Oncotype Dx No

Hi. I asked my dr if I would have oncotype dx or another genenomic assay done. She said no because my snlb was positive. Most of these tests say you can have 1-3 nodes positive and it will still work. However dr said the nhs doesnt approve these tests for people who are premenopausal and lymph positive.
I’ve had my axillary clearance. How will they decide if I need chemo or not? I don’t want to have chemo unnecessarily, but equally I don’t want to miss chemo if it will help prevent reoccurrence.

Hi. I was ER and PR positive. 1 of my lymph had micrometastasis. They did agree for the Oncotype for me and I am glad they did because my score came back very low and not much benefit of Chemotherapy so I didn’t have it. I looked up Oncotype and actually called them, they were very helpful. Keep pushing for the test as it does say 1-3 positive nodes. All the best x

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If you have positive nodes and are pre-menopausal you will get chemo. There’s no reason for an oncotype test because that that will be the gameplan no matter what. If you were over 50, that’s when it gets murky and the oncotype test can offer pertinent info on whether chemo is appropriate.

Hi @Kay0987. Even for 1 node? They haven’t told me this. I had a macrometastasis of 4mm in sentinel. I appreciate that if the axillary clearance has more then I will need chemo, but they could be all clear. I thought a test like oncotype could help to avoid overtreating me. Thanks for your info. Makes me even more curious!

That’s what they would do in the US. If you have positive nodes and are pre-menopausal they do chemo.

Im in UK. I’ve no idea what my plan is. Four months into this, I’ve had 2 surgeries and depending on outcomes of latest one, it’ll be chemo or radio next. That’s why I’m surprised that I’ve had no genomic assay tests done. Hope you are doing well.

Such a difficult subject seems to change depending on which NHS trust you come under. NHS won’t generally allow the Oncotype test if you have a positive node (different if micromestasteses) like you I had 1 positive node so had full axillary clearance 18 months ago. I couldn’t get the test on NHS but I have PMI through work and Bupa agreed to pay. It isn’t standard chemo with 1 node positive it will also depend on grade, size of tumour and type of cancer. Your oncologist should use breast predict to support their suggestions I’ll drop the link below. Mine was grade 1, 14mm, ER+ PR+ HER2- the benefit of chemo for me was 1% so I decided not worth it and onc agreed. As a minimum I’d ask that they work out your risk of recurrence using breast predict, best of luck, do your research and be your own advocate

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Hello bluesatsuma.

Thank you for posting.

It’s understandable that you are wondering how decisions to recommend chemotherapy are made.

Genomic assays, such as Oncotype DX are tests that look at groups of genes found in breast cancer. They help identify who is most likely to benefit from chemotherapy and how likely the cancer is to return (recurrence). If the benefit of chemotherapy for you is unclear, these tests can help your treatment team decide if chemotherapy should be recommended.

As @Kay0987 says based on research trial evidence, chemotherapy is usually recommended in premenopausal women with positive nodes. These decisions are made based on multiple factors which include the size and grade of the cancer, hormone receptor and HER2 receptor status and axillary node status.

Oncotype DX testing may be recommended if you have been diagnosed with primary invasive breast cancer, your cancer is oestrogen receptor positive and HER 2 negative and has not spread to the lymph nodes under your arm. NICE guidance for testing suggests women with micro metastases in a lymph node should be included in the lymph node negative testing criteria which would explain why testing was offered to @NatalieS42.

Depending on the test used, if you have three or less positive lymph nodes you may also be eligible for a genomic assay. If do not meet the criteria for a genomic assay, you may be asked if you would like to participate in the OPTIMA trial .

The best people to advise on whether any genomic testing will be of benefit in helping guide treatment recommendations are your treatment team when your full pathology results are available.

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