Genomic Testing in Breast Cancer: What You Must Know

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:

LIST OF QUESTIONS FOR YOUR DOCTORS:

FOLLOW US:
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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.

[yvonnequinones]

The average OncotypeDX number is 31. Mine was a 9. Going on six years cancer free. IDC, stage 2A, Estrogen 90% driven, Progesterone 10% driven, HER-2 Negative, Grade 1. BRCA mutation Negative. Took Tamoxifen for a year but had liver enzymes rise so my oncologist took me off. I feel my outcome was a miracle. 💗

[intisarsalim]

Ur lecture is very good but needs markings to be more clear

[aprilchapman]

I was BRCA2 positive/Invasive ductal carcinoma, there was no treatment other than do nothing because you have your own source, lumpectomy or bilateral mastectomy with reconstruction. When I was 26 I had a total hysterectomy because of being ovarian cancer cells, and so many other female issues to list, and if the genetic coding would of been around back then I could of avoided a lot of things I am going through now.

[katsem]

My Oncotype DX score was six. But, my doc only kept me on Arimadex 5 years, even though I suggested longer. It came back in the breast after a mastecomy, in the fat. It's early, and supposedly hasn't spread. I balked at chemo, and that's the only reason he ordered the Oncotype test, but that was 7 years ago. Now it's standard, thanks to a huge study that showed the value of this test.

[mrking]

Could you make another video on mammaprint and the hormone blocker? You are the first doctor I’ve found on YouTube that mentions mammaprint. Mine came back ultra low risk.

[exploringarchitecturalheritage]

In my country oncologists give all patients chemo, radiation and other therapies based on ER PR HER2 results.

[Ke-qvmd]

I have had Nebula Genomics testing done. Is it a good one?

[margaretlester]

I would love to see an episode on the Signatera type tests. Tests for residual cancer dna cells

[khaledhasan]

my mom is 73 yrs old ... did a lumpectomy surgery ... the pathology report says : stage 3a with positive ( er, pr ) negative her2 ... nodal count ( 5/12 ) the oncologists said chemotherapy is a must ... at her age i feel its difficult to take the chemo decision .. my question is : does she qualify for a genomic test ??

[chanthellejaganath]

I am triple negative breast cancer, stage 2b grade3.... HER2 2+, FISH negative, ER negative. I have had 4cycles of AC that shrunk my tumor from 3cm-1.5c. and 6cycles of Paclotaxol that had no response to the tumor. Will these genotests help me find a chemo that will work.

[lisamartin]

Let's talk about all the risks of tamoxifen including uterine cancer, pulmonary embolism among many other things. The doctors never seems to mention this. And how about secondary malignancies from radiation 15+ years out? Doctors never mention beyond the 5 year mark! I hope women will learn as much as they can before being lured into such "treatments."

[TheYaqub]

Hi Doctor, What do you mean by small tumor. My tumor is 3cm. Is that considered small

[rosegombos]

I took prepro to hinder the effects of the change of life which was later found to have caused the breast cancer "Prempro

[TenneesseeCarlos]

Correction her2 NEU score 3positive positive

[gaurikaveeshwar]

Hello Dr.John, Thank you very much for this information. please suggest how do you look at Prosigna test in terms of giving results?

[yvonnequinones]

My friend had IDC, Stage 1, Estrogen, Progesterone Positive, HER-2 Negative, Grade 3. OncotypeDX number 19. She had a lumpectomy then refused radiation and meds. She is trying to eat better and reduce acidity. I'm very concerned about her refusing treatment but I'm not Dr. Yvonne & it wasn't my place to push treatment.

[bonnieinnocentini]

Why aren't you talking about the Chek 2 gene mutation?

[deshpalsingh]

The background music is irritating so much so that it hard to listen your voice