Genomic Testing During Breast Cancer: Should You Have Testing?

[@quasimodem5260]

I’m in Canada so this is covered by our health system, there is no waiting for insurance to approve. This shortens the waiting time because I was told we could contact the company and ask for turnaround times. You can also sign a waiver and get it emailed to you. Ironically there are no labs in Canada that do this so my tumour was shipped to California. Bout a week, got mine in 4 days of them having it. When my oncologist opened my file , I knew my score and was prepared with the relevant questions. Although they sent my biopsy, they didn’t do so till after the lumpectomy. One micrometastic node, post menopausal, grade 2, stage 2. Onco score 9. So glad we live in the day and age we do. Thanks so much for your presentations. It means so much. Loved the explanation on the difference between genomic and genetic.

[@cristinagoedecker3432]

Did you decide to go for chemotherapy?

[@AnneS508]

I'm in Ontario Canada, and government would not cover it because tumour was smaller than 1 cm (dcis invasive, stage 1, grade 1, no nodes). It still bothers me not to have had this.

[@yerbba]

It's heartening to hear about the efficient process and support provided by the Canadian health system, making crucial tests like these more accessible. Your proactive approach in managing your care, from understanding your Oncotype DX score to preparing questions for your oncologist, is truly commendable. Thank you for watching!

[@naththomas9946]

Thank you, Dr. Griggs, for your continuous support of breast cancer patients.

[@yerbba]

Thank you very much for your kind words. Your support means a lot to us!

[@rebeccaherder8296]

My oncotype and mammaprint scores indicated high risk of recurrence. Did chemo and radiation and endocrine therapy and verzenio. Still scared of recurrence.

[@yerbba]

It's hard not to be scared of recurrence. Perhaps it's helpful to know that the treatment you received is effective in people with higher scores. You may also want to check out our videos on managing fears of recurrence: kzbin.info/www/bejne/eWPXgWqXh7yFaqM.

[@aditamckenzie2224]

I am 61 years old and diagnosed with DCIS in right breast 2 weeks ago. . Had DCIS in left 14 years ago . I am going to ask for a Oncotype DX test. Right now they are recommending 20 rounds of radiation after my lumpectomy. If it wasn’t for your information I might have had radiation when I didn’t need it. Thank you so much for your information 💖

[@yerbba]

Thank you for sharing your story. We're glad you’re taking charge of your treatment plan, and the Oncotype DX test can certainly be a useful tool in guiding decisions like whether radiation is necessary. Every case is unique, and it's possible that the characteristics of your DCIS are not such that the OncotypeDX test would be recommended. Feel free to come back and let us know what you found out.

[@youcamille]

Can you do the Breast Cancer Index before the 5 year mark, or right away, so that you can see how long you will need treatment in advance? It would help me with expectations.

[@yerbba]

The test has been validated in people who are disease free after five years. These people are different from "all comers." At some point, it is likely that the indication will be expanded.

[@donnabradley4577]

Thank you for this information! I was curious about the Breast Cancer Index and now you have answered my questions.

[@yerbba]

You're welcome! We're glad to hear you found this information helpful!

[@ctmom2114]

Insurance refused to cover the OncotypeDX genomic assay. We fought it, appealed, etc. Nope, no go. They insisted that it was genetic testing. My efforts to explain that it isn't were futile. Fortunately, the company wrote it off, which was a real blessing.

[@yerbba]

It's disheartening to hear about the challenges you faced with insurance coverage for the Oncotype DX assay, especially during a time when your energy is best focused on healing. It's fortunate that the company stepped in to support you by writing off the cost. Wishing you wellness on your journey ahead.

[@luticia]

I learn a lot from you. Thank you.

[@yerbba]

Thank you for watching and being part of our community!

[@BeateSchierle]

Thank you, Dr. Griggs. Highly informative!

[@yerbba]

Thank you for watching! We're glad you found this video helpful!

[@mmbhc233]

Dr please reply..can we take iron supplements during chemotherapy treatment???

[@yerbba]

Taking iron during chemotherapy is safe but should only be taken if someone is iron deficient or under treatment from a medical provider.

[@sindhuvalluri7195]

I m 36 yr old female. Stage 2 bilateral synchronous idc (3.5 cm and 2.5 cm); node negative;Strong er pr positive her 2 negative. Negative for brca gene. Lumpectomy done on both sides. Can assist score was low risk. Do you think i should consider bilateral mastectomy. Currently on tamoxifen. Do you recommend chemotherapy

[@yerbba]

Bilateral mastectomy is a very personal decision especially if your lymph nodes were negative. It’s best to weigh the risks and benefits with your oncologist. Regarding chemotherapy, since your score indicates low risk, chemotherapy is likely not to be recommended, but your oncologist can provide more personalized advice based on your complete medical profile.

[@sindhuvalluri7195]

@yerbba my reports for oncotype came back with score of 55. Her 2 also positive. Can you suggest the treatment course

[@RCB2010]

Dr Griggs I have found your videos to be the most useful and interesting videos on BC on the web however I am in London UK so a lot of information regarding insurance is not relevant to us! This CAN be a problem however as the NHS in the UK have a policy whereby a Grade 1 tumour will never have genomic testing - I assume because of cost. Is it standard to do, say an Oncotype DX assay on a Grade 1 Er+ IDC in the USA and do you recommend them? Or is it assumed that chemo will be of no value therefore the patient will never get a recurrence score? Thank you.

[@yerbba]

Thanks for sharing the UK experience. Grade 1 tumors have a low risk of recurrence and respond so well to endocrine therapy. The OncotypeDX and other genomic assays help oncologists decide whether chemotherapy offers benefit. Most people with grade 1 tumors have a low score, and thus the test(s) are not particularly helpful in creating a treatment plan.

[@Barbara-ex3ge]

Thank you for interesting video. Why are these tests not done for HER +ve. Is it because chemotherapy is always recommended? If so why?

[@yerbba]

Chemotherapy and targeted therapy part of the treatment plan in people with HER2-positive breast cancer because without them, the risk of recurrence is much higher. In people with HER2-positive breast cancer, the recurrence score is always "high."

[@Adishaktiparashakti369]

In India we have test called can assist test, can u plz make video on this.

[@chetnakalelkar6700]

Hi,can you elaborate on this test. I am in india.

[@yerbba]

Thanks for the suggestion. We'll add it to our list.

[@jenna5986]

My oncotype is 37 but my mitotic rate is 1. Im confused how chemo would help it only works on fast dividing cells?

[@yerbba]

That’s a great question. The OncotypeDX test result is of greater predictive value than the mitotix index.

[@jenna5986]

@yerbba thank you so much. I chose lupron and anastrazole as my treatment instead of chemotherapy. Is this an effective treatment option for this? I was diagnosed with IDC. 2.4 cm grade 2 and 1 micromet of 0.3. Thank you

[@TrudyContos-gq1bw]

Why would an onco test onco dx test come back with a score when the Her 2 was equivocal? It stated this should be fished and discussed further with your doctor!? When did you start testing in situ? What are your specifications for size and prognostic markers. Oops just heard you don't do her 2 testing that I'm well aware of. But, you score it anyway without a fish!? Just curious

[@yerbba]

FISH testing for HER2 became the standard in 2007. FISH testing for HER2 gene amplification in breast cancer became widely adopted as the standard method following the publication of the initial American Society of Clinical Oncology/College of American Pathologists guidelines in 2007. Before 2007, HER2 testing was performed using immunohistochemistry (IHC) to detect HER2 protein over-expression, with FISH used only in a those people whose IHC testing was "equivocal." However, the 2007 guidelines recommended that IHC should be used as a screening test for HER2 status. All IHC equivocal (2+) cases should undergo confirmatory FISH testing to determine HER2 gene amplification status. In people with ductal carcinoma in situ, HER2 testing is not necessary.

[@TrudyContos-gq1bw]

So, what if there's 3.5 nodes involved ?

[@yerbba]

If there are 4 or more lymph nodes involved, the recommendation generally is for chemotherapy and radiation therapy. Lymph nodes don't come in halves, so more than 3 lymph nodes would be 4 or more lymph nodes. But we get the point.

[@cristinagoedecker3432]

Hi Dr. Griggs, My husband have a breast cancer diagnosis. He had a lumpectomy. He is Hers negative, also hormone receptor positive and had 1 lymph nodes positive for cancer too. His genoma Dx test came back with score 9, but the doctor keep saying that she recommend chemotherapy, since there is not a lot of data for man. He is 45 years old. What do you think about not doing chemotherapy in his case? Thank you!

[@yerbba]

It is indeed difficult in men to know how well different tests function. Nonetheless, it is possible that the benefit of chemotherapy is low. Further discussion with your husband's oncologist may be helpful.

[@libasekhasbynaheedsultana4422]

Hi.i m in breast cancer 1st stGe age 40 want to know how much time it ll take to recover menstrual cycle

[@yerbba]

In general, it can take up to a year for periods to resume. For people over 40, many will not have their menstrual periods again. This does not mean that someone cannot get pregnant, so it's important to use birth control, especially on endocrine therapy.

[@chetnakalelkar6700]

Very informative. These tests may predict re-uccerance based on genetics and give the percentage but doesn't lifestyle management and decreasing all the triggers for your cells to go haywire more important than genetics? Getting cancer is an wakeup call.We cannot change our genes but certainly can change our lifestyle.So how does these tests ultimately help? Thanks for your videos which are very simple, interesting and learning.

[@yerbba]

Thank you for the feedback. In addition to lifestyle changes, chemotherapy and endocrine therapy can decrease the risk of recurrence. Genomic assays can help make decisions about whether chemotherapy are going to be helpful. If not, how good not to receive it.

[@chetnakalelkar6700]

@@yerbba thanks for the clarifications and insight . Your videos are very simple but so informative allaying so many fears about cancer.

[@Sacredly_sarah]

Why does the oncotype take SO LONG to get results?!

[@yerbba]

The 21-gene assay (brand name: OncotypeDX) takes 14 days due to the detailed genetic analysis required. It’s designed to help predict cancer recurrence risk and whether you'd benefit from chemotherapy, making the wait frustrating but potentially very beneficial for personalizing your treatment. If insurance takes a while to approve the test, this can add additional time.

[@selfofthephalanx]

Thank you for presenting this information so well. I have a question on the Mammaprint versus the Oncotype DX. Is there a particular reason why many people are hesitant to use Mammaprint to make a determination on whether chemotherapy should be used and why do they not have the same hesitation with using Oncotype DX for this purpose?

[@yerbba]

The preference for the OncotypeDX test is likely due to the fact that there is substantially more data, which has increased comfort with and confidence with the OncotypeDX results.

[@TrudyContos-gq1bw]

When did they start doing this on dcis? I can imagine the price goes up as the gene count does ..... How can a genomic testing have such difference in the amount of genes and give a confident score? Index should and was done in the original dx ( do you mean AI) HT . Well if it's 20 percent it's an 80 percent you won't get it back. Why don't you just cut through the Chase and tell everybody what the difference is with this test and without it because when I had my done 5 years ago it was the same exact thing as I was told without the DX test. Just seems like another way to gouge another poor womens bank account.

[@yerbba]

Genomic testing on DCIS started in 2011 as a way to see if genomic assays could help determine whether people could omit radiation therapy after surgery for DCIS. Without doing the assay, radiation therapy would be the standard treatment. When some large studies validated the test, the results were then used to determine if a patient could skip radiation therapy. Although the test is very expensive, radiation therapy is much more expensive. Overall, the test is considered "cost effective" from the standpoint of payers because some people can skip radiation therapy. Nonetheless, for a given person, it's understandable that it would seem like it didn't add much.

[@Kongszeman]

😊

[@yerbba]

Thanks for watching!