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Topic: Mammaprint-who has had one?

Forum: Just Diagnosed — Discuss next steps, options, and resources.

Posted on: Oct 17, 2017 08:39PM

LizabethM wrote:

Just curious if anyone has used this test as oppose to the onco test? What was your result? Did it affect your decision on treatment.

Thanks, I just ordered mine. Waiting.

Stage 1 but "High Risk" on Mammaprint-so chemo! It is well, with my soul. Using Dignicap cold cap to save my hair. Dx 9/15/2017, IDC, Right, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 10/12/2017 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 11/15/2017 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 2/13/2018 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Oct 17, 2017 08:50PM Meshell5324 wrote:

Hi LizabethM,

My oncologist used a Mammoprint. It only has low or high risk results. Mine came back Low risk. He said I wouldn't receive any additional treatment benefits from chemotherapy. It took 7 days for the results to come in. Good luck, I hope yours comes back Low Risk.

Dx 9/7/2017, DCIS/IDC, Right, 5cm, Stage IIA, Grade 1, 0/5 nodes, ER+/PR+, HER2- (FISH) Surgery 10/19/2017 Lymph node removal: Right, Sentinel; Mastectomy: Right; Reconstruction (right): Silicone implant Hormonal Therapy 12/11/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Oct 17, 2017 09:24PM LizabethM wrote:

Thank you for sharing your results! And, I'm glad your result took only seven days as I heard it could take up to two weeks.

Stage 1 but "High Risk" on Mammaprint-so chemo! It is well, with my soul. Using Dignicap cold cap to save my hair. Dx 9/15/2017, IDC, Right, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 10/12/2017 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 11/15/2017 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 2/13/2018 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Oct 17, 2017 10:42PM Tappermom383 wrote:

I didn't even realize my MO had sent my tissue out for a MammaPrint. I also came back low risk so I didn't have chemo.

M

Diagnosed at 70 after four excisional biopsies over the course of 47 years. MammaPrint came back Low Risk. DexaScan: osteopenia. Cancer removed was 1.8 cm. Dx 3/23/2017, DCIS/IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 3/31/2017 Lumpectomy: Right; Lymph node removal: Sentinel Radiation Therapy 5/22/2017 Whole-breast: Breast Hormonal Therapy 7/17/2017 Arimidex (anastrozole)
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Oct 18, 2017 08:33AM gb2115 wrote:

Yes, I had one. My Onc said she preferred it to Oncotype. And since that time, it has been added to the standards of care for the ASCO.

It came back as low risk luminal A. That meant, even though I had one positive axillary lymph node, we decided to not pursue chemotherapy because that would have added only 2% to the long term survival. So instead of 95% it dropped to 93% (or something like that.) I hope it was the right choice, I had a family member just have a metastatic recurrence after 17 years NED from the same type of breast cancer. But we are trying to predict the future and that's so hard when we are not at all in control of it.

Dx IDC in October 2016, stage 2A, 1.2 cm ER/PR+ Her2-, Grade 2, 1/3 nodes. Mammaprint low risk luminal A, Lumpectomy + radiation + tamoxifen. Age 38 at diagnosis.
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Oct 22, 2017 05:07PM LizabethM wrote:

Thank you, Ladies, for sharing your experiences!

I am hoping to have my mamma print back the end of this week so we can plan treatment,


Stage 1 but "High Risk" on Mammaprint-so chemo! It is well, with my soul. Using Dignicap cold cap to save my hair. Dx 9/15/2017, IDC, Right, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 10/12/2017 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 11/15/2017 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 2/13/2018 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Oct 22, 2017 06:58PM TaRenee wrote:

I had one and it took close to a month to get results. That was thanks to my insurance, which decided I didn’t need it (I am going to fight that!) I was so frustrated and mad and scared it was all I could do not to call the doctor daily after the first week. In the end I was low risk and my MO said that chemo wouldn’t need to be done since I was so low risk. I’m on Tamoxifen now. I was so relieved to get the results back that I was rather shocked when I got my treatment plan.

So if it takes a little longer than you expect, try not to panic.

Dx 7/29/2017, IDC, Left, 2cm, Stage IIA, Grade 1, 0/4 nodes, ER+/PR+, HER2- Surgery 9/14/2017 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 9/26/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 3/29/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Oct 22, 2017 07:16PM LizabethM wrote:

Thank you! I will be relieved when I finally have all the pieces of this bc puzzle. The mamma print will help with that! But, the waiting really is difficult.

Stage 1 but "High Risk" on Mammaprint-so chemo! It is well, with my soul. Using Dignicap cold cap to save my hair. Dx 9/15/2017, IDC, Right, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 10/12/2017 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 11/15/2017 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 2/13/2018 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Oct 22, 2017 07:31PM teegirl wrote:

Has anyone had a high risk score on Oncotype and low risk on Mammaprint? I got a 35 on Oncotype but my MO didn't order a Mammaprint. I wish I would have insisted on it to compare. I'm stage 1, grade 2 IDC 100% estrogen positive, clear margins, no lymph node involvement and had bilateral mastectomy with reconstruction in July. Going through chemo (AC+T) now but dreading the next few months of this treatment. I want to do everything to reduce my risk of recurrence but concerned of the long term side effects of chemo on my body, not to mention dealing with the current side effects.

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Oct 22, 2017 08:12PM CIW wrote:

I had both mammaprint and oncotype done. Oncotype was 23, which is middle of the road, but my mammaprint came back in the high risk category, so I am glad I got it tested. It definitely helped finalize the decision to get chemo!

Dx 7/21/2017, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/2 nodes, ER+/PR+, HER2- Surgery 8/7/2017 Lymph node removal: Sentinel; Mastectomy: Right Chemotherapy 9/19/2017 AC + T (Taxol)
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Nov 29, 2017 07:18PM LizabethM wrote:

Just updating this in case anyone searches "mamma print" testing. Mine came back as "high risk" so I am currently doing the chemo that I had hoped to avoid. But, I am grateful for doing the Mammaprint because it helped solidify our treatment moving forward.

Stage 1 but "High Risk" on Mammaprint-so chemo! It is well, with my soul. Using Dignicap cold cap to save my hair. Dx 9/15/2017, IDC, Right, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 10/12/2017 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 11/15/2017 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 2/13/2018 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Nov 30, 2017 10:38PM - edited Dec 1, 2017 08:51AM by Garifalia

This topic is timely for me so I thought I'd share my experience. I just received my Oncotype DX result of 18, low end of intermediate risk. Oncologist stated I didn't need chemo because my result was less than 24. That appears to be his personal cut off point. But I was still concerned and pressed him on “why 24?" I was also concerned about my risk since my Mom battled breast cancer and died from it. He's not very empathetic with my concerns and brushed them off. But he did say I could have chemo if I wanted it. Who the heck WANTS it! I was going to get another opinion when he raised the option of ordering the MammoPrint test. That seemed like a fair and objective solution since the result is either Low Risk or High Risk. My husband was with me and he agreed so now we wait again for the result. This is so stressful.

Dx 9/27/2017, IDC, Right, <1cm, Stage IA, Grade 2, 0/5 nodes, ER+/PR+, HER2- (IHC) Surgery 10/27/2017 Lumpectomy: Right Surgery 10/27/2017 Lymph node removal: Sentinel Chemotherapy 1/3/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 1/25/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 2/15/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 3/8/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 4/23/2018 Whole-breast: Breast Hormonal Therapy 6/25/2018 Arimidex (anastrozole)
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Dec 1, 2017 12:08AM TaRenee wrote:

I understand your concern. Breast cancer runs amok in my moms family so I was concerned about not having chemo when my MO said he didn’t think it would be necessary. Ihad the Mammoprint and came back low risk. The waiting for results was a hard time because I wanted answers and was ready to start treatment. I’m glad we waited. Mine came back low risk so we opted to go straight to Tamoxifen.

Dx 7/29/2017, IDC, Left, 2cm, Stage IIA, Grade 1, 0/4 nodes, ER+/PR+, HER2- Surgery 9/14/2017 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 9/26/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 3/29/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Dec 1, 2017 09:03AM Garifalia wrote:

TaRenee—Thank you for your response and for understanding that I had a reasonable concern. I wish we would have known about the MammaPrint and did that test first. It would have spared a lot of personal angst and avoided such strained discussion with the oncologist. I’ll be fine with the result either way

Dx 9/27/2017, IDC, Right, <1cm, Stage IA, Grade 2, 0/5 nodes, ER+/PR+, HER2- (IHC) Surgery 10/27/2017 Lumpectomy: Right Surgery 10/27/2017 Lymph node removal: Sentinel Chemotherapy 1/3/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 1/25/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 2/15/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 3/8/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 4/23/2018 Whole-breast: Breast Hormonal Therapy 6/25/2018 Arimidex (anastrozole)
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Dec 1, 2017 10:34AM EastcoastTS wrote:

Garifalia:

Similar situation here -- though mine came in at 14 (which I know is lower) but I wanted to be very sure with the NO chemo decision. My mom is a survivor and quite a bit of prostate cancer on maternal side of my family, which I've read may be related to ILC. (Which my mom and I both had, though all BRCA, etc., negative.)

Mamma came in low risk. I was happy in any case to have all the info I could. Why would we not want to know all we can???

Hope yours is low risk and you can rest easy with your decision. Good luck!

Dx@ 49. Oncotype: 14, BRCA 1/2- Dx 1/4/2017, ILC, Left, 1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 2/27/2017 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 9/7/2017 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 1, 2017 07:39PM Garifalia wrote:

Thank you EastcoastTS! I tested negative for BRCA mutations too, but I developed BC at the same age as my mom so I think there’s a genetic link somewhere. She was ER+PR+ HER2 neg too. I’ll post my result when it comes in

Dx 9/27/2017, IDC, Right, <1cm, Stage IA, Grade 2, 0/5 nodes, ER+/PR+, HER2- (IHC) Surgery 10/27/2017 Lumpectomy: Right Surgery 10/27/2017 Lymph node removal: Sentinel Chemotherapy 1/3/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 1/25/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 2/15/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 3/8/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 4/23/2018 Whole-breast: Breast Hormonal Therapy 6/25/2018 Arimidex (anastrozole)
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Dec 2, 2017 09:00AM - edited Dec 2, 2017 09:01AM by ahw1971

My local Oncologist didn't want to,do a Mammaprint or Oncotype test saying that these tests should only be done if you don't want chemo. I went and had a 2nd opinion and she has ordered a Mammaprint and said if it came back as a Low risk, that I would not need to do chemo. I don't know how I feel about not doing chemo if the Mammaprint comes back low risk. Has anyone had their doubts about not doing chemo and has anyone had chemo with a Low risk result?

My Breast cancer is Invasive ductal Stage II Er+, Pr+, her2-. Grade 1, 1/5 sentinel nodes positive. Genetic testing was also negative

Dx 10/3/2017, IDC, Left, 1cm, Stage IIA, Grade 1, 1/5 nodes, ER+/PR+, HER2-
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Dec 2, 2017 09:18AM Mommabear0316 wrote:

what is a mammoprint

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Dec 2, 2017 09:22AM ahw1971 wrote:

it is a test done on the tumor to determine whether you are Low risk or High risk of your cancer returning. It also determines of you will need chemoor not.

Dx 10/3/2017, IDC, Left, 1cm, Stage IIA, Grade 1, 1/5 nodes, ER+/PR+, HER2-
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Dec 2, 2017 09:28AM keepthefaith wrote:

ahw, You might want to ask your first MO why they don't recommend chemo for you. I believe that the higher grade tumors respond better to chemo than the lower. I would be surprised if you were a high MP. Sometimes the risk of chemo out-weighs the benefit I was offered, but declined the MP test, after getting an intermediate onco-score. I think the MP is becoming more of a standard practice than it was when i was DX'd. Best wishes to you all!

Dx 9/17/2013, IDC, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 10/17/2013 Lumpectomy: Right; Lymph node removal: Right, Sentinel Chemotherapy 12/2/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 12/25/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 1/15/2014 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 2/10/2014 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 3/31/2014 Breast Hormonal Therapy 5/22/2014
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Dec 2, 2017 09:39AM - edited Dec 2, 2017 09:40AM by ahw1971

thanks! My local MO want to do Taxotere and Cytoxan and I think I would feel better with chemo even if MP is Low risk

Dx 10/3/2017, IDC, Left, 1cm, Stage IIA, Grade 1, 1/5 nodes, ER+/PR+, HER2-
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Dec 2, 2017 11:44AM LizabethM wrote:

I think the grade of the tumor is a big factor with the onco and mamma print tests. I am Stage 1, no lymph node involvement and clear margins on a 1.8 cm tumor but my tumor grade was a "C" and the mamma print gave me a "high risk" score.

I think the Mammaprint is the latest generation of genetic testing but oncotype still seems to be more recognized.

Side by side, Mammaprint looks at 70 genes associated with recurrence when onco is less than 20. We requested the mamma print and it was about 2 weeks to hear back.

I have had one infusion of TC and my second infusion is next Wednesday. I'm glad we did Mamma because I did NOT want chemo and this was the deciding factor.

God bless you girls waiting on test scores. Once you get this last piece of the puzzle, you can move forward with a plan and that takes some anxiety away.

Stage 1 but "High Risk" on Mammaprint-so chemo! It is well, with my soul. Using Dignicap cold cap to save my hair. Dx 9/15/2017, IDC, Right, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 10/12/2017 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 11/15/2017 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 2/13/2018 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 2, 2017 02:45PM keepthefaith wrote:

lizabeth, you are so right about the anxiety diminishing as treatment is starting. I guess it makes us feel like we are fighting back and doing something positive. I hope you tolerate TC well. Drink plenty of water and stay as active as you can. The SE's are cumulative. ((HUGS)).

Dx 9/17/2013, IDC, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 10/17/2013 Lumpectomy: Right; Lymph node removal: Right, Sentinel Chemotherapy 12/2/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 12/25/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 1/15/2014 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 2/10/2014 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 3/31/2014 Breast Hormonal Therapy 5/22/2014
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Dec 2, 2017 03:44PM LizabethM wrote:

Keep the Faith-thanks for the heads up, I was wondering how the SEs are with each subsequent treatment. Love your log in name-God is Who sustains me. :-)

Stage 1 but "High Risk" on Mammaprint-so chemo! It is well, with my soul. Using Dignicap cold cap to save my hair. Dx 9/15/2017, IDC, Right, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 10/12/2017 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 11/15/2017 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 2/13/2018 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 3, 2017 09:11PM TaRenee wrote:

ahw1971 I was totally prepared for chemo. I think I actually wanted it because I just wanted to DO something. When my MO said no chemo I was rather taken aback. I asked questions, got more information, and finally just trusted the science and said okay. I’m thankful not to have to go through what so many others are with chemo, but sometimes I just hope I’m doing the right thing. I think I might mentally feel better with chemo but if it’s not going to be effective, why put myself through that

Dx 7/29/2017, IDC, Left, 2cm, Stage IIA, Grade 1, 0/4 nodes, ER+/PR+, HER2- Surgery 9/14/2017 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 9/26/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 3/29/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Dec 3, 2017 09:14PM EastcoastTS wrote:

TaRenee:

I'm right there with you. Same sentiment. Didn't do chemo and was glad -- but then fear: should I have done chemo? I trusted science (and doctors), too.

Dx@ 49. Oncotype: 14, BRCA 1/2- Dx 1/4/2017, ILC, Left, 1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 2/27/2017 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 9/7/2017 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 4, 2017 12:00PM FarAwayToo wrote:

To those of you who are uneasy with their decision not to do chemo based on Mammaprint result - keep in mind, that being Low Risk (Luminal A) doesn't just mean you DON'T NEED chemo, it also mean chemo may not be very effective for your cancer. So, while it may make you feel better mentally, it may be doing more damage to your body than helping you fight cancer. Simple cost-benefit analysis.

(take it from someone who is doing neoadjuvant chemo, and as part of the clinical trial I'm in my tissue was sent for MammaPrint - they don't need Luminal A in the study)

Dx 8/31/2017, IDC, Right, 2cm, Stage IIA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Dx 9/15/2017, DCIS, Left, 3cm, Stage 0, Grade 1, 0/3 nodes, ER+/PR+, HER2- Chemotherapy 9/29/2017 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxol (paclitaxel) Hormonal Therapy 2/22/2018 Zoladex (goserelin) Surgery 2/27/2018 Mastectomy: Left, Right Surgery 2/27/2018 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 4/4/2018 Femara (letrozole) Surgery 8/20/2018 Prophylactic ovary removal; Reconstruction (left): Saline implant; Reconstruction (right): Saline implant
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Dec 4, 2017 12:43PM gb2115 wrote:

TaRenee---I totally get what you said---I had those same thoughts. I actually found myself worrying about not getting chemo, and didn't understand why my MO's nurse was so happy for me to not get it. But yes, like FarAwayToo said, Mammaprint shows little benefit. And that's what my MO said...she said the risk of side effects outweighed the benefit for my luminal A cells.

Dx IDC in October 2016, stage 2A, 1.2 cm ER/PR+ Her2-, Grade 2, 1/3 nodes. Mammaprint low risk luminal A, Lumpectomy + radiation + tamoxifen. Age 38 at diagnosis.
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Dec 5, 2017 01:48AM Amelia01 wrote:

I'm in Europe where ideas are a bit different than in the US and when asking about Mammaprint or Oncotype was told that they aren't really guidelines but in any case it is the tumor markers which decide for chemo or not. With any lymph node involvement they state that chemo is a must to ensure that rogue cells aren't elsewhere.

Dx 10/17/2017, ILC/IDC, Left, 6cm+, 17/21 nodes, ER+/PR+, HER2- Surgery 11/7/2017 Chemotherapy Cytoxan (cyclophosphamide), Ellence (epirubicin), Taxol (paclitaxel)
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Dec 5, 2017 09:00AM gb2115 wrote:

Amelia01---that's interesting that they aren't using the Mammaprint more in Europe. It was invented in Europe--Netherlands I believe. You'd think it would be popular.

Things are definitely so different. I think here in the US, tumor markers aren't often routinely done unless the cancer is advanced or they are monitoring metastatic disease.

Dx IDC in October 2016, stage 2A, 1.2 cm ER/PR+ Her2-, Grade 2, 1/3 nodes. Mammaprint low risk luminal A, Lumpectomy + radiation + tamoxifen. Age 38 at diagnosis.
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Dec 5, 2017 12:59PM - edited Dec 5, 2017 01:21PM by BarredOwl

Amelia01:

I believe that your team was saying that in your specific situation, with 17/21 positive lymph nodes, the Oncotype and MammaPrint tests are not within your local guidelines. This would also be the case in the USA, Canada, and the UK, considering lymph node status alone. The various guidelines do not differ in that regard (with more than three positive lymph nodes).

gb2115:

Amelia received case-specific advice that she is not eligible for either the OncotypeDX ("21-gene") test or the MammaPrint ("70-gene") test. These tests would not be indicated for a person with 17 positive lymph nodes under applicable consensus guidelines in the US or under formal eligibility criteria from the test providers either.

Other patients in Europe with different pathologic features may indeed be eligible for and may receive the MammaPrint test under their local consensus guidelines. Patients should seek case-specific advice from their Medical Oncologist, any may be interested in consulting the current texts of their local guidelines for their information. Multiple guidelines may be in play, including regional European as well as national guidelines. The policies of health authority payors may be a separate question.

ESMO's guideline (European Society for Medical Oncology) for primary breast cancer in 2015 provided very generally:

"Gene expression profiles, such as MammaPrint (Agendia, Amsterdam, the Netherlands), Oncotype DX Recurrence Score (Genomic Health, Redwood City, CA), Prosigna (Nanostring technologies, Seattle, WA) and Endopredict (Myriad Genetics), may be used to gain additional prognostic and/or predictive information to complement pathology assessment and to predict the benefit of adjuvant chemotherapy. The three latter tests are designed for patients with ER-positive early breast cancer only. The clinical utility of Mammaprint and Oncotype DX is still being prospectively evaluated in large randomised clinical trials such as MINDACT for Mammaprint, WSG PLAN B trial, TAILORx and RxPONDER for Oncotype DX."

Since the, the primary results of MINDACT have been published and local guidelines may have changed. See for example, this press release from Agendia (the provider of the MammaPrint test).

More recently, the St. Gallen International panel noted in 2017:

"The Panel agreed that a number of gene expression signatures served as prognostic markers in the setting of adjuvant endocrine therapy in node-negative breast cancers, including the 21 gene [OncotypeDX] recurrence score, the 70 gene [MammaPrint] signature, the PAM50 ROR score, the EpClin score, and the Breast Cancer Index. The Panel endorsed all of these assays for guiding the decision on adjuvant chemotherapy in node-negative tumors as they all identify node-negative cases at low risk, with an excellent prognosis that would not warrant chemotherapy [23–27]. [NOTE: Our local ASCO guidelines are more nuanced than this, and do not broadly support the use of the MammaPrint test in all cases.]

Nodal status is a strong prognostic factor regardless of gene expression signature. The Panel agreed that gene expression signatures offered information that can refine the prognosis for node-positive breast cancers. However, the Panel did not uniformly endorse the use of gene expression signatures for making treatment decisions regarding adjuvant chemotherapy in node-positive cases. The 21-gene recurrence score and the 70-gene signature have now been evaluated in prospective studies including small numbers of node-positive cancers. In the prospective trial (MINDACT), only patients with node-negative, or one to three positive nodes were included. Patients with low-risk tumor scores and a limited degree of nodal involvement appear to have a good prognosis with or without chemotherapy [28, 29]."

In the US, the various guidelines from ASCO and NCCN also differ somewhat in what they provide regarding the use of these tests node-negative versus node-positive disease. Here as well, patients should seek current, case-specific expert professional advice from their Medical Oncologist.

BarredOwl

Stage IA IDC, 9/2013 BMX. Right: IDC (1.5 mm, grade 2) with DCIS (5+ cm), 0/4 nodes, pN0. Left: DCIS (5+ cm), 0/1 node, pN0(i+).

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