What You Need To Know
- According to the National Cancer Institute, women 70 and older have a 1 in 24 chance of developing breast cancer at some point in their lives. Men can also get breast cancer.
- Treatment which could include surgery, hormone-blocking pills, targeted radiation or a combination of these therapies depends on the characteristics of the tumor. Chemotherapy is used occasionally.
- Healthy, active, independent patients have the best chance of a good outcome.
Biology Of Late Recurrence Different From That Of Early Recurrence
Also presented at SABCS, a gene discovery study conducted by the NCI cooperative group, SWOG, identified a number of new genes and pathways that may be important in early breast cancer recurrence or response to chemotherapy. The study also showed that the biology of late recurrence was very different than the biology for early recurrence. This is a particularly important finding because it provides an opportunity for a new technology like liquid biopsy which may be better suited to predict late recurrence based on evolution of the tumour to help guide duration of hormonal therapy and to track cancer progression and drug resistance.
What Are Genomic Tests
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.
While their names sound similar, genomic testing and genetic testing are very different.
Genetic testing is done on a sample of your blood, saliva, or other tissue and can tell if you have an abnormal change in a gene that is linked to a higher risk of breast cancer. See the Genetic Testing pages for more information.
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Patient And Tumour Characteristics
Data were collected from a total of 713 patients. Information was collected from 14 NHS trusts from across the UK , with a median of 38 patients from each site . Baseline patient and tumour characteristics are shown in Table 1. The median age was 55 and the median tumour size was 24 mm .
Table 1 Baseline patient and tumour characteristics
Concordance between RS and RSPC scores was variable. For patients with low RS , 54.0% were also classified as low risk by RSPC . However, 35.9% and 10.1% were reclassified as intermediate and high risk by RSPC, respectively. For patients with intermediate RS , 48.8% were also classified as intermediate risk by RSPC. 15.2% were downgraded to low risk and 36.1% were upgraded to high risk by RSPC. For patients with high-risk RS , 82.1% were also classified as high risk by RSPC. 16.8% and 1.1% were reclassified as intermediate and low risk, respectively.
Oncotype Dx Predicts Chemotherapy Benefit In Node
Among women with node-positive, hormone receptor-positive breast cancer, use of the Oncotype DX test identifies a subset of women who do not appear to benefit from adjuvant anthracycline-based chemotherapy.6
To assess the test among women with node-positive, hormone receptor-positive breast cancer, researchers evaluated information from 367 patients. Some patients received adjuvant therapy with tamoxifen alone, and some received tamoxifen plus anthracycline-based chemotherapy.
- The addition of chemotherapy to tamoxifen significantly improved breast cancer survival among women with a high Recurrence Score .
- The addition of chemotherapy did not improve breast cancer survival among women with a low Recurrence Score.
- Women with an intermediate or high Recurrence Score had a two- to threefold increase in recurrence risk compared to women with a low Recurrence Score.
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If I Have Invasive Breast Cancer Do I Have To Have A Mastectomy
Mastectomy is one treatment for invasive breast cancer, but it isnt required in all cases, Tran says, especially now. Which treatments your doctor recommends and the order in which theyre given depend on several factors.
For example, she says, You and your doctor may decide that the best option for you is to undergo chemotherapy first. Chemotherapy can shrink the tumor and melt part of it away, so it is small enough to be managed with a lumpectomy instead of a full mastectomy.
If surgery is the best choice for you, new advancements for breast-conserving surgery and mastectomy with reconstruction can offer alternatives that preserve your appearance and self-image, such as oncoplastic breast reduction, nipple-sparing mastectomy, aesthetic flap closure and other techniques.
How Does The Test Work
After you have surgery , samples of the tumor are sent to Exact Sciences Laboratory where the test is performed. Results take about two weeks to be returned to your provider.
Scientists look at the tumor samples and determine the levels of expression of 21 specific genes in the tumor tissue. Sixteen of the genes are cancer-related the other 5 are used as “reference” genes. Based on the level of expression of each of these genes, a score is assigned. This is called the Recurrence Score . This score is on a scale of 0-100, with higher scores indicating a greater risk of recurrence. Your recurrence score is looked at in combination with your age and the size and grade of your tumor to determine the best course of treatment to prevent recurrence for you.
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Prostate Cancer Oncotype Dx Results
The prostate cancer Oncotype DX test analyzes 12 genes to produce a score from 0 to 100 correlating with the aggressiveness of your cancer.
Your patient report will provide you with a rating of your cancer from very low to high risk. The report also gives you your odds of death from cancer within 10 years and the chances of your cancer progressing to a Gleason score over 4 + 3 or pT3.
A Team Approach To Breast Cancer Treatment
Tran says older patients or anyone diagnosed with breast cancer can benefit from getting care at a comprehensive center, such as the one where she performs surgery: the Sullivan Breast Center at Sibley Memorial Hospital in Washington, D.C.
Our team meets weekly to discuss individual patients cases, and that helps us bring the best thinking to each persons treatment plan, Tran says. Our combined experience supports every patient.
Breast Health Services
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How Does It Work
The test is done on a small amount of breast cancer tissue already removed .
The tissue is sent to a laboratory in the USA, where the test is carried out. The test looks at groups of genes found in breast cancer.
The results are given separately from your pathology report and are sent to your specialist within 10 to 14 days.
If your specialist has recommended you have hormone therapy before surgery, the test must be done on the tissue removed by a core biopsy, before you start hormone therapy.
How Does The Oncotype Dx Breast Dcis Score Test Work
The Oncotype DX Breast DCIS Score Test analyzes the activity of 12 genes that can influence how likely the DCIS is to come back, either as another DCIS or as invasive breast cancer.
The Oncotype DX Breast DCIS Score Test assigns a Recurrence Score a number between 0 and 100 to the DCIS. 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. Its 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 DCIS and the number of hormone receptors the cancer cells have . Together, you can make a decision about whether or not you should have radiation therapy.
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Oncotype Dx Predicts Local And Regional Breast Cancer Recurrence
In addition to providing information about risk of distant breast cancer recurrence, the Oncotype DX® Recurrence Score also provides information about risk of local or regional breast cancer recurrence.
To evaluate the Recurrence Score in relation to risk of local and regional breast cancer recurrence, researchers evaluated information from 895 women treated with tamoxifen , 355 women treated with placebo, and 424 patients treated with chemotherapy plus tamoxifen. All of the women had node-negative, estrogen receptor-positive breast cancer.
- Among women treated with tamoxifen, 10-year risk of local or regional cancer recurrence was 4.3% among women with a low Recurrence Score, 7.2% among women with an intermediate Recurrence Score, and 15.8% among those with a high Recurrence Score. The Recurrence Score also predicted risk of local or regional recurrence among women treated with placebo and women treated with chemotherapy and tamoxifen.
These results indicate that in addition to predicting the risk of distant cancer recurrence, the Recurrence Score also predicts the risk of local or regional cancer recurrence in women with node-negative, estrogen receptor-positive breast cancer.
Application Of Oncotype Dx Test In Er+ Breast Cancer Patients
Utilizing the SEER database, we first defined clinical differences among 375,350 breast cancer patients who were stratified based on the usage of Oncotype DX .1). Multivariable analysis indicated that patients with lower tumor stages, lower grade, negative lymph node status, negative HER2 status, and of Caucasian descent were all significantly more likely to be an Oncotype DX user compared to non-users .1). Discrepancies in Oncotype DX testing rate between different races have indeed been observed in previous studies . Oncotype DX users were also less likely to have received chemotherapy, but they were more likely to have received radiation therapy compared to non-Oncotype DX users.
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Who Is Oncotype Dx For
The test is suitable for people recently diagnosed with early stage invasive breast cancer that:
Sometimes the test may be considered for people whose breast cancer affects one to three lymph nodes under the arm.
The test is not suitable for people whose breast cancer is oestrogen receptor negative or HER2 positive.
What Is The Oncotype Dx Breast Recurrence Score Test
The Oncotype DX Breast Recurrence Score Test analyzes the activity of a group of genes that can affect how an early-stage breast cancer is likely to behave and respond to treatment. The Oncotype DX Breast Recurrence Score Test is used in two ways:
- to help doctors figure out a persons risk of early-stage, estrogen-receptor-positive breast cancer coming back in a part of the body away from the breast
- to help figure out if a person will benefit from chemotherapy
The results of the Oncotype DX Breast Recurrence Score 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, HER2-negative breast cancer.
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Treating Breast Cancer In People Age 70 And Up
Older age increases the risk of several types of breast cancer. But advancements in diagnosis and highly individualized treatment plans are increasing the odds of recovery for older patients and making it possible for many to live longer, healthier lives.
Breast surgeon Hanh-Tam Tran, M.D., explains what people age 70 and older should know about being diagnosed with breast cancer and why theres reason for hope.
What Is The Oncotype Dx Breast Dcis Score
DCIS is the most common form of non-invasive breast cancer. DCIS usually is treated by surgically removing the cancer . After surgery, hormonal therapy may be recommended if the DCIS is hormone-receptor-positive .
Radiation therapy may be recommended for some women. Doctors arent always sure which women will benefit from radiation therapy.
The Oncotype DX Breast DCIS Score is used:
- to help doctors figure out a womans risk of DCIS coming back and/or the risk of a new invasive cancer developing in the same breast
- how likely a woman is to benefit from radiation therapy after DCIS surgery
The results of the Oncotype DX Breast DCIS Score Test, combined with other features of the DCIS, can help you and your doctor make a more informed decision about whether or not you need radiation therapy.
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The Root Of Breast Cancer Disparities
There are many glaring differences between the outcomes of Black and White women with breast cancer. For example, Black women are more likely to be diagnosed with advanced cancer and to die from it.
This study adds an additional layer to our understanding of breast cancer disparities, Dr. Li said. But we have yet to understand what factors are contributing to the differences observed, he added.
The conditions where people are born, live, work, and play are clearly the root causes of health disparities and undoubtedly play a role in why we saw that mortality disparity in the study, Dr. Hoskins said.
Greater poverty and segregation in communities, institutional racism, and limited access to high-quality medical care all contribute to unequal health outcomes for Black Americans, Drs. Sparano and Brawley noted. For breast cancer in particular, these factors can make it more likely for Black women to delay or stop treatment.
Biology and genetics likely contribute to breast cancer disparities, as well, the editorialists wrote. For example, women of African heritage have higher rates of certain side effects from chemotherapy, leading them to take lower doses.
Dr. Hoskins and his colleagues are delving into some of these possibilities. Theyre currently taking a closer look at social determinants of health to see how they might be influencing Oncotype DX scores.
How Oncotype Dx Dcis Is Different
Whereas Oncotype DX looks at 21 genes, Oncotype DX DCIS only looks at 12 genes, generally after a lumpectomy to determine its likelihood of developing into invasive breast cancer. A recurrence score below 39 means that the benefits of radiation therapy do not outweigh its risks. On the other hand, patients with scores above 54 may need radiation therapy to avoid the recurrence of breast cancer. A score between 39 and 54 shows an intermediate risk, so you will need to discuss your options with your healthcare provider.
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Oncotype Dx Score Is 15 Or Lower And Lymph Node
For premenopausal women with lymph node-negative breast cancer, if the Oncotype DX score is 15 or lower, its unlikely chemotherapy would add much benefit to treatment. So, the use of hormone therapy alone is recommended .
In this way, Oncotype DX may help some women with ER-positive breast cancer avoid chemotherapy and its side effects.
Common Breast Cancers In Older Adults
The most common cancer diagnosed in this age group is invasive ductal carcinoma, or IDC , followed by invasive lobular carcinoma . These cancers arise in different tissues of the breast, but are treated in similar ways.
Most invasive cancers in this age group are hormone receptor positive. Hormone-positive breast cancers are considered slow-growing tumors, which can mean a good overall prognosis.
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Chemotherapy Improves The Prognosis Of High
Oncotype DX has been used to decide the use of adjuvant chemotherapy in ER+ breast cancer. We thus performed multivariable Cox regression analysis to examine whether chemotherapy improved the prognosis of patients. As shown in Table , we found that high-risk patients benefited from chemotherapy with the risk of overall death decreasing by 40% after chemotherapy use as compared to high-risk patients with no/unknown chemotherapy use .2). Patients with intermediate-risk also benefited from chemotherapy use compared to intermediate-risk patients with no/unknown chemotherapy use .2). In contrast, chemotherapy was not associated with prolonged OS for patients with low-risk .
Who Should Get This Test
To better understand if this test is right for you, an understanding of normal breast tissue is helpful. Breast tissue is made up of lobules that produce milk, and ducts that carry the milk to the nipple. Breast cancer starts in a duct or a lobule. Where the cancer starts, along with how it looks under the microscope, determines the type of breast cancer you have . Oncotype DX® testing is used if you meet the following criteria:
- You are diagnosed with invasive breast cancer.
- The Oncotype® DX test is mainly used in women with breast cancer but is being studied in men with breast cancer.
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What Are The Benefits Of Oncotype Dx Testing
Oncotype DX testing, together with other prognostic tests, can help your doctor determine how your cancer will act and whether the benefits of chemotherapy or radiation therapy outweigh the side effects and costs. Your test score can be interpreted with other markers such as your age and tumor grade and size.
Studies have reported Oncotype DX testing altering the decision to administer chemotherapy in as many as 30 percent of doctors treating people with ER-positive and HER2-negative breast cancer.
Oncotype DX testing may be most beneficial for people with medium-risk cancer, where itâs unclear if chemotherapy or radiation therapy would increase the chances of survival.
In the large TAILORx clinical trial, researchers compared the benefit of chemotherapy guided by gene testing in a group of 9,719 women with ER-positive and HER2-negative breast cancer. In women over age 50 with medium Oncotype DX scores, the researchers found no significant difference in overall survival between women who:
- received hormone therapy alone
- received hormone therapy and chemotherapy together
The researchers found some benefit of adding chemotherapy to treatment in women under age 50 with a medium score.
The results your test provides depends on the type of test and the type of cancer you have.