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Christianne - I have been struggling with the same question - small tumor but some aggressive markers, which put me in the gray zone (I am 43). I contacted Genomic Health (the maker of the Oncotype test) and got the following response in regard to the effectiveness of this test relative to a Her2+++ tumor.
Thank you for inquiring about the Oncotype DX® Breast Cancer Assay. As you stated below, the Oncotype DX® Breast Cancer Assay is validated for testing on early stage female breast cancer patients who are ER positive and lymph node negative. Though the HER2 gene status of a patient is not required for testing (meaning a patient HER2 positive or negative can be submitted for testing), the majority of the tests performed by Genomic Health, Inc.® are for patients who are HER2 negative. A highly positive HER2 status through IHC or FISH testing will likely correlate to a high recurrence score and so testing may not prove beneficial. However, an equivocal or uncertain score for HER2 may prove to be HER2 equivocal or negative by RT-PCR (Genomic Health's method of testing HER2 and all other genes within the assay) and therefore results of the Oncotype DX® Breast Cancer Assay may prove extremely beneficial in determining average rate of distant recurrence. Beginning on September 27, 2008, the Oncotype DX® Breast Cancer Assay report will include the values for ER, PR, and HER2. These values are just three of the 21 genes used within the assay.
So... I kind of took away that Oncotype testing would not be real beneficial for me as I am highly HER2+++. Being weakly ER+ and PR- does not help either as I know being ER/PR + would "lower" an Oncotype score. Which makes me wonder if there are other "markers" such as high ER/PR positivity that might also be playing into your onc's point of view ? Was Her2 status confirmed via FISH ?
I would be very interested in what you find out ! Best of luck !
Jill
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