1. < Breast Cancer

chemo or not?

Posted by justbreathe11 @justbreathe11, 5 days ago

Hello, I'm 45 years old, was dx with IDC in Sept.
ER+ PR+ HER2-
Stage IIA
Oncotype for 2 tumors was 17 and 19. Tumors were approx 3 cm and 4cm.

I was scheduled to start radiation later this month, followed by endocrine therapy. I just met with my oncologist and he offered (but didn't push) chemotherapy before radiation. What I'm being told is that my distant risk of recurrence at 9 years is about 12%. Chemo could possibly reduce it to 6-7 %. There's a possibility that endocrine therapy alone would already have that effect but it's unknown right now.

I've gone over it with my family, and I've gone back and forth in my head about what to do and I'm just lost. I'd appreciate any comments from anyone who had to make this decision. Thank you.

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justbreathe11 | @justbreathe11 | 4 days ago

@windyshores Sorry, the Oncotype report says < 1% (which would lead me to not do it) but again, my oncologist was taking those numbers and adjusting them for my particular case, and said it was more like 6.5% I just don't know what to do with that number. Considering my age, it doesn't feel like an obvious yes or no.

The tumors were grade 2.

REPLY
1 reply
windyshores | @windyshores | 3 days ago
In reply to @justbreathe11 "@windyshores Sorry, the Oncotype report says < 1% (which would lead me to not do it)..." + (show)
@justbreathe11

@windyshores Sorry, the Oncotype report says < 1% (which would lead me to not do it) but again, my oncologist was taking those numbers and adjusting them for my particular case, and said it was more like 6.5% I just don't know what to do with that number. Considering my age, it doesn't feel like an obvious yes or no.

The tumors were grade 2.

Jump to this post

@justbreathe11 one thing that helped me was calling Genomic Health, which at the time owned Oncotype. I think it is Exact Sciences now. You could ask what age range their statistics are based on.

I just found this!
https://precisiononcology.exactsciences.com/healthcare-providers/treatment-determination/breast-cancer/oncotype-dx-breast-recurrence-score/clinical-evidence/node-negative
" In an exploratory analysis, TAILORx also showed a chemotherapy benefit for those aged 50 years or younger with Recurrence Score results of 16–25. This subgroup represents about 8% of patients."

The info online also says "Age: For women over age 50, chemotherapy may not be recommended based on the risk of recurrence."

Do these snippets of info assume the patient is post-menopausal?

You are in a pickle with intermediate Oncotype score (which usually means no chemo) and borderline menopausal status, though you are "over 50." How to know which side of the line you fall?

As another poster suggested, you could suppress whatever estrogen your ovaries are producing with Lupron. Or do tamoxifen, which the Oncotype bases their recommendations on. You could also ask your doctor how your ER and PR status factor into their statistic (are your ER and PR high?).

I felt better after getting other opinions. It was hard because I felt rushed to decide within the window of time I had to decide. I had to send pathology samples to each opinion (different hospitals) and got to know the lab people well!

Another factor is your general health and ability to tolerate chemo. I am very sensitive. On my way to the oncologist with my decision I reacted to a flavored soda! Chemo has serious side effects for some, and so ultimate life span can be affected that way too. Ugh!

The TailorX study was not that long ago and while some doctors (and the NCCN guidelines) rely on the Oncotype, I was happiest with an MD who did look at pathology and understood my concerns. Unfortunately that complicates decisions!

REPLY
1 reply
justbreathe11 | @justbreathe11 | 3 days ago
In reply to @windyshores "@justbreathe11 one thing that helped me was calling Genomic Health, which at the time owned Oncotype...." + (show)
@windyshores

@justbreathe11 one thing that helped me was calling Genomic Health, which at the time owned Oncotype. I think it is Exact Sciences now. You could ask what age range their statistics are based on.

I just found this!
https://precisiononcology.exactsciences.com/healthcare-providers/treatment-determination/breast-cancer/oncotype-dx-breast-recurrence-score/clinical-evidence/node-negative
" In an exploratory analysis, TAILORx also showed a chemotherapy benefit for those aged 50 years or younger with Recurrence Score results of 16–25. This subgroup represents about 8% of patients."

The info online also says "Age: For women over age 50, chemotherapy may not be recommended based on the risk of recurrence."

Do these snippets of info assume the patient is post-menopausal?

You are in a pickle with intermediate Oncotype score (which usually means no chemo) and borderline menopausal status, though you are "over 50." How to know which side of the line you fall?

As another poster suggested, you could suppress whatever estrogen your ovaries are producing with Lupron. Or do tamoxifen, which the Oncotype bases their recommendations on. You could also ask your doctor how your ER and PR status factor into their statistic (are your ER and PR high?).

I felt better after getting other opinions. It was hard because I felt rushed to decide within the window of time I had to decide. I had to send pathology samples to each opinion (different hospitals) and got to know the lab people well!

Another factor is your general health and ability to tolerate chemo. I am very sensitive. On my way to the oncologist with my decision I reacted to a flavored soda! Chemo has serious side effects for some, and so ultimate life span can be affected that way too. Ugh!

The TailorX study was not that long ago and while some doctors (and the NCCN guidelines) rely on the Oncotype, I was happiest with an MD who did look at pathology and understood my concerns. Unfortunately that complicates decisions!

Jump to this post

@windyshores Sorry, I was not clear. I'm currently 45 and definitely premenopausal. I was thinking about the 9 year recurrence risk which puts me in my mid 50s. Yep, I'm in that small subgroup of the TailorX study that it's not clear.

I'm hoping to speak to my oncologist today. I'm leaning towards getting chemo (even though I'm anxious about it) because I want to do anything to lower that recurrence risk.

REPLY
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