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Thursday, October 01, 2009 JCT asks

Q: Which has more weight, histology score or Oncotype-DX score?

T1c / N0 / Mx. In 10/07 had a biopsy of a calcification which was negative. Follow up mamm at 6 months 5/08 was clear, next mamm in 7/09 showed the mass but could only be discerned in one direction (top down). Biopsy showed IDC, G2, ER+ and PR+ intermediate, HER2-neu negative. Removed mass 9/21/09. Only one sentinal node found (radio + dye) and determined negative. New path report did not recharacterize or quantify ER, PR or HER2 but provided G3 histology score with 3/3 mitotic score, high nuclear grade, tumor size 1.8 cm, well-circumscribed, microcalcifications in both carcinoma and non-neoplastic tissue.  Intraductal tissue also present, not extensive, with central necrosis.  In 1981 mother had lumpectomy and 1 year of chemo when she was 54 (I am 56 now) but no other 1st degree relative. Had TVH/oophorectomy 11/07. The G3 and size seem to suggest chemotherapy + RT and aromatase. But if the oncotype-DX score is low how much faith should I put into that?

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Answers (1)
PJ Hamel, Health Guide
10/ 1/09 4:18pm

Hi - The Oncotype-DX test has proven quite reliable, so if you believe in statistics, you can put store in it. If it comes back low, however, that doesn't mean you can't still opt for chemo. If you feel strongly that chemo would help you deal with this cancer emotionally; or if you feel that you just want to do everything possible to eradicate cancer, even if the chemo MIGHT not help, then you should discuss with your oncologist your chemo options. Good luck - PJH

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10/ 2/09 2:51pm

Thanks for the reply, PJ. Your answer must be the standard approach...I've happened across similar Q and A excerpts on this and now I'm convinced I must make such a deep-seated decision based on my own and my family's convictions.  My confidence in stats depends on the study and how much extrapolation goes into the final result. I will be asking my oncologist how closely I fit the "model" and all the permutations. Hopefully, he's the patient sort!

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PJ Hamel, Health Guide
10/ 2/09 9:12pm

Hi - Data: It can be tortured until it tells you what you want, right? Smile I hope you have a fruitful talk with your oncologist. A word of advice - if s/he ISN'T patient, now may be the time to find another one. You're going to have a good, long relationship with this person; so it had best be someone you like and trust. Good luck, and stay in touch here, OK? We can help. PJH

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By JCT— Last Modified: 12/22/10, First Published: 10/01/09