Any Her2+ With Low Onco Type DX Score?

Pam,

I dont know if this will help but my info is:

IDC, 2.4 cm, node negative, Stage 2, Grade 1....her2 negative.....onco score 12...

I had lumpectomy w/snb and 37 rads...now on tamoxifen.

And doing wonderfully. I had my 6 month followups last week and was told I am NED

Jule

Thanks Dejaboo. i guess i don't qualify for an onco score now that my node turned out to be positive (the pathologist screwed up!) Is that a chocolate lab in your picture?

My thoughts exactly Dejaboo.....but I don't really like that kind of "subjective" interpretation. I would have preferred if my onc told me the real numbers from the Oncotype DX and then explained to me about the "gray" area - instead of just saying my score was "low". This is why I really want to see the report - his office said they'll mail it to me today. It won't change my mind about my treatment.....but at least I'll know what the official report said.

What is your onc recommending Dejaboo? If you are pre-menopausal, will you go on any anti-estrogen hormone drugs?

Good luck tomorrow Christianne - I know that dreaded feeling.....here's hoping you get a low score!

Thanks for the good luck wishes.

Ok, I got my Onco results today.  My oncotype score was 20, which is in the bottom of the intermediate range.  My oncologist said my risk for recurrence in the next 10 years is 12% and that chemo would only reduce my risk to 9%.  He didn't think it was worth it.  Another way to say this is that 97 out of 100 women would do no better with chemo and only 3 would benefit.  And my doctor felt that the side effects and risks of chemo would outweigh that 3%.  So even with a high Her-2 score, which he said is factored into the oncotype test, I didn't get a high risk score back.  I was very, very relieved--I totally expected to be in the high risk range.  I will start Tamoxifen and be closely monitored.

Swimangel (and Dejaboo, and others), I don't normally hang out on this thread since I'm not HER2+, but I saw your question about your HER2 report and your Oncotype score:

"...is it possible to be Her2+ and have a low Oncotype DX score? And must one have a Fish test done BEFORE getting the Oncotype DX results? Or does the company that conducts the Oncotype DX perform their own pathology testing on the tumor, including the FISH?"

Yes, it is mathematically possible to be HER2+ and have a low Oncotype score.  The formula for the Oncotype recurrence score contains weighted results of tests for the expression of genes in 7 different "gene groups".  Results from 4 of those gene groups add to the recurrence score; results from 3 other groups subtract from it.  HER2 is in one of the groups that increases the score, but so are other genes like Ki-67.  ER and PR are in a group that subtracts from the score.

So, it's all very complicated; but theoretically, even if the HER2 result was positive, it could be counterbalanced by high numbers in the "subtractive" groups or low numbers in the other "additive" groups.

And, no, it is not necessary to have a HER2 test result before the samples are sent for Oncotype testing.  It's my understanding that only the size of the tumor, a positive result for ER, and negative nodal status, are necessary.  Nodal status may be changing, but our insurance companies are not even keeping up with reimbursement for testing on node-negative tumors.

Genomic Health does test the tissue for HER2 as a part of Oncotype testing, but they don't include those results with their report.  They only include the Oncotype recurrence score and the ER and PR results.  You should be able to get a copy of the actual test report--it's part of your medical record, and it includes an interpretation of the results.  There is also lots of stuff available on-line, including on the Genomic Health website, that explains the test and its interpretation.

otter 

Northstar - after nearly a year of treatment with Herceptin and online research about Her2+ cancers, I found out that the latest studies are saying ALL Her2+ tumors, no matter how small, need to be treated with Herceptin because of the aggressiveness of this type of tumor. Tell your friend she can get a ton of information about Her2+ breast cancer at www.her2support.org.

Hi,

My oncologist told me that HER2+ "trumps" the oncotype score because they are generally more aggressive cancers. They would generally recommend chemo if you are Her2+ so the oncotype score is not that helpful. I guess a lot of the genes they assay for the oncotype are Her genes so my guess is it would be high if you are Her2+. My Her2 was "equivocal" and I'm waiting for a "FISH" test. If positive, then chemo. If negative, then Oncotype will be done.

Oncotype DX is definitely doing node positive. They are a great company.  I had double mastectomy on May 8th.2009. Left had two tumors 2.2 and 2.7 cm with microscopic bridge so they added them together to make 5.5 cm (count space between). Right breast had odd things but no cancer found on tests but I decided to have both removed. Right simple mastectomy Left modified radical. No reconstuction. My age 62. Negative sentinel node but surgeon felt odd node so removed 13 lymph nodes..1-6 clean 7th had cancer cells, 8-13 clean. it was tan. so that made me 1//13..thus node positive. Insurance company refused payment because of the 1 positive node. Contacted  Onco company..they will do appeals to insurance company but said if I met financial guidelines they would not charge for part insurance wouldn't pay and if appeals failed...pro bono.

They are a great group of people truly trying to help women with breast cancer. So test was done. Because of the size of my tumor and the node..doctors were talking radiation, hormone and chemo. My Oncotype DX came back 16. Please note my oncologist told me she was certain it was going to come back high, surgeon thought it would come back low. But I am a 16 and with a 16 I definitely do not feel the damage chemo would do to possible cancer is worth the damage it would do to my body and immune system. If you are node positive and don't make over 40-50,000 a year...you should contact them or have your oncologist contact them.  They truly will try to help you get the test.  The test company is Genomic Health in California

My surgeon has suggested the oncotype test, but my "1st opinion onc." will not recommend the test, with good reason I suppose.  Since my IDC was only 1 mm and I am struggling with treatment decision, I was hoping the score would help me decide.  He is recommending Tamox only and I'm sure the test results would probably suggest otherwise.  I'll see what my "2nd opinion onc." suggests, but since there don't seem to be many women out there who are Her2+++ and pT1mic, maybe I should insist on the test.  If only as an experiment...Any opinions?   

Yes KorynH.........since you are Her2+++ you know already that you'll need chemo and Herceptin so there's really no need for the Oncotype DX test. My onc sent my tumor out for Oncotype DX BEFORE he received the results of my FISH test - somehow the FISH test got lost in the shuffle while my breast surgeon was moving his office. Even though my score was a 22, my onc said I didn't need chemo - however, once the FISH came back with Her2++++, he said I had no choice not but to get Herceptin with chemo for a year, even though my tumor was smaller than 1cm. I'm happy now I listened to him - I'd hate to think that sneaky Her2+ BC was trying to stage a come-back somewhere else in my body!