Saturday, July 31, 2010

Oncotype Results - ambiguous

The Oncotype DX score came back, but it may not be at all relevant. The score is based on the tumor being Estrogen (ER) positive (hormone receptive). That means that one of the long-term treatments is to take anti-estrogen medication for five years, and that has been shown to be the most effective treatment for node-negative early stage breast cancer with positive ER receptors.

My ER score is right on the edge of being positive. The Oncotype folks use a score of 6.5 to declare the cancer as ER+. My score was 6.2. It's a close call and apparently these things are not absolute.   My first oncologist made the statement "positive is positive" referring to the biopsy pathology report which called my ER "weakly positive".  My Progesterone receptor was more definitely negative. The cutoff is 5.5 and I was under 3.2, so that one is not ambiguous, but probably also less important.

And the HER2 score is 8.7, clearly negative with a cutoff of 11.5. HER2 is a gene that sends control signals to your cells, telling them to grow, divide, and make repairs. A healthy breast cell has 2 copies of the HER2 gene. Some kinds of breast cancer get started when a breast cell has more than 2 copies of that gene, and those copies start over-producing the HER2 protein. As a result, the affected cells grow and divide much too quickly. The treatment is a year's worth of Herceptin infusions, so I'm happy to be negative with that.

The surgeon had called me late Thursday afternoon and just stated the results, read the Oncotype score and said all the hormone receptors came back negative, without any clarification. That was bad news to say the least and we were extremely disappointed by what we heard. On Friday morning, I got a hard copy of the report with the details and realized that it wasn't quite as bad as I had feared. I had a brief discussion with the radiation oncologist and he seemed to discount the report, telling me to focus on the fact that the tumor was smaller than anticipated and the nodes were clear.  He also said that a tumor marker blood test, if taken now, would probably be normal.  However, the use of tumor marker tests is controversial and more useful when known tumors exist, chemotherapy is administered, and then retesting indicates the degree to which the treatment has been effective.

So, it's worrisome for sure. But we've decided to not be overly concerned for the moment and wait for the consultation with the oncologist (next Friday morning). In the meantime, I have been researching things like the effects of chemo on diabetics, "gentler" chemotherapy, alternatives to chemo that have shown to reduce recurrences, and any clinical trials that might apply to my situation. One new development involves a "vaccine" for "triple negative" cancer patients that looks very promising. 

On another note, the Mammosite radiation treatments have been going very well.  I have four down, six to go next Monday, Tuesday and Wednesday.  Last night I was very tired which could be a side effect...or it could have been the result of lack of sleep after stressing from the news we got on Thursday. 

My goal is to enjoy my weekend, spend time today with my mom and maybe try to do a little laundry.  I've been banned from vacuuming (must be a threat of dislodging the Mammosite catheter) so I'm assuming I shouldn't do anything too strenuous.  But I feel absolutely fine, other than some very skin minor irritation from a couple of stitches that have overstayed their welcome.

I hope everyone has a great weekend!



  1. Sorry Michelle, I don't quite understand but is negative not good? Or is it the fact that the ER score is ambiguous? If all three results of the Oncotype were clearly negative, would that mean you are not a candidate for the anti estrogen medication and would need another type of therapy?


  2. Michelle, I'm with Elaine. I really don't understand all of this. Sorry too!!!


  3. Michelle, it just keeps on keeping on doesn't it? I am so glad you are able to do the Mammosite. Takes a real load off. RE: the Oncotype, they have a method of delivering chemo that I read about on one of the threads on BCO that is very do-able. Check this out:

    You may be able to do this easily.
    Thoughts and hugs are with you!!