Topic: Age 40, ER+/PR+/HER2-. OncoType 20. Chemo???

Forum: Young With Breast Cancer — Connect with those under 40 who have been diagnosed.

Posted on: Mar 15, 2021 08:40PM

Posted on: Mar 15, 2021 08:40PM

ailuj9 wrote:

I was diagnosed with invasive ductal carcinoma in January at age 40 (I turned 40 four days after diagnosis). Receptors: ER+/Progesterone+/HER2 negative. I underwent lumpectomy (tumor size 2cm) with sentinel lymph node biopsy, which was negative for cancer. I will have to do radiation. I tested negative for the BRCA1/2 gene and for other breast cancer genes. I do not have a strong family history of breast cancer. At this point, my Oncotype Dx score came back at 20. This puts me in a gray area for determining if I should proceed with chemo or not. According to the literature, if my score is 21 or higher, based on age, one should proceed with chemo. Since my score is 20, my oncologist is leaving it up to me and now I am tasked with making a very challenging decision. Chemo would be taxotere and cyclophosphamide once every 3 weeks for 4 rounds. Followed by the hormone blocker, Tamoxifen, regardless of whether I do chemo or not. Thus, I am reaching out to you for your knowledge and to those of you who have possibly had to make similar decisions. Thanks in advance

Dx 1/15/2021, IDC, Right, 2cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2-, Surgery 2/18/2021 Radiation Therapy Breast
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Mar 15, 2021 09:16PM moth wrote:

Hi & welcome to the boards. I'm sorry you find yourself dealing with this diagnosis and such a difficult decision.

I didn't have to make your decision as chemo was a given for me right from the start but I wanted to give you some things to mull over:

As I understand the TailorX study results, for <50 year olds, if recurrence score was 0-15 there was no benefit to chemo; recurrence score 16-20 has ~1.6% benefit; 21-25 has ~6.5% benefit. (this is from the TailorX study which studies intermediate results. Reported out in 2019. You can see the under 50 yo subset analysis here towards the bottom hit a grey bar near right side which says "...may differ for younger patients =<50"

soooooo. all this to say, at 20, there is some benefit, though whether it's 'worth' it is a good question.

Several things I'd consider:

-your race. Oncotype may be less accurate for black patients

-how strongly ER+/PR+ was your tumor? If it's very strong, that's a better predictor of tamoxifen being an effective therapy

-what Grade? Grade is a proxy for the speed of the tumor growth & to an extent, its aggressiveness. High grade tends to be more dangerous but also tends to respond better to chemo

-how likely are you to put up with the possibly very unpleasant side effects of Tamoxifen? Only you know your tolerance for suddenly feeling like a creaky old lady, or loss of libido, or vaginal atrophy or mental fog etc etc etc. Which is not to scare you off hormone therapy but to be honest about the fact that while for many, it's a tolerable treatment with minor side effects, the reality is also that many women do NOT stay on these meds for the length of time recommended (5-10 years)

-otoh - if you have some issues like neuropathy or just feeling aged by a decade after chemo which might not have been necessary, will you regret that or will you think it was worth it for the extra guarantee?

-your personal risk personality & feelings of regret. Do you want to be able to say 'I did everything' or are you ok with saying 'I did what I thought was right & reasonable & I'm ok with how things play out'

Whatever you decide, you want to get to a place of having no regrets, kwim?

best wishes

I take weekends off

Initial dx at 50. Seriously?? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: Never Tell Me the Odds

Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- Surgery 12/12/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Chemotherapy 2/13/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole breast: Breast Dx 2/2020, IDC, Left, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/18/2020 Tecentriq (atezolizumab) Chemotherapy 11/25/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/8/2020 External Hormonal Therapy 12/15/2020 Femara (letrozole) Radiation Therapy 3/2/2021 External Local Metastases 3/2/2021 Radiation therapy: Bone Targeted Therapy 1/1/2022 Trodelvy (sacituzumab govitecan-hziy)
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Mar 15, 2021 10:44PM cowgirl13 wrote:

I wanted to throw everything at it because if I hadn't, and I recurred, I was afraid of really regretting my decision. As it turned out, I really didn't have a choice because I'm triple positive. Good luck finding the right decision for you.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, ER+/PR+, HER2+ Surgery 6/16/2009 Chemotherapy 8/2/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/22/2010 Arimidex (anastrozole)
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Mar 16, 2021 05:54AM moderators wrote:

Dear ailuj9 - We're so sorry for the circumstances that have brought you here, but you've come to the right place for support and information. Welcome!
We know it's not easy, but hope we can help you make the most informed decision along with other members advice and your medical team. Here are some links to more information on Oncotype from our website:

We hope this helps, and we look forward to hearing more from you soon!

The Mods

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Mar 16, 2021 07:11AM kathabus wrote:

I had a low oncotype....10. BUT...I was 43 with a Macrometastases in the sentinel lymph node. Usually that's automatic chemo.

Ultimately our decision wound up being no chemo.....but ovary suppression (I opted for oopherectomy) and an aromatase inhibitor (versus the tamoxifen). I feel like with highly positive ER/PR......sometimes that's a good middle road between no chemo and chemo for young premenopausal patients. Might be a good conversation to have with your oncologist. Good luck to you!

Dx 2/17/2020, IDC, Right, 2cm, Stage IB, Grade 2, 1/1 nodes, ER+/PR+, HER2- Surgery 3/23/2020 Lumpectomy; Lymph node removal Surgery 3/24/2020 Lumpectomy (Right); Lymph node removal (Right): Sentinel Surgery 5/1/2020 Radiation Therapy 5/14/2020 Whole breast: Breast, Lymph nodes, Chest wall Radiation Therapy 5/15/2020 Whole breast, Radiation boost: Right breast, Chest wall, Lymph nodes Hormonal Therapy 7/1/2020 Femara (letrozole) Surgery 7/20/2020 Hormonal Therapy 8/20/2020 Femara (letrozole)
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Mar 16, 2021 07:59PM - edited Mar 16, 2021 08:00PM by ailuj9

This Post was deleted by ailuj9.
Dx 1/15/2021, IDC, Right, 2cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2-, Surgery 2/18/2021 Radiation Therapy Breast
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Mar 16, 2021 08:02PM ailuj9 wrote:

Thank you Moth, Cowgirl13 and Kathbus for all the things to consider and sharing your stories with me! Definately helps to get others opinions and lists of things to consider that I didn't know or hadn't thought of! Really apprecite it! Also, thank you all for the website info for my research!

Dx 1/15/2021, IDC, Right, 2cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2-, Surgery 2/18/2021 Radiation Therapy Breast

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