathering stage. Hang in there - it gets better once you decide on a treatment plan.

oldladyblue, oh, the threshold Oncotype score issue is tricky but I have some information for you from our fellow boardie Beesie.

I suggest you ask your oncologist to run the RSClin score. That takes the Oncotype + your age + the grade of the tumor + the size and gives a more precise estimate of chemo benefit. Beesie posted about it here: https://community.breastcancer.org/forum/85/topics...

For your own benefit for large scale stats you can also look at Predict https://breast.predict.nhs.uk/tool & LIfeMath http://www.lifemath.net/cancer/

Regarding the margin issue, as I understand it it is an area with not a lot of evidence & at that 1-2mm there's some variation of opinion among surgeons and facilities. At my facility under 2mm for IDC is considered close & they either re-excise or do a radiation boost, based on a risk assessment (age, whether the pt will be accepting or declining systemic therapy, nodal involvement, grade of cancer). Radiation boost to the tumor bed is a reasonable alternative from what I've read.

It is hard when you feel you're making some decisions. I sometimes look at these people and go "wait, you went to school for decades. YOUR guess is going to be way better than mine about how to proceed." I find often they have a slight preference/recommendation, just not a strong one so they're a bit more reluctant to present it but if you can tease it out of them, IMO that's a reasonable path to take.

TazMom, I suggest you reach out K-Gobby https://community.breastcancer.org/member/307255/p...

She's at City of Hope and is also doing trial and genetic testing. You can read her story here: https://community.breastcancer.org/forum/5/topics/...

I've participated in clinical trials before. I think it's worth it but you need to decide for yourself what your goals of care are. Here is a BCO page explaining lots about clinical trials and what to ask about them https://www.breastcancer.org/treatment/clinical_tr...

TazMom, I'm afraid I must question your oncologist's knowledge of the National Comprehensive Cancer Network's (NCCN) guidelines for genetic testing. I looked at the guidelines and a woman with a personal history of breast cancer (you) would qualify

Diagnosed at age 45 or under

Diagnosed age 46-50 and limited family history (your father's side missing)

I read in another post of yours that you are 45. So it seems you do quality according to the guidelines in the USA at least. You can ask to be referred to a cancer genetics counselor -- maybe at City of Hope -- who will have expertise in eligibility as well as what genes should be tested (there is more than just BRCA). Hopefully you can do this before surgery because the result could inform your choice of lumpectomy vs. mastectomy.

(I have not copied the guidelines here because of copyright, but you can look up NCCN genetic testing criteria for breast cancer.)

Hi Taz,

Are you in Southern California? If so, I would really encourage you to indeed go see those folks at City of Hope if for no other reasons than that which Shetland mentioned. Personally, I don't think genetic testing right now is a necessary driver of treatment because it is too soon to know if you will need chemotherapy. But, in the event you do, it is important to know if you have any actionable mutations which might direct therapy. Shetland did allude a bit of a lazy approach of your oncologist since it is now the standard of treatment for someone in your age group. Also, moth spoke of genomic testing - OncotypeDX - which tests the actual tumor tissue. That will indicate the degree of aggressiveness of your tumor and how likely you might benefit from chemotherapy - which actually could be done before surgery, depending on what your tissue discloses.

Have you considered a second opinion while you get things sorted out.

I wish you the best,

Jane

Responding to jhl's comment "Personally, I don't think genetic testing right now is a necessary driver of treatment because it is too soon to know if you will need chemotherapy." The reason I was thinking genetic testing (blood test for Ambry panel or similar) before surgery would be important is that if a germline (inherited) pathogenic BRCA mutation is found, a patient might convert lumpectomy to double mastectomy because of the high risk of another occurrence of cancer in the breast. So no info until after surgery is not right in my opinion, TazMom.

With ER+ Her2- bc genomic testing (of the tumor) as in Oncotype is often done after surgery to determine whether chemotherapy is recommended.

Sometimes there is confusion between the two types of testing.

This period of diagnosis and treatment planning, of gathering information and making decisions, is a crazy stressful time for sure. Waiting for appointments and test results is hard. There is a steep learning curve and sometimes we don't know what we don't know. Do all the steps, and ask questions and get medical opinions until you are comfortable with the plan. I think most patients would agree that once you have the plan and are taking action, you feel better.

You can call City of Hope and ask them how to go about getting a second opinion and/or genetic counseling and testing there, and they can help you with the process.

Both Shetland and Alice make good points, keeping in mind that every case is unique. There is a strong family history of BC on my maternal side however, I didn't have genetic testing until after my 2nd lumpectomy. I have a genetic mutation and would have likely opted for a BMX had I known that information prior to surgery.

Alice - you are one strong woman. My 2nd lx was longer than the first and under full anaesthesia

Best wishes to TazMom and oldladyblue.