Oncotype vs Mammaprint
Looking for info on both of these tests. Both Dr. Susan Love's book and the breast surgeon's office I went to said these are good tests to learn more about the tumor.
However, when I met with an oncologist for a "meet and greet" he said I "did not qualify" as my tumor is less than 6mm. I don't really see why that matters. He also told me that Oncotype is better as it give an actual recurrence %, where Mammaprint just gives a High/Low range.
Can anyone speak to these tests and if there is actually a "qualification" to get one of them done? I feel like the more I know about my tumor the better my treatment plan will be.
I'm scared and overwhelmed with all this and want the best care possible. I have a consult with another oncologist line up as I didn't really click with this guy.
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@macdebbie - it seems the Oncotype is more popular but is only valid for ER+ cancers whereas the Mammaprint works for both ER+ and ER- types of BC. If I'm wrong about this, there are others that will come along with better info.
I had the Mammaprint however, insurance typically won't cover the cost if the tumor is 5mm or smaller, hence why your oncologist stated you won't qualify. You do not want to get stuck with a very expensive bill. In my case, the surgeon requested the Mammaprint as part of a study she is participating in, so the study.covered the cost. If it hadn't I would have been looking at a $8K bill.
Best wishes with your treatment.
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Macdebbie, there is information about both oncotype and mammaprint on the main breast cancer.org site. I found it helpful when learning about them a few years ago. I think the descriptions are under "diagnosis and screening.
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hi, so I had a tiny tumor -5mm. No cancer found in sentinel nodes. My onc had the Mammaprint done(also within a study) and I’m so thankful because it came back as high risk for recurrence. Everyone was surprised. But now I’m getting chemo.
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macdebbie,
If you are node negative, the Oncotype results are based on the TAILORx study. Here is the tumor criteria for participation in the study:
"tumor size 1.1–5.0cm (or 5 mm-1.0 cm plus unfavorable histological features, defined as an intermediate or poor nuclear and/or histologic grade, or lymphovascular invasion)"
This means that Oncotype results are not very representative for those of us who have a smaller tumor. Your 6mm tumor fits into the criteria, but there likely were very few patients in the study with tumors this small. The average tumor size in the TAILORx study was 1.75cm.
Tumor size is one issue with the Oncotype score. Age and grade are other issues. All 3 of these factors have all been shown to affect recurrence risk. Genomic Health (the Oncotype company) don't publicly acknowledge this, but they do unofficially recognize this by making available to Medical Oncologists a computer model (RSClin, which replaced the earlier RSPC Model) that takes 4 inputs - the Oncotype score, the patient's age, the tumor size, and the tumor grade - and recalculates a new 9 year recurrence risk. My MO also refused to run an Oncotype test for me, but he did show me how this model would adjust my recurrence risk at various scores. Even with a 40 score, which falls well into the "you would benefit from chemo" category, once my age (older than average), tumor size (smaller than average) and grade (a 2, which is average for TAILORx) were factored in, my recurrence risk would drop down into the "no significant benefit from chemo" range. My MO's decision was based on his position that no matter what the Oncotype score was, he would not recommend chemo because Genomic Health's own computer model would readjust my risk into the "no benefit from chemo" range.
How old are you and what is the grade of your cancer?
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Thank you so much.
I am still confused by all of this, I just want to make sure I get the best care possible.
I am age 63, my tumor size on the path report is listed as "at least 3mm" and on the Ultrasound before the biopsy it says "questionable hypo echoic mass, measuring 6cm" so I am not sure. The oncologist prefaced his recommendation for no chemo based on available data which he said could change after surgery. I asked him if he used any computer modeling and he wasn't forthcoming.
I have not had my surgery yet (I am meeting with the surgeon on 8/16) so I am not sure if surgery is when the actual size is determined, and I of course don't have any info on node involvement yet. Clinical exam showed no swelling.
I am Grade 2, ER+/PR+, HER-2/neu negative
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I was 63 too when I was diagnosed. If your tumor remains small, then your results on the Oncotype RSClin model would be the same as mine, or even more favorable if your tumor is smaller than mine, which it sounds like it might be. What this means is that at your age with a small grade 2 tumor, even a high Oncotype score will translate to a "no benefit to chemo" recurrence risk when using the RSClin model to factor in pathology and age. My MO used the model to show me the results; I'm sure he didn't need to run the model himself to know what it would show - he has enough experience to know what the outcome of the model would be. I'd guess it's the same for your MO.
That said, you won't know the final size of the tumor until after surgery. At this point all you have are estimates, and the final tumor size could be larger or smaller. If it's larger than the current estimate (did you mean 6mm for the size of the mass, or 6cm?), then your MO will likely order the Oncotype test. That's his point in saying "no chemo based on available data which...could change after surgery".
In other words, the discussion is premature because you don't have the information yet to make the decision. Interesting that you saw the MO before seeing the surgeon. With small ER+ tumors, often patients don't see the MO until after surgery, which is what happened in my case.
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Thank you so much! Yes, I meant 6mm, sorry.
The surgeon's office had me set up appts with an oncologist (I asked to see 2, which is good because I didn't care for the 1st one. He seemed annoyed at my questions and didn't explain things to me), and a radiation therapist I think because 1) I couldn't get into to see the surgeon until 8/16 (I met with her PA who I love, who went over everything with me), and 2) they told me I would need at a minimum, radiation therapy and hormone therapy. Which is what the oncologist and the radiologist who did my biopsies told me after speaking with the pathologist.
I'm nervous about both - I've heard aside from the burns, radiation can damage your heart and lungs, and the hormone treatment has horrible side effects as well. I've read about proton therapy which is supposed to not damage your heart/lungs, but I don't know if that is available where I live. We are from Boston, and if I was at home I would just head to Dana Farber. But I am in SC now, and stuck with the care I can get here. There is an NCI-designated cancer center but they don't take my insurance....
I already have osteoporosis so I don't think an AI is going to work and I don't want to be adding another drug on top of that (Fosomax, etc) to help with bone loss and add even more side effects like femur fractures and jaw bone degeneration. I also read AIs cause debilitating bone pain. The oncologist told me he would likely recommend Tamoxifen which I read has side effects of blood clots and uterine cancer. I don't know which is worse... Seems like the lesser of 3 evils here.
This is all SO stressful. I'm one who does anything to avoid taking meds as I am always in the small % that seems to have a bad reaction to everything I take.
Did you get a second opinion on your pathology report? I'm thinking of checking into that. It seems like that is the most important part. I know there are "Online Second Opinions" at places like Cleveland Clinic, Johns Hopkins, etc. Dana Farber offers it but it is 2K, which I can't afford. Some of the others are in the $700 range, which I could do though.
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macdebbie - for what it's worth, I'm 60 and (like you) have osteoporosis. I have been taking anastrozole (an AI) for eight months with no side effects or discomfort at all. Because of the osteoporosis, I am also getting Zometa infusions every six months for the next three years. The first infusion gave me about 24 hours of intense flu-like symptoms; I was told that the second and subsequent infusions would be much easier, and indeed I had no reaction at all to the second infusion (last Friday). Yes, the AIs and bisphosphonates can cause unpleasant side effects in some people. But many of us have no trouble with them at all. You don't hear much from us, because "doing fine, thanks" tends to be a conversation ender, not a conversation starter. I guess what I'm suggesting is that you give some consideration to the thought that you might be one of the people who does "fine, thanks" on one of the AIs and/or bisphosphonates.
Wishing you all the best in this tough decision-making process!0 -
macdebbie because my bones were already crap, my MO recommended tamoxifen even though I was 59 and post menopausal. He also sent me to an endocrinologist, who put me on Prolia shots. Unfortunately I had an allergic reaction to the second one, and now I take a daily injection of Tymlos.
I asked about an Oncotype test before I agreed to try the tamoxifen because I wanted to know what my risk of recurrence was. He couldn't do that test, but did order the Mammoprint.
I did have radiation and tolerated it just fine. The fatigue is real but bearable.
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Just wanted to say that I had 36 radiation sessions with no real issues and have taken Arimidex for nearly 5 years with no complaints. i also take Fosamax once weekly for my osteopenia with no problems. Don't automatically assume you will have the worst side effects or even any at all. Many of us get along just fine.
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