What to do with a borderline OncotypeDx score?

[NanW]

Hi - I am an otherwise healthy 56 yr old postmenopausal woman dx'd with IDC in March 2010. 2cm, medium grade (Nottingham score 7/9),  ER+, PR+, HER2 negative on FISH (though it was 2+ on IHC).  . One of 4 sentinel nodes contained a 2mm micrometastasis, triggering axillary clearance. All 56 nodes removed were negative.  

Today I received an OncotypeDx score of 17.  Everything in my cancer seems to skirt the high end of the low category - I have a 2cm tumor, right at the top of T1; a 2mm met, right at the top of micro; and now 17, the highest number in the so-called 'low-risk' category.

My oncologist wants to put me on Arimidex but says that chemo is largely up to me and my individual tolerance of risk.  I can't even enroll in the Tailorx trial because I'm node-positive.  I'd be interested to hear your opinion as to what a score of 17 should be telling me, and just how significant that little micromet should be in my thinking.  Also, what is your opinion regarding HER2 equivocal scores? I read a study abstract suggesting that even if a patient isn't technically HER2 positive and eligible for Herceptin, they should nonetheless be considered for more aggressive treatment.

Thanks in advance!

Thanks.

[Cleveland Clinic]

Dear NanW,  Decisions about adjuvant chemotherapy or hormonal (antiestrogen) treatment are based on several factors including size of tumor, status of lymph nodes under the arm, the appearance of the cancer under the microscope, the presence or absence of hormone receptors for estrogen and/or progesterone, as well as HER2 status, the general health of the patient etc.  

We can not make specific treatment recommendations for an individual in this forum. We can tell you that anti-estrogen treatments are frequently given following surgery for ER-positive breast cancer to reduce the risk of recurrence in the form of metastatic disease. Chemotherapy may add an additional benefit that needs to be weighed against the potential side effects.   You may want to consider a second opinion from a breast oncologist who can discuss with you the risks and benefits of chemotherapy in context of your individual situation.

[Marylou_II]

I am not a doctor but I am a cancer patient, I have had two alleged primary cancers in 6 months, thus I have my share of pain and suffering because doctors do make severe and heavy mistakes.

If you believe there is a mistake with your HER2, have another test until they come with the same results, they don't have to be different they should be the same.

My breast was removed due to the radiologist, pathologist and surgeons mistake, I had a mastectomy and the dissection of 3 lymph nodes which were clean. Before knowing this I rejected further treatments. I had terrible doubts and requested my path plates and had them examined in another country and I never had breast cancer I cried my eyes out for days,I have sued this surgeon through the International Human Rights Court in Europe and the Constitutional Tribunal here in Peru.

With my first cancer I had chemotherapy and I regret it to this day though I was not given a choice, but I could have spoke out. You can't imagine the terrible side effects that can show up 15+ years after the chemo, mine began 7 months after  the treatment, my liver, veins, stomach, kidneys and bladder are practically destroyed. I feel 100 years old and very sick permanently. I also had these path plates checked in a foreign country, I did have cancer but a grade 1 and less than a 1cm in size, chemo was not justified. According to the foreign doctors I should have never received chemo but only a treatment with an AI. That is what happened to me, now make your own conclusions.

The Oncologists will never assume the responsibility to say "you must have chemo and/or radiotherapy" in the states you can sue them for assigning the wrong treatment and damaging your whole body, thus they are so "nice" they let you choose your treatment but it is only to void the responsibility and a further court issue. Please read the enclosed link, it clearly states when chemo applies or not:  
http://ecog.dfci.harvard.edu/general/gendocs/tailorx_oncodxfact.pdf

Don't trust anyone with what you will swallow or put into your body, do a Google search like this "Arimidex side effects" and each time the Oncologist mentions another AI search again and see if you will be able to tolerate the side effects, read them all no matter if they say eventual or 7 y 100 cases reported these side effects, you could be one of those seven.

I am not saying you should not take the Aromataze Inhibitors but search for the least aggressive side effects. Remember that the one who will have the side effects is YOU not your Oncologist.  

I hope I have at least opened your eyes to what the cancer business is about.

Regards.

[NanW]

Oops, I wrote Nottingham score by mistake. Obviously it's the Bloom-Richardson score. My Nottingham score is 4.4, moderate risk.