Oncotype dx test and decision for chemo or just radiotherapy

I was diagnosed with breast cancer on 8 May after a routine mammogram. I’m 52 and the original diagnosis has altered in the last three weeks from ‘two lumps’ to treating both lumps as one ‘biloped’ tumour (two lumps joined together) extending across 33mm. Both ends are ER positive and HER2 negative, grade two invasive ductal tumour. I’ve had a lumpectomy with clear margins. Three sentinel nodes removed, one with micrometasasis. I’ve been given an NPI score of 3.66 and my consultant has sent tissue off for further analysis (oncotype dx) to determine whether my type/grade of cancer will benefit from chemo, or whether I could ‘just’ have radiotherapy.


My husband died five years ago (prostate cancer) and I have two children, 19 and 10. There is only me, and a wealth of support from friends and family, but essentially just me for them. I saw what chemo did to my husand and it was devastating, but he had me to care for him.


Chemo will, I know, be deblitating. But even if the test determines that I won’t get much benefit, I still have a delimma as to whether the cancer that was found in the sentinal node will have done its worst and ‘leaked’ more cancer cells into my body.


Do I have chemo anyway, blast my whole body and ride out the storm and possible long-term health damage but possibly prolonging life? Or do I opt for just radiotherapy which will target just the breast?


It’s all happened so quickly that I’m only now just coming to terms with the significance of the diagnosis and prognosis. Not helped tonight by watching ‘A monster calls’ with my ten year old about a boy whose mother dies of cancer! (Great choice not realised until 10 minutes into the film!)


Any thoughts?






Well, to start with I think you should be guided by your oncologist’s advice when the result comes back.  I know nothing about that as it didn’t exist when I was diagnosed.  


Having said that, if you’re borderline I personally would veer towards the chemo option.  You have a 10 year old who you don’t want to be left an orphan.  For most people chemo can be very unpleasant but not ‘devastating’ (your word about your husband).  I don’t know how it affected him, but from my personal knowledge of friends who have been through it (and myself), it’s very unpleasant at the time, but not impossible, and there have been no lasting consequences.


I don’t envy you your position, I wish you all the best with your decision

Dear Loz


apart from the two lump thing, we are The same age and cancer type with a micro on the sentinel lobe.  My surgeon took out two nodes more than she needed to (it was late evening surgery and I think she was knackered!) fortunately and they are clear.  I’ve got to go in for more margin clearance today on one bit as mr c has come back bigger than we thought.   Mine has also been sent off for oncotype and am in similar dilema as to do I don’t I go for chemo.   They show you this predict thing which I am not exactly over enthused with but we are only 52, in ten years time, 62 so looking forward and if the percentage chance of survival is raised from then on by having chemo, then worth it for four to five months of discomfort.  However, my personal circumstances are different and I can see why you really worry about chemo.   Do take into account that chemo isn’t a one size fits all because there are different chemicals used for different cancers.


i am with you on the whole micromet thing.  My thoughts exactly although they’ve been so careful and thorough so far (inducing loads of anxiety in me but hey ho) that I think the data must point that what is in our heads regarding that is unlikely.   


I’ve decided I’m going to go with the numbers and if there is a grey area (which I expect) then opt for chemo unless if it is just (ie, one or two number) above a threshold, then will really grill the oncologists.  If we have chemo, from what I can tell, we’d be done by Christmas or a bit before (I can’t start until todays surgery is healed).   I think it will be better once we get the scores because we could be worrying needlessly or have a very clear cut decision.


happy to wibble with you in a corner.



I just wanted to wish you all the very best for your op today and to say that when the oncotype thing does come back, feel free to message me. I’ve been through the whole border line thing and the crazy decision making process so may be able to support you a bit through that decision if it comes back in the grey area. I think (if memory serves me right) that we had our ops at about the first time and that the diagnoses were similar. Anyway, good luck for today! 


Alice x

Thank you, Alice.  Back home.  All went well.  Lots more nork pain than before.  Met the most inspirational lady who had eight rounds of chemo before surgery, has a toddler and worked in a manual job throughout.  She looked fab in her wig and said that it was more than doable.

Hi Flyingarcher, glad it all went well and good to hear news of inspirational women doing well. It all helps, doesn’t it? Hope pain settles soon for you. Do let me know what happens with your oncotype test. I’ll be thinking of you and hoping that it’s straightforward, clear cut and a no brainer!

Hi Ali


no chemo needed as oncotype score was 18.  But, margin still not clear so now got a big decision on what to do - take more margin, have mx, have mx with reconstruction of some sort.  I’m a bit wobbly but I think my poor surgeon was very upset!