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Dec 23, 2011 08:19PM
Nancy, you asked: "Has anyone else seen their treatment plan change so dramatically after receiving the Oncotype score?"
Yes, absolutely, as everyone here has said.
When I met with my breast surgeon and medical oncologist shortly after my surgery (left mast/SNB), both were happy that my tumor was less than 2 cm, the grade was 2 ("not 3"), the tumor had estrogen receptors (ER+) but was HER2 negative, and my nodes were negative. The surgeon was forecasting that I would not need chemo at all -- I would go directly on to an aromatase inhibitor to suppress estrogen synthesis.
The med onco wasn't quite as confident. He said having an ER+ tumor was a good thing because ER+ tumors were less aggressive and less likely to recur than tumors that lacked estrogen receptors. As a result, he said, many women in my situation did not need chemo. But, he said, it was hard to tell whether a particular ER+ tumor was going to recur or whether chemo would be helpful against an ER+ tumor, without more information. So, he said, we're going to order an Oncotype DX test.
My Oncotype DX score ended up being 26, which translated to a 17% likelihood of metastatic BC within the next 10 years (more about that in a minute). That was way too high for me, or for my cancer docs; so I had 4 rounds of Taxotere & Cytoxan. (Six rounds was not the norm back then.)
In other words, I went from "probably no chemo" to "chemo is highly recommended" on the basis of my Oncotype score. Apparently, dramatic changes in treatment recommendations based on the Oncotype result are not unusual.
It's important to realize that the Oncotype score doesn't just estimate the "recurrence risk." It predicts the likelihood that a woman will develop "distant recurrence" in the next 10 years. A "distant recurrence" means metastatic breast cancer. That's serious stuff. Once a tumor metastasizes, we can't put the genie back in the bottle.
According to the company that runs the test (Genomic Health), Oncotype DX scores of 18 or lower represent a "low risk" of distant recurrence. Scores from 19 to 30 represent "intermediate risk"; and scores of 31 or higher are designated "high risk." Here's more information about the test, from the company's website: http://www.oncotypedx.com/en-US/Breast.aspx
So, yes, it really sux, but your Oncotype score is high enough to put you in the "high risk" category. The good news is that the higher the Oncotype score, the greater the likelihood that chemo will have a significant impact on the outcome.
2008, IDC, Stage Ia, Grade 2, 0/3 nodes, ER+/PR-, HER2-