We teach you about genomic testing and how these sophisticated tests can guide you to personalized therapies for your breast cancer.
THE BREAST CANCER SCHOOL FOR PATIENTS:
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LIST OF QUESTIONS FOR YOUR DOCTORS:
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Questions for your Breast Surgeon and Medical Oncologist:
*Do I qualify for an Oncotype DX genomic test?
*If so, will you order genomic testing for me?
*Would you order a genomic test before I see a medical oncologist?
*Are there any other genomic tests that apply to me?
*What is a genomic assay?
These sophisticated tests are performed on a small sample of cancer tissue in appropriate patients with early stage breast cancer. Genomic tests are usually ordered after surgery when the pathology report is finalized. It measures unique aspects of the tumor to determine if a patient will benefit from chemotherapy in addition to hormonal therapy. Such “genomic assays” developed over the last decade are a dramatic advance in breast cancer care. The Oncotype DX assay by Genomic Health Inc. is the most utilized genomic assay of those available in the United States.
Who should consider a genomic test?
Patients who have small “Estrogen receptor positive” (ER+) and “HER2 receptor negative” (HER2-) tumors and no evidence of cancer in their lymph nodes may benefit from an Oncotype DX assay. The purpose of this test is to better identify people who do and do not benefit from chemotherapy. The decision to undergo chemotherapy is a complicated one. Your medical oncologist will examine multiple factors to help determine if you will benefit from chemotherapy. The NCCN Guidelines, listed in the website links below, outline in much greater detail recommendations for the use of genomic tests. An Oncotype DX test can be instrumental in this decision for many patients.
You may qualify for a Genomic Assay if…
You have early stage cancer (Stage I or II)
Your tumor is Estrogen receptor positive (ER+)
Your tumor is Her2 receptor negative (HER2-)
No cancer was found in your lymph nodes
You are willing to consider having chemotherapy
You are healthy enough to undergo chemotherapy
How is chemotherapy tailored to patients?
Genomic breast cancer tests are a leap forward in our ability to “look inside” breast cancer cells. Sophisticated breast cancer care is based upon the principle of providing maximal benefit from the least toxic therapy. Newly diagnosed breast cancer patients deserve the best information available to decide whether they need chemotherapy. Take our video lesson on “Will I Need Chemotherapy?“ (here) to understand the general concepts. Genomics is a promising and rapidly developing field.
OTHER GENOMIC TESTS:
Oncotype DX Breast DCIS Test
This assay of DCIS or “precancerous” breast cells may help identify some women who may not benefit from radiation therapy after a lumpectomy. Genomic Health Inc. is a leading personalized medicine company. More information is about this test is located (here).
MammaPrint
This genomic test is used for Stage I and II breast cancers to determine prognosis and survival. This test is now included in national guidelines for some with hormone sensitive breast cancers that are found to have a small amount of cancer in a few lymph nodes. It is also a genomic test for some without “node positive” breast cancer. Agendia is a leader in personalized and molecular cancer diagnostics. More information about MammaPrint is located (here).
Endopredict
EndoPredict is a 2nd generation genomic breast cancer recurrence test to assess for 10-year risk of cancer recurrence. This test also accounts for tumor size in helping determine if chemotherapy may be needed in early stage, favorable breast cancers. Myriad Genetics is global leader in genetic testing and personalized medicine. More information about Endopredict is located (here).
Breast Cancer Index (BCI)
This test is designed for women with favorable, early stage breast cancer who have been on hormonal therapy for 4 to 5 years. It can help determine if someone will benefit (or can avoid) five additional years of hormonal therapy, such as tamoxifen or an aromatase inhibitor. This test is not yet approved by the FDA. Medicare and some insurance companies may cover the cost. Biotheranostics is a molecular diagnostics company. More information about BCI is located (here).
Take Home Message:
Make sure to ask both your breast surgeon and medical oncologist if a genomic assay might play a role in your treatment decisions. For appropriate patients, these tests should be considered only one piece of the many “pieces of the puzzle” in deciding treatment decisions about chemotherapy and hormonal therapy.
1 июн 2024
