I am helping my cousin who has an Oncotype of 34. We did not expect this. Her pathology is grade 2, with the highest possible score for ER, but the Oncotype has an ER score of 7.5 out of 12. This is hard to reconcile and her current doc goes by the Oncotype to the extent that he didn't even have the pathology report during the first appointment. I am encouraging a second opinion. The question really is whether low progesterone means that hormonal meds are less effective, and some studies say no. My cousin is older and medically fragile already so she is weighing effects of chemo versus a 23% risk of recurrence on the Oncotype (with >15% improvement in risk with chemo). I was shocked that pathology wasn't even included in the discussion.