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The Oncotype DX Test and Some Controversy
Most in the medical field would agree: early detection of breast cancer saves lives. But how do doctors really know which treatments will be best to prevent the return of your cancer?
The Oncotype DX is a diagnostic test that helps your oncologist determine which treatment plan will most effectively prevent your cancer from returning (recurrence) or help to control your disease.
In order to be considered for this test, patients must have a diagnosis of estrogen-receptor positive (ER+), or estrogen-fueled breast cancer, be Stage 1 or Stage 2 and have no lymph nodes with cancerous cells, information that isn’t available until your lump has been biopsied.
When I went through breast cancer in 2004, this test wasn’t available. It wasn’t until 2007 that the test was trialled.
What is the Oncotype DX?
The Oncotype DX test is a tumor profiler. It examines samples of tissue from your tumor and rates it for a specific set of genes that can influence the likelihood of recurrence within 10 years after your original diagnosis. The result of the test is reported as a number between 0 and 100, known as the Recurrence Score® result.
The Recurrence Score
All of these test results make it easier for your oncologist to provide you with a diagnosis, but the genetic information (along with all of the other diagnostics) gives a clearer picture of whether or not your particular tumor will respond to chemotherapy to prevent any recurrence.
Your recurrence score will be based on the genetic expression of 21 genes, 16 of which are cancer-related, and 5 of which are reference genes. The genes are grouped by function: proliferation, invasion, hormone receptors (estrogen and progesterone), and growth factors. Each person’s test results are unique, and will fall into one of three categories – low risk, intermediate risk, and high risk.
Those who have a low risk of recurrence may not need any chemotherapy but may be offered hormone therapy as a follow-up treatment after surgery. Those in the intermediate to high-risk categories may be offered chemotherapy as well as hormone therapy to further reduce a risk of recurrence. There are many other factors such as age, tumor grade, hormone receptor status, etc. that will be considered by your oncologist before a treatment plan will be put together, but research has shown that results from the Oncotype DX test are a very strong predictor for recurrence.
The Controversial Part
Medicare and several private health insurance companies will help cover the cost of an Oncotype DX test. Check with your insurance provider to find out if you are covered for this test. The current list price for the Oncotype DX is $4,000.00 and it’s done by one company, Genomic Health.
This upsets me (and a whole host of others, let me tell you!). There is no way that test should be so expensive. It’s like holding us hostage – pay up or you aren’t going to know exactly which therapies you should be given. It’s absolutely disgusting. I invite your comments below.
References:
http://breastcancer.about.com/od/diagnosis/p/oncotypedx.htm
http://www.oncotypedx.com/en-US/Breast/PatientsCaregiversInvasive/OncotypeDX/Overview
http://ww5.komen.org/BreastCancer/OncotypeDX.html
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Hi, Marnie,
I had the Oncotype DX test done and was not impressed by the findings. The data is based on studies done in 80’s and 90’s and the test went on the market in 2004 (I called the company to discuss my questions and concerns and asked this of them).
Dear Carolyn,
Thanks for your input. Good to know. Just out of curiosity, did you use the score you received to decide whether or not you would undergo chemotherapy? Or did you decide to disregard it?
Warmest regards,
Marnie
I had the Oncotype DX testing done. The lab did call me to let me know what my part of the cost would be, and also told me that when I got the bill, to call them. They will ask the patient questions, and they will waive some/all of the cost based on income, and other things. My husband and I both work as health professionals, but I got as far as the question of whether I had college age children, and since I have 2 in college, my cost was totally waived. And yes, this test ruled out Chemo for me, which would have cost so much more- physically, mentally, side effects, and money. I am sure it costs more than it could/should, but if there is any question about treatments, I believe it is worth every penny. It was to me.
Dear Beth,
Thanks so much for your comment and for sharing some of your experience with the Oncotype DX test with my readers. Blessings to you.
Warmest regards,
Marnie
I agree with Beth. I also had the Oncotype DX test done in February 2016 and Genomic Health called me before performing the test to make sure I was willing to assume whatever portion of the bill was not paid by my insurance, which was estimated to be around $600. Based on the results of my test, my oncologist agreed that I did not need chemotherapy nor would it have helped me. This news was well worth any price! As of June 2016, I still have not received a bill from Genomic Health as they are still in dispute with my insurance company. Whether my bill ends up being $600 or $300, I will gladly pay! It is worth every penny. It really makes you stop and wonder how many women undergo unnecessary, costly chemotherapy. Long live Oncotype DX!
I was diagnosed in May of 2017 with ILC. Lumpectomy on 6-14-17, and 20 radiation treatments in the month of August (16 regular, and 4 Boost). I then requested the Oncotype test, but the MO declined, saying “they always come back low with your pathology”. I have resisted the Tamoxifen and/or AI’s, so she decided to order the test. My score was 24. So not that low.
I’m having a difficult time getting straight answers, especially since I have the ILC. (My understanding is that the Oncotype was developed specifically for IDC.)
Also, since prior to my surgery, I have had ZERO blood work to check vitamin levels or anything else, such as bone density.
Mary,
Subsequent to my writing this article, an Israeli study was published that found that for 46% of ER+ breast cancer patients (IDC and ILC), the Oncotype DX score and how those patients were subsequently treated was associated with favorable outcomes. Here’s the study if you’d like to read it: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869476/
And it’s true what you say – oncologists spend next to no time discussing vitamin levels or any sort of nutrition as they are not trained to do so. For that kind of information you’ll need to talk with an oncology naturopath (see https://oncanp.org/world-map/us/ and click on your state) or integrative oncologist (just Google that with your city name and see what comes up). That’s where I suggest you begin. Let me know if I can help you further.
Warmest regards,
Marnie Clark
I had the test. Indicated 30% chance it could come back in 10 years. To me, there is a 70% chance it won’t. If I did chemo, there’s a 12% chance and by taking Letrozole a 20% chance…for a difference of 8% I’m happy to take the pill. I would never do chemo. Have seen too much destruction with it in people I know personally. My quality of life means more to me than taking something to destroy my immune system.
Cydne,
Thanks for sharing that. I would just like you to be aware that when taking Letrozole, you need to monitor yourself carefully. The drug has some rather significant side effects, so just be cautious please.
Warmest regards,
Marnie
I was diagnosed 1/19/23 with IDC er+pr+, in March had lumpectomy in 2 areas, no lymph involvement and my oncotype score came back as 11. The doctor states that anything under 18 would not respond to chemo, thankfully as I would not choose to do so. My insurance paid for the entire cost. It gives a bit more piece of mind to know that it would not have responded to chemo as I would have not done so and may have been questioning myself if I did the right thing.