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:
www.breastcancercourse.org
LIST OF QUESTIONS FOR YOUR DOCTORS:
www.breastcancercourse.org/bre...
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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.

[@yvonnequinones3972]

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. 💗

[@suman9190]

wow. Congratulations.

[@saeedametlo3869]

Congratulations

[@cicit9356]

Wioo

[@sarathcpc]

Congratulations

[@elliegarcia9791]

Congratulations

[@aprilchapman2758]

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.

[@mrking695]

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

[@intisarsalim7461]

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

[@katsem2649]

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.

[@jessicaquinn9730]

My Oncotype DX was 6 too. I had cancer on both breasts and had double mastectomy 2 months ago. How did you find the cancer came back? I mean, after a breast was removed and no mammogram on that breast anymore? Congratulations on cancer free for 7 years!

[@rosegombos2120]

My onco DX results were a "7" of recurring I did have it in the 2nd breaat 5 years later the results spared me from chemo I wa so wvwe greatful

[@Ke-qv3md]

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

[@architecturalheritage]

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

[@chanthellejaganath8982]

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.

[@2007cgarza]

How are you doing now, Chanthelle? Hoping you are looking at this all behind you.

[@margaretlester2293]

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

[@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?

[@BreastCancerSchoolforPatients]

They all are similar, genomic tests that is. I highlight on our website the most commonly used tests in the US here. Same video, but great information and links below the video. www.breastcancercourse.org/genomic-testing/

[@gaurikaveeshwar]

Thank you very much for your reply. really appreciate it.

[@TheYaqub123]

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

[@khaliddurrani6432]

Yes anything 3 cm or less is a small tumor. However it’s the definitive pathology that will determine the role of any adjuvant treatment ( chemo, radiation, hormonal or others) and the outcome.

[@rosegombos2120]

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

[@khaledhasan9001]

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 ??

[@katsem2649]

I think its pretty standard now, but push for it.

[@lisamartin6847]

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."

[@missdemeanor1092]

Does radiation put you at risk for other cancers?

[@chrsch5309]

@@missdemeanor1092 It’s been shown to have detrimental effects on the heart. As so many women today have heart disease, it is something to think about before proceeding.

[@aremedyproject9569]

Lisa Martin. When you get diagnosed with breast cancer, then you can come back and comment:) Until then, you’re opinion is not helpful.

[@isabellamomodu1812]

Chemo and radiotherapy comes with risk but with cancer the benefit outweighs the risk

[@lisamartin6847]

@@aremedyproject9569 I have Stage 1 IDC

[@bonnieinnocentini7587]

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

[@thinkpositive3084]

Hi, do you have check 2?

[@bonnieinnocentini7587]

@@thinkpositive3084 Yes I have Check 2. My aunts have it too and they have had breast cancer twice. Once had the double mastectomy and lymph nodes removed and it came back in her lymph nodes. The other had a lumpectomy and radiation and it came back in her other breast. CK2 means your chance of recurrence is higher and it also means you have a higher risk of ovarian and colon cancer.

[@1979hellcat]

Thousands of years?!?!😳😳😳

[@yvonnequinones3972]

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.

[@agnesmatheus6585]

She made the right choice I chosed the same choice as well, don't worry will be fine

[@CrystalVIsMe]

@@agnesmatheus6585 not always. My aunt was stage 1A Er/PR positive HER2- grade 2 had the mastectomy and chemo and declined hormone therapy and it returned stage IV 18 months later. It’s not always good to give people advice on breast cancer Treatments because every cancer and every person is different and each journey can vary. What will work for you could be a death sentence for another. Take it from someone who watched her aunt die and then get diagnosed herself at the same age with the same cancer but our journey was totally different and you have to have trust in your medical team and if you don’t, find one that you do.

[@maggieg5719]

@@CrystalVIsMe Wow Crystal!!! Thanks for the comments. I’m sorry you lost your aunt. I hope you are doing well. I’m at the beginning of my journey.

[@mrking695]

@@CrystalVIsMedid your aunt have genomic testing after surgery and genetic testing before surgery? I had mammaprint on my tumor post surgery and mine showed ultra low risk. National Institute of Health shows 99.7% 5-10 year survival rate without adjuvant therapy. I also had genetic testing before surgery and was normal. I had same initial diagnosis as your aunt. I am having radiation for any microscopic cells that aren’t yet detectable but testing shows chemo is not advisable for me.

[@deshpalsingh1955]

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