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Topic: Oncotype Questions

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: Aug 26, 2021 07:59AM

macdebbie wrote:

I have met with 2 oncologists, and my BCS and I am confused...

I only have biopsy results right now, my surgery has not yet been done, so the only thing we have to look at is a prelim from the ultrasound that says the "area" is 6mm.

The first oncologist said that if the tumor is under 5mm I do not qualify for Oncotype. He said the at greater than 6mm I qualify for Oncotype and that depending on other features of the tumor, different therapies would be considered.

When I mentioned Oncotype to the BCS, she told me that all the "breast cancer gurus" - Dana Farber, MD Anderson, Sloan Kettering, etc. say if the tumor is under 1cm, it should not be sent for Oncotype and that they actually could be criticized for sending it as being too aggressive with testing. She did say though that if it's between 6mm-10mm the oncologist would have a discussion with me.

The 2nd oncologist I met with told me if it's under 5mm, no chem and no Oncotype. He said if it's 5mm-1cm we would have a long discussion about chemo, but said nothing about Oncotype, and said if it's greater than 1cm but less than 2cm and less than 3 nodes involved, we would "talk about Oncotype". So he seems to be leaning toward not sending for Oncotype in the 6mm-1cm range, where the first oncologist told me I qualified over 6mm.

I looked at the NCCN treatment guidelines, and all the treatment guidelines for ER+, PR+, HER2- tumors are based on tumor size of 0.5cm, which if my math is right is 5mm. it says if tumor is larger than 0.5cm and gene test not done, either chemo followed by endocrine therapy is recommended or just endocrine therapy. But if gene testing was done, it gives very definitive treatment guidelines such as if score is less than 26 no chemo is recommended, when it's 26-30 it could be either chemo followed by endocrine therapy or just endocrine therapy, and if score is 31 or more, chemo followed by endocrine therapy is recommended.

So it seems like Oncotype is a a valuable tool. When I tried to get into more detail with the 2nd oncologist, he told me there were a lot of rabbit holes we could go down, but we don't know the final size, so right now I should focus on my surgery.

The problem I have now is that my surgery is on 9/14 and the BCS told me that when she has the final path and has reviewed everything she contacts the oncologist with the results and he and I should have already had an "if this then that" conversation so he will know to send for Oncotype or not. Well since he didn't go into detail with me about that, we haven't had that conversation and I don't meet with him until 9/30. Whether I need chemo will hinge partly on Oncotype which I read takes two weeks to come back, so now we're at 10/14, and the radiation therapist told me she wanted to see me for my "planning" appt 2 weeks after surgery after my BCS post op, but I can't see her until I know if I'm having chemo first, right? Because chemo would be before radiation.

I'm so confused....

Dx 7/29/2021, IDC, Right, <1cm, Grade 2, ER+/PR+, HER2- (IHC) Surgery 9/13/2021 Lumpectomy: Right; Lymph node removal: Sentinel Hormonal Therapy
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Sep 2, 2021 06:28AM oldladyblue wrote:

Hi macdebbie, I am newly diagnosed with cancer similar to yours but post-surgery now. My surgery was the day before you were diagnosed. They did an oncotype test after surgery, it took just over 2 weeks, and my score is 28. That is over the score of 25 (70% of women score 25 or less and can safely avoid chemo). At first, pre-surgery and the genomic test, it was thought I would only need radiation and hormone therapy. .

I talked to the radiation doctor yesterday for a full consult over the phone. He said "if you decide to do chemo, we will talk in about 3 months about scheduling radiation. If you don't decide to do chemo, call me back right away to get set up for radiation." He didn't pressure me either way, just spent about 30 minutes on the phone with me to get his intake questions answered, leaving only the physical exam to be done later. I felt much better having the oncotyping done before the conversation with the radiology doctor.

My next step is a muga scan of my heart, ordered by the doctor who will do my chemo workup. I was still undecided to do chemo when that was scheduled for Sept 14. I am now pretty certain I will do chemo.

I hope you can have a discussion with your team members to get your tumor oncotyped after your surgery.

64 years old, Oncotype 28 Dx 6/25/2021, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 7/27/2021 Lumpectomy: Left; Lymph node removal: Sentinel, Underarm/Axillary Chemotherapy 10/8/2021 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Sep 2, 2021 06:00PM Murfy wrote:

macdebbie, your tumor appears quite small and will soon be removed. Take a take a deep breath, because then the waiting game begins. We've all gone through this and it will likely be the hardest part of your ordeal. But there is a method to this madness and once all your tumor's info is gleaned and a treatment plan acknowledged, you WILL breath easier.

Here's hoping surgery goes well for you and you soon have all your answers...

Dx at 62: Oncotype=52; Path (ER=99%, PR=0%, Ki67=55%) Dx 10/2017, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER+/PR-, HER2- Surgery 11/13/2017 Mastectomy: Left Chemotherapy 1/12/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 3/29/2018 Aromasin (exemestane)

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