What Is An Onco Score

The Oncotype DX test is a genomic test that analyzes the activity of a group of genes that can affect how a cancer is likely to behave and respond to treatment. The Oncotype DX is used in two ways:

to help doctors figure out a woman’s risk of early-stage, estrogen-receptor-positive breast cancer coming back (recurrence), as well as how likely she is to benefit from chemotherapy after breast cancer surgery

to help doctors figure out a woman’s risk of DCIS (ductal carcinoma in situ) coming back (recurrence) and/or the risk of a new invasive cancer developing in the same breast, as well as how likely she is to benefit from radiation therapy after DCIS surgery

Of all the breast cancer genomic tests, the Oncotype DX test has the strongest research behind it.

The results of the Oncotype DX test, combined with other features of the cancer, can help you make a more informed decision about whether or not to have chemotherapy to treat early-stage, hormone-receptor-positive breast cancer or radiation therapy to treat DCIS.

Genomic tests analyze a sample of a cancer tumor to see how active certain genes are. The activity level of these genes affects the behavior of the cancer, including how likely it is to grow and spread. Genomic tests are used to help make decisions about whether more treatments after surgery would be beneficial.

You may be a candidate for the Oncotype DX test if:

you’ve recently been diagnosed with stage I or II invasive breast cancer

the cancer is estrogen-receptor-positive

there is no cancer in your lymph nodes (lymph-node-negative breast cancer)

you and your doctor are making decisions about chemotherapy.

Most early-stage (stage I or II), estrogen-receptor-positive breast cancers that haven’t spread to the lymph nodes are considered to be at low risk for recurrence. After surgery, hormonal therapies such as an aromatase inhibitor or tamoxifen are prescribed to reduce the risk that the cancer will come back in the future. Whether or not chemotherapy is also necessary has been an area of uncertainty for patients and their doctors.

If you’ve been diagnosed with early-stage, estrogen-receptor-positive breast cancer, the Oncotype DX test can help you and your doctor make a more informed decision about whether or not you need chemotherapy. (Some research also suggests the test may help postmenopausal women with estrogen-receptor-positive breast cancer that has spread to the lymph nodes make chemotherapy decisions. Talk to your doctor if you are in this group.)

You also may be a candidate for the Oncotype DX test if:

you’ve recently been diagnosed with DCIS

you’re having lumpectomy to remove the DCIS

DCIS is the most common form of non-invasive breast cancer. DCIS usually is treated by surgically removing the cancer (lumpectomy in most cases). After surgery, hormonal therapy may be recommended if the DCIS is hormone-receptor-positive. Radiation therapy may be recommended for some women. Doctors aren’t always sure which women will benefit from radiation therapy.

If you’ve been diagnosed with DCIS, the Oncotype DX test can help you and your doctor make a more informed decision about whether or not you need radiation therapy.

The Oncotype DX genomic test analyzes the activity of 21 genes that can influence how likely a cancer is to grow and respond to treatment.

Looking at these 21 genes can provide specific information on:

the likelihood that the breast cancer will return

whether you’re likely to benefit from chemotherapy if you’re being treated for early-stage invasive breast cancer

whether you’re likely to benefit from radiation therapy if you’re being treated for DCIS

So, the Oncotype DX test is both a prognostic test, since it provides more information about how likely (or unlikely) the breast cancer is to come back, and a predictive test, since it predicts the likelihood of benefit from chemotherapy or radiation therapy treatment. Studies have shown that Oncotype DX is useful for both purposes.

Oncotype DX test results assign a Recurrence Score — a number between 0 and 100 — to the early-stage breast cancer or DCIS. Based on your age, you and your doctor can use the following ranges to interpret your results for early-stage invasive cancer.

For women older than 50 years of age:
Recurrence Score of 0-25:
The cancer has a low risk of recurrence. The benefits of chemotherapy likely will not outweigh the risks of side effects.

Recurrence Score of 26-100:
The cancer has a high risk of recurrence. The benefits of chemotherapy are likely to be greater than the risks of side effects.

For women age 50 and younger:
Recurrence Score of 0-15:
The cancer has a low risk of recurrence. The benefits of chemotherapy likely will not outweigh the risks of side effects.

Recurrence Score of 16-20:
The cancer has a low to medium risk of recurrence. The benefits of chemotherapy likely will not outweigh the risks of side effects.

Recurrence Score of 21-25:
The cancer has a medium risk of recurrence. The benefits of chemotherapy are likely to be great than the risks of side effects.

Recurrence Score of 26-100:
The cancer has a high risk of recurrence. The benefits of chemotherapy are likely to be greater than the risks of side effects.

The Oncotype DX DCIS score analyzes the activity of 12 genes. You and your doctor can use the following ranges to interpret your results for DCIS:

Recurrence Score lower than 39:
The DCIS has a low risk of recurrence. The benefit of radiation therapy is likely to be small and will not outweigh the risks of side effects.

Recurrence Score between 39 and 54:
The DCIS has an intermediate risk of recurrence. It’s unclear whether the benefits of radiation therapy outweigh the risks of side effects.

Recurrence Score greater than 54:
The DCIS has a high risk of recurrence, and the benefits of radiation therapy are likely to be greater than the risks of side effects.

You and your doctor will consider the Recurrence Score in combination with other factors, such as the size and grade of the cancer, the number of hormone receptors the cancer cells have (many versus few), and your age. Together, you can make a decision about whether or not you should have chemotherapy or radiation therapy.

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