Dx testing

[sumanb]

I had simple mastectomy and Snb on in the first week of April.   They submitted my tumor sample for DX testing. I am ER/PR positive, Her2 _ve as well as node negative. Tumor sz was 4 CM.
now my medical oncologist is saying generally they would recommned 16 weeks of chemo since the tumor was rather large. In that case, I wonder why did they even sent for ONC score.  My path report said tha there is angio lymphatice invasion.  would my onc score comprehend this condtion? I did not get any definite answer from my surgeo.  Thanks

[Cleveland Clinic]

Dear sumanb:  There is no “perfect” method of predicting recurrence.  Before the oncotype dx test, we used information about the cancer, such as size of tumor, angiolymphatic invasion, lymph node status, and hormone and Her-2 receptor status to help determine risk and help to guide treatment decisions.  The oncotype dx test is designed to help predict who will be more likely, or less likely, to recur – thus helping us to determine who might benefit from chemotherapy and who might not need it.  It is most helpful in cases where the predicted benefit to chemotherpay is felt to be quite modest and the physician and patient would like further information to make a decision about chemotherapy. The oncotype may simply confirm the recommendation for chemotherapy. If it comes back as 'low-risk', you should discuss with your oncologist how to use the information.

[docboston]

What was your OncDx score?

[sumanb]

Dear Docboston

I still don't know what the Onc score is. It has been over a month since they requested it. Not knowing the plan of action is driving me nuts.

[lizziecee]

We didn't have the Onc test when I was dx with a 2 cm invasive tumour and DCIS in 2003. The pathology results of my wide local excision and 8 sample nodes, 3 of which were cancerous, so a total axillary removal, one more node cancerous,  led my surgeon, Oncologist and pathologist to strongly advise chemo - in my case FEC, which is not as hard on the heart as the Adromyacin (sp?) they use in the US.I live in England.  My multi disciplinary team are of the opinion (rightly or wrongly) that any tumour of 2 cm or above must be treated by chemo, and rads. This is what I did, and I am NED (no evidence of disease) some 4 years later. Cancer doctors (surgeons and Oncologists) do have differing opinions, and as I was completely naive in those days, I just went along with what they suggested. I am no doctor, and just had to trust their judgement, which, as a patient of socialised medicine, I don't have to pay a penny for (neither surgeries, chemo or medications like Arimidex as I take now) I don't believe their beliefs were predicated by the bucks they could earn as is the case in the US.  I rest my case.
Take care, and possibly get a second opinion.
Liz.

[sumanb]

Thanks all for commenting. I finally have my dx onc score. The score is zero with 3% chance of reccurance. It sounded too good to be true. My oncologists said no chemo, and suggested that I start with Armidex rightaway. I had scheduled an appointment with another med onc for second opnion. I almost wanted to cancel it based on my onc score but we decided to keep it. The new oncologist just did not believe the onc score of zero based on my path reprot finidngs ( 4cm, er/pr pos, her2 neg, angio lymphatic invasion and poorly differentiated nature of the tumor, second smaller tumor 1 mm, in situ). He suggested a 16 weeks of chemo 8 weeks of AC and 8 weeks of taxol. He said he would not have even bothered with dx testing based on the shere sz of the tumor. I thought dx testing was pretty well respected in field. Now i am totally confused. Any thoughts?

[boninclyde]

Chemo is almost always recommended for anything over 1cm. I have never heard of someone having an oncoscore of 0. That should mean you did not have cancer in the first place. I may be wrong just trying to help. I would run not walk from this first doctor. The onco test is fairly new. Get a third opinion if you need to. I had several. I also had my biopsy sent to Duke Unversity for a second opinion. Go over to breastcancer.org and share this with the ladies there. Join the discussion board. Lots of info on the site and the ladies are wonderful. Your best chance is to be agressive now. Please don't drop this because of what your first dr. told you.

[sumanb]

Thanksto Bonninclyde for her recent  response. I am tired of getting conflicting opinions from the medical comminity. still would like to join the discussion board but I can't seem to find a way to start a new thread in the discussion board.

I searched the bc site for dx testing and found some information which is suggesting that I am not even a candidate for dx testing. I spoke to the testing service. They are pretty confident about their finidings.

can someone tell me how to start a thread for dx testing?

[azaudiotek]

I have been a daily visitor to the breastcancer.org site for the past couple of months. Had a biopsy and was diagnosed last week with DH and follow up in
6 months (B9 of course). Anyway, I don't have a clue how to start a new thread. I normally find the forum that I want and click on that, and then from there you can start a new post. They have many forums (subjects) to choose from and am pretty sure you can find the one you want. Give it a try. Best of luck to you. Prayers and hugs! Leah

[boninclyde]

If when you come here you want to post a question, come to medhelp, click on the breast cancer forum at the top look and it say post a question. I hope you find it. If you are referring to breastcancer.org,  go to their site and click on join the discussion board under support and community, then you have to register, click on the topic you are interested in posting under, at the top of that subject you will then see the word post. Just click there and post your question. Gosh I hope this helps if not let me know and some how we will get you there. Doctors are such jerks sometimes and actually uneducated.

[docboston]

Wow, 4 cm tumor, poorly differentiated with angiolymphaatic invasion, and a Oncotype dxscore of zero!!!!!!!!!!!. If I was your oncologist, I woulld be extreeeeeeemely sceptical of this result. You should definitely get a 3rd opinion, in a university hospital setting.

[docboston]

can you please post the exact report of your pathology and exact report of you oncodx test? Also, how old are you and do you have a family history of cancr? I would really appreciate it. Thanx.

[docboston]

also what percent of your tumor was er+, pr +. How did they test for Her 2, by immunohistochemistry or FISH?

[sumanb]

Thanks for all the comments so far. I am going for a third opnion this week. I wish i ould go to a univiersity hospital but I would have to wait at least 2 weeks to get in at UM. The third doctor i am going to is participating in the Trialx that menas he believs in the trial criteria which are amazingly broad (tumor sz 1cm to 5 cm node negative, ER/PR positive ).
They will register someone whose tumor is less than 1 cm only if  if there is lymphtic invasion. They do not disqualify anyone like me whose tumor sz is 4 cm plus there is angiolymphatic invasion.

Genomic health does not put a lot of emphasis on tumor sz. I believe they do factor in Lymphatic invastion. This test is fairly new but as per their website, 5500 oncs have used their service and they have done testing of 20,000 or so samples. you can read about the trialx by going to

http://www.cancer.gov/search/ViewClinicalTrials.aspx?cdrid=472066&protocolsearchid=2626593&version=patient

my history and path report:

I am 64, with no BC history in the family.   Both my parents lived till 84.
NO aunts, uncles sibblings or even distant cousins with cancer.

ER/PR status was listed as strongly positive ( >10% of the cells)

Her-2 negative. I did not see the mention of fish test anywhere.

The most unusual about the tumor is that it had prominent neo endocrine differentiation.As per some, you typically do not see this feature in BC.

My oncotype dx report is one page, showing the recurrence score of zero, and avg rate of distant recurrence at 10 years at 3% with 95% confidecne interval. There is a graph which I can't copy and past here.

When I called them, I was told the score of 0 is rare but it is dervied by a complex algorythm and there are few cases where they have seen a score of zero.

.Thank you again for your comments. They help a lot.

.

[boninclyde]

How are you?

[555boston]

Thanks a lot for posting your results.
Please visit https://www.adjuvantonline.com/ and click on the section on breast cancer and put in your data. You will need to register, but it is free. It will give you an estimate about your risk of tumor comicg back and the amount of benifit you will get from hormonal therapy and chemotherapy.

As your oncodx score is zero, you will see that the risk is very different when you use the oncodx tool vs when you use the standard version. So which is the right estimate? No body knows and hopefully the trial will answer that question.

I dont mean to increase your uncertainity, but you need to know that before oncodx came out, most oncologist used to go by the results of the standard version.

Enrolling in the trial will definitely help the medical community to know what is the right approach for people with your kind of breast cancer.

Good luck to you.

[sumanb]

I was reading your comments in another thread. Looks ike you are on Tamoxifin (tamoxifen). I was wondering if you have considered Armidex. I am still undecided on chemo. Meanwhile I am on Armidex for the last 4 days. No major problems with the drug so far. I did see a third oncologist who has 34 years of experience and seems reasonable. My second and third oncologists are from the same hospital. This is a teaching hospital but not in a university settingas like the first one. This hospital does their own testing similar to gene expression study done by Genomic. Their lab would look at all the slides, margins, her2 expression  plus gene experssion of the cancer cells. All I know is that my slides have made it to the new hospital and are with the pathologist. Hopefully I will know something by next week Friday to make a decision. I am also anxious to see what Genomic Health presents next week at the ASCO confernece in Chicago.

The more you read on the oncotype dx testing you realize how divided the medical community is on this.

[Katie2u]

A related discussion, OncoDx Score was started.