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Onco Score before BRCA results

SJ1976
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I had breast cancer diagnosed again at 49. First time at 32. These were separate cancers. First time I had surgery, chemo, radio, zoladex and tamoxifen. This time I had lumpectomy (tumor was 5.4cm). No lymph nodes involved, estrogen positive. Onco Score came back as 18 but this was before BRACA1 positive status results. I’m also on bone by phosphates and letrozole and had post surgery radio. If BRcA1 result was given at same time as ONCO Score, would I have been given chemo too, especially due to tumor size? Worried that they haven’t given systemic treatment. Especially as gene mutation and tumor size.

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    Hi SJ1976,

    I am sorry to hear that you are worried about not being given systemic treatment this time. Have you asked your care team about this? They are best placed to give you their reasons. I know how worrying a second breast cancer can be. I was diagnosed with one of the less aggressive types of breast cancer, 16 years ago and advised that it was slow growing and unlikely to reoccur. I had a lumpectomy, followed by Tamoxifen.

    Within 6 months I discovered a lump in the other breast, which was pre-cancerous. Within a year from the lumpectomy, I found a second cancer in the original breast and had a double mastectomy, followed by Letrozole for 6½ years. My bones were tested at the time and were fine, but I have just broken 4 metatarsal bones in my foot. These are the first bones that I have ever broken and I have been sent for another DXA scan next week. I sincerely hope that all goes well for you this time. Please keep in touch an let us know how you get on. We are always here for you.

    Kind regards,

    Jolamine xx

  • Hello SJ1976, and thank you for posting,

    I am sorry to learn that you have been diagnosed with breast cancer for a second time and have needed further treatment. This must be a very difficult time for you.

    Your treatment team would have based their decisions on the information available at the time. An Oncotype DX score of 18 is considered low risk for any meaningful benefit from chemotherapy in post‑menopausal, oestrogen‑positive, node‑negative breast cancer.

    Although a BRCA1 mutation is important information, it doesn’t automatically mean chemotherapy is recommended for every breast cancer. Treatment decisions are based on several things, including the cancer’s size and stage, type, grade, receptor status, your menopausal status and your overall health. Tools such as Oncotype also help estimate the risk of the cancer coming back and the benefit of chemotherapy.

    In your situation, letrozole and bisphosphonates are systemic treatments that work throughout the body to help reduce the risk of the cancer returning, so you are receiving systemic therapy even though chemotherapy was not recommended.

    It would be helpful to discuss your BRCA1 result with your breast cancer team and ask whether this information might have changed the treatment plan if it had been known earlier. As they are involved in your care, they can clarify why they chose your current treatment plan.

    I hope this helps in some way. Please do get back in touch if you have more questions. You can also speak with one of our nurses on the helpline if you prefer. We’re available 9–5, Monday–Friday, on freephone 0808 800 4040.

    Jemma

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