I had clear margins and no node involvement, Stage 2A, and was post-menopausal. I also had intraoperative radiation following the surgery. We thought that was all I’d need, but after my Oncotype results came back, my score was 43 - high risk for recurrence. My oncologist was surprised as was I. So, I went in for chemo - 4 rounds.
Hello - re Oncotype eligibility - NICE (the National Institute for Health and Care Excellence) which issues recommendations for treatment and care of people within NHS England and Wales approved use of Oncotype DX in May 2024 for post-menopausal node-positive patients with 1 to 3 positive nodes as the cutoff.
Here is a link to the announcement. I am in Scotland where different rules apply, so I have to pay privately for the test (£3K) even though I would be eligible in England or Wales. Perhaps discuss eligibility with whomever provides a second opinion? From what I read, in general (and it’s always best to get specific personal advice of course), there seems to be more chemo benefit for pre-menopausal patients, though less than 3% benefit may be worth a discussion of its merits in your own case. It’s a very hard time having to weigh up all the factors and feel confident that you’re getting the best treatment advice for you as an individual. Wishing you all the best. I’m currently waiting for results of Oncotype DX and trying to prepare mentally for whatever eventuality arises. Take care of yourself and I hope your second opinion doctor has better poeple skills - it’s so important! xx
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Hi there,
I had this test and am now in week 12 of chemotherapy. If you have any questions, and I can help at all… please let me know. I found decision to undergo treatment a really hard one and I went back for two more consultations to ask the many questions I had.
Take care,
Mags
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@roxie1 Interesting the rules are different here. I’m in Scotland was offered Oncotype testing (today!) I’m pre menopausal with a Grade 3 ER+ PR+ HER2- tumour with no node involvement. The nurse seemed a little unsure tbh. She mentioned chemo at first and I questioned it (was sure I’d be straight to rads, especially given tumour was actually smaller than they’d estimated at scans) When she checked she said I was right and my next step is supposed to be radio but I guess I’ll know for sure when the test results come back.
Best wishes for your results and treatment.
It would be wonderful if you can finish treatment earlier than expected and with fewer side effects.
The rules in NHS Scotland cover funding for Oncotype DX for node negative patients but not for node positive patients unfortunately. It was a ruling informed by the opinion of the Scottish Health Technologies Group.
By contrast, since May 2024, node positive patients (one to three positive nodes is the limit) can access the Oncotype DX test for free according to recommendations set by NICE which apply in NHS England and Wales but not in Scotland - so alas it is not a level playing field across the UK.
It’s costing me just over £3,000 including VAT.
Take care x
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In general, I think oncotesting is done for patients where its not obvious whether they should have chemo or not. Pemenopausal with any lymph node involvement, would usually be enough info to stear to chemo, so no test needed. Some post menopause cancers can be slower growing types, so if 1 or 2 lymph nodes are involved then ALND might be enoughb ut they need to know for who this could be the case, so the oncotype DX is useful.
If premenopausal, with 0 LN involvement, a test is useful as without it, some would not be offered chemo who actually have a high risk. I was on the other side of the coin where a genomic test wasn’t done as I was perceived to be too low risk, also complicated by not being able to have oncotype DX, due to being her2 + ( I think there are other genomic tests in that case available). It probably does come down to cost too, they don’t want to be wasting money when the treatment path is already obvious, which is understandable.
I was 53 and premenopausal, ER+, HER2-, 100mm tumour, 1 node. Chemo was recommended as I was perceived to be at high risk of recurrence. My Predict score showed an 9% benefit from chemo.
The eligibility for the Oncotype test was:
- newly diagnosed with early stage invasive breast cancer,
- have cancer cells that are ER+,
- have cancer cells that are HER2-negative,
- are either lymph node negative, 1-3 lymph node positive or have micrometastases in the lymph nodes
- have a large tumour size
I paid for my Oncotype test and it showed a 2.8% CT benefit, so very different to Predict’s 9%. The caveat in the report was that for premenopausal women over 50, it is “not known whether the benefit observed with CT is due to CT alone, ovarian function suppression or a combination of the two.” My treatment plan also included ovarian suppression.
I decided to go ahead due to my age and if I had a recurrence, didn’t want to regret that I hadn’t thrown everything at the cancer. In the end, I had an anaphylactic reaction to the paclitaxel in the first session and it had to be discontinued!
Hiiiii.
I had tumours that spread in size, had all my lymph nodes removed as cancer in all but one. Post menopause. Had both tumours tested with Onco, low results but due to size of cancer spread, it left my oncologist with a negative opinion on the option of chemo as I am high risk of recurrance, said it will rid me for a short term & I needed a longer length treatment. Not sure if this helps. Hope you are ok x