Let’s talk about Oncotype scores

The test evaluates 16 different genes in my tumor, and tells me how likely my cancer is to recur, on a scale of 0-100. It also quantifies the effect of chemotherapy on recurrence, if any. 

The test is fairly new, and applies only to hormone positive, Her2 negative breast cancers. It isn’t widely available outside of the US, and it is expensive. I’m fortunate to have this guide my therapy. 

My score is 19, putting me in the intermediate range of recurrence, with a 6% risk of distant recurrence (metastatic, stage IV cancer) in the next 9 years with endocrine therapy alone. 

The good news is chemotherapy only lowers that risk another 1.6% - not enough to justify the risks. So for now, I won’t have systemic/traditional chemotherapy - just endocrine therapy to block estrogen. It means I get to keep my hair (or at least what doesn’t fall out from menopause/estrogen blockers), and I get to keep my veins intact. 

A reassuring visit with the medical oncologist today put my mind at ease about not having chemo. It weighed on me that if I “do nothing” and my cancer comes back, I will always wonder “What if?”, and I will always have regrets. But chemo doesn’t work that way: it works on rapidly dividing cells, run amok and clinically evident - it doesn’t work on slow growing, non replicating, dormant cancer cells lurking in the depths of my body. So it wouldn’t help now, anyway. 

The countdown has started to 15 years - 180 months until I can breathe easily that my cancer is gone and not coming back. It is a long time. Maybe in a year or two, it won’t be the first thing I think of every day, or the last thing at night. With each passing day, I’m closer to a breast cancer free life.