ER/PR score on Oncotype report

tiff, I think Marcia is talking about the ER and PR results in the Oncotype report, not the Oncotype recurrence score itself.

Marcia, yes, the formula for calculating the Oncotype score is really complex.  You are right in noting that it includes ER and PR levels, and also 14 other genes that are involved in regulation of cell growth (positively or negatively).  Each value is weighted (by a multiplier factor) according to its importance in the grand scheme.  The original papers in which the Oncotype formula was devised are kind of neat reading.  I really wish Genomic Health would report all the the expression levels that go into our Oncotype scores, and not just the ER and PR levels.

As to why I am getting chemo:  Originally, I was probably not going to need it.  My surgical oncologist was optimistic that I might not need chemo, because my tumor was less than 2 cm, ER+, HER2-, and had not spread to my nodes.  She handed me off to a medical oncologist, who said the same thing, especially since many ER+ HER2- tumors are not especially responsive to chemo anyway.  But he submitted tissues for Oncotype testing, as is (or should be, IMHO) the standard-of-care for early, node-negative, ER+ BC.

My Oncotype score was 26.  Bah, humbug!  My onco said there were several factors weighing in favor of chemo:  The size of my tumor (greater than 1.0 cm); the fact that it was PR- (which may be "more aggressive," but the role of PR is still poorly understood); the fact that it was Grade 2 (Grade 1 would have been better); my age (56 is apparently not "old" enough to skip chemo); and of course the Oncotype score.

The original "intermediate range" for Oncotype scores went from 18 to 30, which meant mine was in the upper half of that range.  What concerned me more was that 25 was the cutoff for the "chemo vs. no chemo" decision in the TAILORx clinical trial.  That's a study currently underway to test whether women whose Oncotype scores are between 11 and 25 really need chemo.  Anyone in that trial with a score above 25 automatically gets chemo; so if I had enrolled in the study (which I declined to do), I'd be getting chemo anyway.

Oh, BTW, I switched onco's at about the same time my Oncotype score came back.  My original onco and I were just not getting along--a major difference in personality and style.  I was offered a different onco in the same medical group, and we get along fabulously.  She also recommended chemo, based on those same variables.  But it was really my choice--I could have declined, and I don't think anyone would have pressured me.  My calculated risk of recurrence based on my Oncotype score was 17% with surgery and tamoxifen/AI (no chemo).  According to the AdjuvantOnline calculator, I could reduce that risk by 1/3 (to about 12%) with chemo.  That's what onco #2 said, as well.

So here I am.  It's not so bad.  (Ask me again in 10 days, when I'm in the throes of SE's from tx #3.)  OTOH, I would not do this for a "mere" 1% or 2% improvement in recurrence risk.

otter

Marcia, that's what 2nd opinions are for ... at least, we hope so.  If #2 gave you the opposite recommendation as #1, then I guess it would be your choice.  Oh, heck.  It's really your choice anyway, and I have no idea what I would do if I were in your situation.  I hoped and hoped my Oncotype score would not put me on the fence; and it really didn't.

I hope along with you that onco #2 can help.

otter 

Hi and thank you for this post. Clarified a couple of questions I had concerning my Oncotype results...ER+/PR-/HER2-, overall score 27 with 18% chance of recurrence. My onc is not recommending chemo and has put me on Letrozole (AI). I was quire concerned about not having chemo, but decided to go with his recommendation based on the fact that the added benefit of chemo was only about 3%, which would not offset the impact of the side effects. I'm comfortable with my decision (I'm 65 and also have rheumatoid arthritis, so I am happy to avoid chemo side effects) My bigger concern is that there seems to be a fair amount of time that goes by between treatments, and I wonder if this has an effect on overall outcome. For example, diagnosed Oct 5, lumpectomy on Oct 30th...the results came back (unclear margins), re-excision to clear the margins on Dec 2...margins still not clear, so will have MX Jan 26 - is this common? There are still cancer cells remaining, and it seems that this overall 12 week delay could give it time to 'travel' - especially given that there was lympho-vascular presence. There was only microscopic cancer cells in 2/3 sentinel nodes, so my cancer has been deemed node negative, but I can't help being anxious about this time lag in treatment.

I thought chemo was always recommended for cancer with lymph node involvement.

All the comments I am reading have helped me understand doctors recommendations. I had both ILC and IDC, I think I made the right decision for me, no chemo. I had only one oncodx score 34.

JuniperCat, when the doctor is discussing recurrence as related to the Oncotype test, the recurrence is the 10 year risk of distant recurrence.

Very informative post! My oncotype score was 27 and my tumour was 4.5 cm, also PR-, grade 2 (lobular). I am 65 (so I guess lobular and old helped me avoid chemo), They better be right or I'll sue lol

Hello Meow13! I, too, am a cat lady! We have eight indoor cats and five barn cats. One more and I'm sure my husband will divorce me! Truth is is that he's as much a cat person as am I! Re: recurrence of cancer: is that the case even if the lymph nodes were negative in the original tumor? How can it spread if the tumor was excised?

Hi JuniperCat:

I agree with SummerAngel. The tumor was in there for a while before it was removed, providing a potential opportunity for cells to escape either by the lymphatic system or via the blood stream prior to surgery. Unfortunately, this is possible even with node-negative cancers. Sentinel node biopsy (SNB) is pretty good, but unfortunately does not appear to be a perfect read on the question of whether any cells moved away (laying the groundwork for a distant recurrence). If SNB was perfect (which it is not), then the chemotherapy question would be more of a no-brainer for node-negative patients (which it is not).

BarredOwl

Hi Junipercat, I have 2 Persian cats one male pure white the other white/muted calico female. Oh the fur, daily brushing and vacuuming. They love to snuggle and make me feel better. Don't worry too much about your cancer chances are in your favor you won't have to deal with it again. The reason stage 1 is treated aggressively is so the probability is minimised that it will come back and might be metatised and become harder to control.

I chose to take hormone therapy AI, no chemo even though my oncodx was 34. I am 4 years with no recuurrence.