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Jul 27, 2019 08:22AM
I was just reading your post, and something struck me that hasn't been mentioned by anyone else. You said:
"I was told I had a 30% chance of recurrence if I don't go through radiation and tamoxifen. Would an oncotype determination help me make a more informed decision as to what therapies I should proceed with?"
My question is whether the 30% is referring to a local recurrence (i.e. in the breast area) or a combination of both a local and/or distant recurrence (distant recurrences being metastatic). This is something you need to ask your Medical Oncologist.
After a breast cancer diagnosis and breast cancer surgery, we all face 3 risks.
- The first is the risk of a local recurrence. This can happen if a few rogue cells remain in the breast after surgery and have the opportunity to develop again into breast cancer. This risk increases if the tumor is large (from your signature line, yours doesn't appear to be), if the cancer is aggressive (your cancer, being grade 1, ER+/PR+/HER2- and node negative, does not appear to be aggressive), and if the surgical margins are close. A 30% recurrence risk, as you were quoted, seems very high unless your surgical margins were small. Do you have the information about the size of the surgical margins? From a treatment standpoint, Radiation and Tamoxifen/AIs are used to kill off any rogue cells left in the breast, thereby reducing the risk of a local recurrence.
- The second is the risk of a metastatic recurrence. This can happen if a few rogue cells escaped from the breast and moved into the body either through the blood stream or through the lymphatic system, prior to the removal of the cancer from the breast. In most cases when this happens, it happens well before the cancer was even discovered. This risk increases if the tumor is a) genetically aggressive (as measured by the Oncotype or Mammaprint tests), b) pathologically aggressive (your cancer, being small, grade 1, ER+/PR+/HER2- and node negative, is pathologically very favorable / non-aggressive), and c) the patient is younger (at 67, your risk will be considerably lower than someone in their 30s or 40s). From a treatment standpoint, Chemo and Tamoxifen/AIs are used to track down and kill off these rogue cells that might be in the body, thereby reducing the risk of a distant / metastatic recurrence.
- The third is the risk of a new primary breast cancer. This is a new breast cancer that develops at any point over the rest of the patient's life, and that is not a recurrence of the first diagnosis, i.e. it is not the same cells reactivating, but new cancer cells that develop in either breast. As women, we all can develop breast cancer again - we are not immune because we've been diagnosed before. In fact our risk is higher because we've been diagnosed before - our bodies have already shown that cancer cells can develop and thrive. This risk increases significantly for those who are young (therefore at 67, your risk will be lower), who have a genetic mutation that increases risk, and who have a first diagnosis with particular pathologies (ER+/PR+/HER2- is the most favorable and presents the lowest risk to develop a new primary). From a treatment standpoint, Tamoxifen/AIs and surgery (a BMX) are used to reduce the risk of the development of a new primary breast cancer.
I'm just guessing, but since Radiation was mentioned, I suspect that the 30% that was mentioned to you refers to local recurrence. The Oncotype test does not provide any information about this.
What the Oncotype test does is add to the body of information about your possible risk of a metastatic recurrence. But as I've indicated previously in this thread, the Oncotype test should not be used alone, without consideration to the other factors that affect metastatic recurrence risk. And if those other factors are overwhelming, the Oncotype test is in effect invalidated. This is precisely what the Oncotype RSPC computer model shows.
- A very young patient who gets a low Oncotype score, but who has a diagnosis that is pathologically aggressive (a large tumor, grade 3, perhaps micromets in the nodes) will likely end up with a revised recurrence risk indicating the need for and benefit from chemo, when the additional clinical/pathological data is input into the Oncotype RSPC model.
- An older patient who gets a high Oncotype score, but who has a diagnosis that is pathologically non-aggressive (a small tumor, grade 1, node negative), will likely end up with a revised recurrence risk indicating no need for or benefit from chemo, when the additional clinical/pathological data is input into the Oncotype RSPC model.
- These are not just theoretical examples, but reflect situations I've seen on this site, where the Oncotype RSPC model was used by an MO, and the Oncotype score has been overridden by clinical/pathololgy factors, leading to chemo or no chemo decisions, contrary to the genetic Oncotype recommendation.
Donnalee, I don't know your tumor size, although from your signature line it appears to be relatively small, but you are 67 and you have a grade 1 ER+/PR+/HER2- node negative tumor. My guess is that this may be the reason why an Oncotype is not being ordered for you, because the results, even if high, might be overridden by your very favorable pathology and your age. In other words, even with a high score, your clinical/pathology factors will likely result in a low recurrence risk, which wouldn't warrant the risks and side effects of chemo. Many facilities will not order the Oncotype test if the results will not change the treatment plan. So if your MO has determined based on your clinical/pathology factors that he would not recommend chemo even with a high Oncotype score, then there is no reason to order the test. That said, I completely understand your desire to find out your score, and hopefully you can convince your MO to order it.
“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke