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....
7/29/2021, IDC, Right, <1cm, Grade 2, ER+/PR+, HER2- (IHC)
9/13/2021 Lumpectomy: Right; Lymph node removal: Sentinel
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