Log in to post a reply
Jul 17, 2012 08:57PM
Jul 17, 2012 08:58PM
OK, well I now have a copy of my Oncotype results in hand. I got both a node-negative and a node-positive printout, but because of that one micromet I haven't even looked at the node-negative versioni.
On the back page, each of the receptor scores is shown in a box, and each also has a graph that looks like a ruler next to it. The ER ruler goes from 3.7 to 12.5, plus room at each end in case your score is less than 3.7 or more than 12.5; my score is 12.0, almost at end of the ruler, which I take to mean that I am very strongly ER positive. On the PR scale, the ruler goes from 3.2 to 10.0, again with room for "more than" and "less than" at each end, and I score 5.7, which is just barely past the cutoff point of 5.5, and I think means that I am weakly PR positive. The HER2 ruler is similar: less than 7.6, ruler from 7.6 to 13.0, with scores below 10.7 negative, between 10.7 and 11.5 considered equivocal, and above 11.5 posivtive. My score of 9.6 is decidedly HER2 negative, but not extremely so.
The front page shows the rate of recurrence* or death** up one side, and the Oncotype score across the bottom. With 1-3 positive nodes, a score of 28 means a recurrence risk of approximately 17% with tamoxifen only, which chemo (specifically CAF-T) would reduce to about 13%. I have to eyeball estimate these percentages from a scale at the other edge of the chart, so take them with a grain of salt, but they are at least roughly consistent with the Adjuvant!online printout I got from Dr F, and with the results I got from the online cancermath.net calculator. This appears to show a benefit for adding chemo of about four percentage points. However, the graph also shows the "confidence interval" on each side of the lines, and this area of doubt is at least twice as large as the estimated benefit of adding cancer. The fine print on the back says my individual hormone and HER2 scores are taken into account in determining this confidence interval. I guess that's why these intermediate scores are considered a gray area. You can't really be sure that including chemo will really improve matters over just tamoxifen. And of course if you use a different chemo regimen than the study, or an AI instead of or after tamoxifen, it really gets to be kind of nebulous.
Nevertheless, Dr F and I agree that 28 is so close to the edge of the "high" range that chemo is advisable. I wasn't advised to have more nodes removed, despite the one sentinel with 1 mm of cancer, and frankly I think I'd be scared to depend on hormone tx alone to deal with any micromets that might still be in the nodes downstream of that affected one. So tomorrow I'm crossing the Rubicon, and starting 6 months of CMF...unless I chicken out of the weekly schedule for this regimen as done at my treatment locale. I could still go for the TCx4 if I call first thing in the AM. But I don't think I will. That 3% chance of baldness is just too much for me, and Adjuvant!online shows the absolute benefit of the CMF is only 2 percentage points less than that of TC. I've thought about it a lot over the last few days, and the conclusion I came to is if I bet on CMF and lose (i.e. I'm one of the two people in a hundred who die with CMF treatment that would have lived with TC) I'll never know it, but if I take TC and I'm one of the three people in a hundred who end up hairless, I'll never be able to escape that. As far as I've been able to find out, here's no treatment for hair lost this way--not Rogaine, not transplants. When it's gone, it's gone forever. I didn't know if I could deal with having that happen and worse, knowing I had brought it on myself. So I'm not going to take the chance.
*recurrence=after 5 years of follow-up, local recurrence, metastasis or new primary tumor
** death=after 5 years of follow-up, death from either breast cancer or other causes
Oncotype score 28--Age 56 at initial DX--mets found at 57 (but I suspect they were there from the start)--mixed IDC & carcenoid (neuroendocrine) tumor. Octreotide (a carcenoid treatment) June-Sept 2013, failed.
3/23/2012, IDC, 1cm, Stage IB, Grade 2, 1/13 nodes, ER+/PR+, HER2-
1/10/2013 Arimidex (anastrozole)
2/26/2013, IDC, 1cm, Stage IV, Grade 2, 1/13 nodes, mets, ER+/PR+, HER2-
6/3/2013 Aromasin (exemestane)
10/30/2013 Taxol (paclitaxel)
1/22/2014 Doxil (doxorubicin)