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May 26, 2012 04:35 PM, edited May 26, 2012 04:39 PM
wildrumara is correct. The "official" categories are still 0-17 for "low risk," 18-30 for "intermediate risk," and 31+ for "high risk." Remember, though:
1) Those categories are defined arbitrarily. What one person considers "low risk" might be different from what another person thinks is "low risk" (etc.). A score of "15" corresponds to a recurrence risk of 10%, which sounds pretty meager. But, that's the risk of developing metastatic breast cancer ("distant recurrence") in the next 10 years. Some people might not think a one-in-ten chance of mets is such a trivial thing. OTOH, other women on these boards have not been convinced that a score in the "high risk" range was necessarily that high.
2) It seems like the difference between the categories is more significant than it really is. Remember that the scale for the "Recurrence Score" is continuous. For instance, a score of "29" is classified as "intermediate risk," while a score of "31" is in the "high risk" group (according to the official criteria). But, that score of "29" corresponds to 19% chance of developing mets, while the "31" represents a 21% chance of distant recurrence. Really, there's not much difference between 19% and 21%, even though the scores are in different risk groups.
Finally, as per the question about the TAILORx categories vs. the official categories: I've been looking for a good answer for that question, ever since I found out my score was a whopping "26". Here's what I've located (note that it's a pdf file)... ecog.dfci.harvard.edu/general/...
The relevant section: "Slide 13 -- Definition of Risk Groups for TAILORx"
1) It is important to point out that the definitions of low, intermediate or mid-range, and high risk have been modified for the TAILORx trial, and are different than the original definitions reported for the assay.
2) The definitions were modified in order to reduce the risk of under-treatment in the trial. In other words, an effort was made to minimize the risk that patients who are truly benefiting from chemotherapy would not receive it.
3) It is currently unclear at which Recurrence Score benefit from chemotherapy occurs. It is clear that chemotherapy is not likely to be beneficial if the Recurrence Score is less than 11. It is also clear that chemotherapy is very beneficial if the Recurrence Score is more than 25. The trial will determine whether there is any chemotherapy benefit if the Recurrence Score is 11-25, and if so, at what level this benefit can be detected.
4) For the low Recurrence Score group, the upper bound was reduced from 18 to 11. … This was done because at Recurrence Score of 10 or lower, there is a less than 5-10 percent chance of relapsing with hormonal therapy alone. This 5-10 percent threshold is typically used for recommending adjuvant chemotherapy. Therefore, women with a Recurrence Score of less than 11 will receive hormonal therapy alone.
5) For the high Recurrence Score group, the upper bound was reduced from 30 to 25. … A RS of 30 is associated with a 20 percent risk of recurrence. This group will receive chemotherapy in addition to hormonal therapy. Lowering the threshold to 25 will reduce the risk of under-treating this group.
6) Finally, the definition of the intermediate or mid-range group was adjusted from 18-30 down to a range of 11-25. This is called the Primary Study Group because it is in this group we are evaluating whether chemotherapy is beneficial. Changing this definition reduces the risk of under-treatment at the upper range of this mid-range group.
The bottom line is that the categories were changed (cutoffs were lowered) for the TAILORx trial for ethical reasons. The researchers dared not risk denying a woman the treatment she ordinarily have received, given the aggressiveness of her tumor.
BTW, my med onco recommended chemo for me in part on the basis of my score of 26. He pointed out that if I had enrolled in the TAILORx trial (which I declined to do), I would automatically be getting chemo with that score.
Dx IDC, Stage I, Grade 2, 0/3 nodes, ER+/PR-, HER2-