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This question was answered on Fri 22, Aug 2008 06:47am by Dr Paul S, MD

Breast Cancer, ILC, 1.2 cm, node negative, Oncotype of 22


    
Asked by bethann (Female; 50; never had cancer, grew up in Nassau County New York, which has a very high rate of breast cancer. Moved at age 19. Multiple surgeries for gallbladder and so forth. Other than heart arrythmia, and a bit overweight- healthy. Very sensitive to meds. Potassium wasting syndrome, take 20 meq potassium 2x per day.; Relevant drugs:prilosec, potassium chloride for potassium wasting syndrome. ) on Thu 21, Aug 2008 10:03am
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Hello, I wanted to weigh in with my Ocotype dx score of 22, and get a second opinion. I am 50 years old, and had mastectomy of left breast two weeks ago showing a 1.2 cm tumor, invasive carcinoma with ductal and lobular features, no lymphatic or vascular invasion, all margins clear, ER & PR positive, HER2 negative, showing a low proliferative index, stage 1, grade 2. Only one node removed, the sentinel node, and no cancer cells found. Surgeon and pathology from Dana Farber Cancer Institute. Below is more data from my path report: e-cadherin positive ERA 99% PRA 60% HER2 negative (1 ) Ki67 5% I was on Premarin since 1993 and stopped July 2 with my biopsy results. I have a strong history of sensitivity to meds so chemo really scares me. I have a heart arrhythmia that can not be treated because the meds made my blood pressure drop dangerously, so I am fiercely protective of my heart, and I know breast cancer chemo can be hard on the heart. My onco doc says my 22 score is Oncotype midrange is a gray area and doesn't really have a recommendation for me, saying I have a 14% chance of distant recurrance in 10 years after taking 7 years of hormonal treatment (which I will do), and that chemo could possibly give me another 2 to 4 percent, which may be as low as 1% and as high (but unlikely) as 6%.I have a second opinion scheduled for Monday. This is a difficult decision and wondered if you had any input they might share with me? Also, do you agree with the survival rate? Thank you. Thank you.

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Answer by Dr Paul S, MD  on Fri 22, Aug 2008 06:47am:

Hi there. When you look at the National Comprehensive Cancer Network guidelines, oncotypeDx testing is mainly indicated for those with tumors 0.6-1.0 cm in diameter. Any tumor above 1cm would definitely derive benefit from the addition of chemotherapy, no matter how small (up to 6%). Furthermore, the score of 22 is indeed a gray area and at the present, clinical trials are on the way whether to recommend chemotherapy for these subset of patients (the results of which will not be available for another 1-2 years). At the present it is safer to be a little more aggressive until the results of such trials can be made available. Given your history with drugs, it is best that you be managed with a multidisciplinary team of specialists (including at least, the oncologist, cardiologist and allergologist). In your second opinion consult, make sure you ask your doctors the possibility and severity of side effects that you might experience from chemotherapy, and see if these risks are worth taking to achieve the small incremental benefits. Regards.

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