Oncotype DX

I am gearing up for my first visit with the Oncologist since my initial surgery to remove the tumors from my breast.  I am a bit anxious about this visit particularly since the last conversation I had with the doctor was over the phone to review the results of the Oncotype DX test.  I know that the Dr. feels strongly about recommending chemotherapy along with Tamoxifen to treat the cancer and I am likely to have to defend my choice not to go through with those treatments.

As I understand it, the Oncotype DX is a test that closely looks at the individual breast tissue sample and analyzes 21 different genes from the sample.  The tests are done three times on the tissue to insure a consistent result.  The lab then returns a document to the doctor with an analysis of the individual cancer cells and genes and the likelyhood that the cancer is agressive and unpredictable enough to predict a recurrance.  The scores are a number from 0 to 100.  The test is used to determine whether chemotherapy should be a recommended course of action for the individual patient.  Only those with a score lower than 31 get a "maybe not" and even those are subjective.  Any score 31 or over gets a strong push for chemotherapy.

The score I believe, is a rate of recurrence that only applies to the next 5 to 7 years.  After that, the test has little predictability. My personal feelings are that while it is very useful to know a "prediction" of recurrence, it is a little overboard to rate any score 31 or higher as "high" and those in between 17 and 31 as "medium" and only those 17 and lower as "low" risk.  I wish they would leave the determination to the patient.  For me maybe only 75 or higher should be considered "high" and for someone else maybe anything over 20 is "high".

So what am I personally doing with this information?  Well, first of all, I am trying not to let it scare me into making any rash decisions.  I have realized that deciding not to follow through with chemotherapy is a decision not made once, but over and over.  I have to take charge of my treatment.  I have to make the choice over and over everyday in what I eat, and what I expose myself to.  My number by the way, is a 48.  So I suppose I have a 48% chance that I will have a recurrence in the next 5 to 7 years.  If I do experience a recurrence, the data shows that it will be more aggressive at that point and difficult to treat.  It is a challenge to repeatedly accept that information and to accept responsibility to live in a way to allow my body to create an atmosphere where it will have what it needs to fight off that 48% chance.

I have repeatedly felt through the Spirit of God, that my choice to follow the alternative path to chemotherapy is the right one for me. It makes it much easier to cope with the anxiety and fear brought on by the medical community that I am not making the best choice, but doesn't eliminate it.  I still have "what if" moments.  Most of all of course is, "what if I have a recurrence in 5 years and have to face death and leaving my family behind?"  In a way I guess that inspires me to live my life more thoughtfully.  I am inspired to be more present for my family, to do more to make each day count and meaningful.  I trust in the Lord above all.  I am sure that even if the "what ifs" come to pass that I am following the path the Lord wants me to take right now.  There is peace in that at least.