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Aug 30, 2019 02:35PM
Each one of us, even if our situations look very similar, have unique things that may make us choose or not choose particular treatment. So, my experience, while similar to yours, isn't exactly the same and your choice may not be the same as my choice - and that doesn't make either of us right or wrong. That said, here is my experience:
Diagnosed in April 2019 age 61 IDC in left breast - surgeon told me I would only need lumpectomy and radiation. From the biopsy, I was told grade 2, ER + (in the mid 90s) and PR + (I think in the 60s?). HER2 was not definitive, so FISH was done and came back negative. I was never tested for a gene mutation.
Lumpectomy in June. I opted to visit two different radiation oncologists and two different medical oncologists to pick ones that I was comfortable with. My surgeon would not refer me to red onc or med onc until after post-surgery follow-up visit.
At the follow-up, I was told the size and that I had clear margins of 5 mm. They found both IDC and DCIS. I wasn't given individual sizes of the two types of tumors. The sentinel node was removed and tested - no cancer found there. Grade 2 No Lymphovascular Invasion and classification pT1c(sn)pN0
I visited the first rad onc. She told me that she also believed that I would not need chemo, but she couldn't start radiation until she had ok from med onc. She did not do breath holding or anything else to protect heart from radiation.
Then I visited the first med onc. She said she wanted to run oncotype just in case and it would take two weeks. I got a bit freaked about that because she thought I might need chemo.
While still waiting for results, I had my second rad onc appt. This was at MD Anderson (major cancer center). They re-read the slides from the lumpectomy and found one place next to DCIS that only had 2 mm clear margin, found lymphovascular invasion not found by the first pathologist and changed my grade from 2 to 3. Of course, all of this was quite concerning to me. This rad onc also believed I would not need chemo and was so sure that she said she would run it by their med onc and get his approval to start radiation. I got marked up and did simulation later that week.
The following Monday, I had appt with the second med on in the morning followed by first radiation in the afternoon. At the appt, the med onc was reading the original pathology report and I told him about the re-read and changed results. He almost cancelled radiation, but then said I could go ahead with it and could do chemo after radiation if needed.
Later that week I got a phone call from the first med onc who said my oncotype result was "quite high" and that I needed chemo. Once I got the report, I found that my score was 29 (so very close to your 30). I started digging into the report and what it meant, etc. Since I am also over 60, I normally would have been given one of the aromatose inhibitors but since I have osteoporosis, the med oncs both agreed to start with tamoxifen. My rise of distant recurrence at 9 years with hormone therapy is 18%.
One of the things I found is that the Absolute Chemotherapy Benefit for those over 50 years old is based on a study that lumped all of the patients with scores between 26 and 100 into one pool. While RS scores under 25 were grouped and the benefit measured by group (with increasing benefit as the score increased), this was not done with the scores of 26 and over. Reading page 2 of the results, it actually says "The magnitude of the absolute benefit of chemotherapy was ~ 6% at RS 26, and increased as the RS results increased from 26-100, with an average absolute benefit of ~24% and a conservative group estimate of >15% based on the width of the confidence intervals." So, basically the >15% isn't "real" if my score is 29. A score of 26 had a benefit of about 6%.
I did a lot of praying, reading, etc, etc. I did find this: https://www.oncotypeiq.com/en-US/breast-cancer/hea... you can scroll down and click on Node Negative Predictive Clinical Trial Results to got more info also. I also found this:
https://www.oncotypeiq.com/en-GB/breast-cancer/hea... if you click that you are a health care professional, then select node-negative to download the information, you will find a graph that shows the possible range of benefit from chemo based on your RS score.
I opted to NOT do chemo. My 2nd med onc wanted me to do chemo, but said he could understand why I might opt out of chemo based on my score of 29. He was not willing to do the RSPC for me.
Diag. 4/19/2019 ER+ PR+ HER2 neg Lumpectomy 5/29/2019 IDC w/ DICS 2.0 cm Grade 3