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Topic: Questions about DCIS Oncotype DX test......

Forum: Diagnosed and Waiting for Test Results —

Share with and support others all waiting for test results from CAT scan, PET scan, Oncotype tests, Mammaprint, FISH, IHC, and other diagnostic tests.

Posted on: Feb 21, 2020 06:19PM - edited Feb 21, 2020 07:06PM by breastquest

breastquest wrote:

From what I understand so far, is after Lumpectomy is performed, pathology samples are sent for this DCIS Oncotype DX test. Once you have the score, you go over it with doctor to decide if you need radiation or not, etc....

Other than the pathology/genomic part of the score, what factors weigh heavily on a higher score? And what factors give you a lower score?

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Feb 21, 2020 09:12PM Beesie wrote:

Molecular Evaluation of Breast Ductal Carcinoma in Situ with Oncotype DX DCIS

"The score helps to identify a subset of women >50 years old with unifocal disease that carries <10% risk of any local recurrence after breast-conserving surgery alone. In this population, individual patients and physicians may consider omitting adjuvant radiotherapy."

"The final 12-gene panel for the Oncotype DX Breast DCIS Score includes seven cancer-related (Ki-67, AURKA/STK15, BIRC5/survivin, CCNB1, MYBL2, PGR, and GSTM1) and five reference genes (ACTB, GAPDH, RPLPO, GUS, and TFRC). The DCIS Score is scaled numerically from zero to 100 and classified into three risk prespecified categories: i) low risk (Oncotype DX DCIS Score <39); ii) intermediate risk (Oncotype DCIS DX Score = 39 to 54); and iii) high risk (Oncotype DX DCIS Score ≥55). The Oncotype DCIS DX Score was designed to quantify the 10-year risk of any ipsilateral breast event (local or invasive recurrence) after BCS for pure DCIS after BCS for pure DCIS without radiotherapy."

"A few studies on the correlation between the Oncotype DCIS Score and traditional histopathologic prognosticators were recently published. A single-institution study of 46 cases of pure DCIS....A low Oncotype DCIS Score was significantly associated with low nuclear grade, ERand PGR expression ≥90%, mitotic count ≤1, and absence of dense periductal inflammation. They found a significant association between high ERand PGR expression, low mitotic rate, and low Oncotype DCIS Score, as well as absence of dense periductal chronic inflammation. In this limited sample, all 13 cases with PR expression ≥90%, ≤1 mitotic figure, and absence of dense chronic inflammation around DCIS had a low score. Moreover, a low score was not observed in any case with at least two of the following: negative PGR expression, >1 mitotic figure, and/or presence of dense chronic inflammation....

Another single-institution study...included 37 patients with DCIS...low Oncotype DCIS Score was associated with low nuclear grade, absence of necrosis, high ER and PGR expression by immunohistochemistry, and a lower rate of adjuvant radiotherapy (P < 0.008). In this study, patient age, mitoses, DCIS size, final margin, DCIS cellularity, dense inflammation, and calcification were not significantly different between the low, intermediate, and high Oncotype DCIS Score groups. However, in approximately one-fifth of cases, Oncotype the DCIS Score was considered unexpected in relation to the histopathologic findings (ie, high nuclear grade with comedo necrosis and a low Oncotype DCIS Score) or hormone receptor discrepancies."

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Feb 22, 2020 10:41AM breastquest wrote:

Thanks for the extensive reply!

The gene test they are doing on the sample, are they similar (or the same) as the genetic testing for the BRCA mutation testing.... because they also screen for about 80 different genetic mutations in addition to BRCA... ???

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Feb 22, 2020 01:34PM Beesie wrote:

Nope, it's a completely different test. The Oncotype DCIS is looking at the genetic make-up of the DCIS cells. A genetic test that looks at BRCA and other genes a blood test that looks at the genes we are all born with, seeing if there are any irregularities (mutations) within any genes.

Genetic testing and advanced genomic testing

"Genetic testing and genomic testing may sound similar, but they are very different procedures. Genetics refers to the genes a person is born with that are inherited from past generations. Genetic tests may help determine whether a person has inherited gene mutations that may increase the risk of cancer. Genomics refers to the molecular composition of a tumor."

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Feb 23, 2020 06:17AM breastquest wrote:

Thx for clarifying... and your quick response!

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May 31, 2020 12:48PM BlueDrifter wrote:

I didn't get an OncotypeDX test at the time of my lumpectomy (Sep 2019), as it was felt to be obvious that I wouldn't need chemo and I was with an HMO. Now I am on medicare and just curious, if an Oncotype test be done now, 9 months later?

Dx 9/9/2019, IDC, Right, 2cm, Stage IIA, Grade 1, 0/8 nodes, ER+/PR+, HER2- (FISH) Surgery 9/24/2019 Lumpectomy: Right Radiation Therapy 10/28/2019 Whole-breast: Breast
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Jun 1, 2020 09:30AM - edited Jun 1, 2020 09:38AM by windingshores

Tests like the Oncotype and Mammaprint can be done anytime. The pathology specimens are stored. You would need a doctor's order. The Oncotype is mainly used to determine whether to have chemo so some docs might not want to order one. Here is a good argument: If your doc won't order it, by all means see another doc.

I just reached the 5 year mark and had both the Breast Cancer Index and Prosigna assay done. (A different doc ordered each one.) It was easy to access my pathology specimens and the pathology dept. took care of sending them out, then the testing company (or lab in the case of Prosigna) returns them to pathology for storage.

Dx 2/2015, DCIS/ILC/IDC, Right, 1cm, Stage IA, Grade 3, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery Lymph node removal; Mastectomy: Right Surgery Mastectomy: Left; Prophylactic mastectomy: Left Hormonal Therapy
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Jun 1, 2020 10:29AM Beesie wrote:

Since this thread is entitled "Questions about the DCIS Oncotype DX test", just for clarity, there are two different Oncotype tests for breast cancer patients.

The first is the Oncotype DX test, which, as windingshores mentioned, is used mainly to determine whether chemo will be recommended for those diagnosed with invasive breast cancer.

The second is the "Oncotype DX Breast DCIS", which is used to determine the need for radiation in patients who've had a lumpectomy with a diagnosis of Stage 0 DCIS. It is this second Oncotype test that was the initial subject of this thread, and it's important that the two tests not be confused for each other (which is difficult, given the similar names).

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke

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