Can Breast Cancer Patients Skip Chemo? There’s an Easy Way to Know

A simple 21-gene assay can determine if chemo is needed.

A simple 21-gene assay can determine if chemo is needed.

The Dreaded Call About the Results of Your Breast Cancer Surgery

It’s now been 8 weeks from the time you noted that lump in your breast. You’ve already gone through the mammograms and the biopsy.  You’ve had the lumpectomy done, and the surgeon said it’s also important that the lymph nodes are examined. You get excited by the great news that there was no spread to the lymph nodes in your armpit. But now your surgeon bursts your balloon and tells you that may need more treatment, even chemotherapy, because your breast cancer was nearly an inch wide.  Chemo too? Really?  Why do I have to take that stuff?

The Value of Genetic Testing 

For decades, the size of a woman’s breast cancer dominated the discussion of whether or not chemotherapy was needed. But all that has changed dramatically with the advent of gene testing for women with early stage breast cancer. A new study supported a decade-long practice of using the 21-gene breast cancer recurrence risk test, otherwise known as Oncotype DX, to decide whether or not a woman needs to undergo chemotherapy.

The TAILORx trial enrolled 10,253 women with breast cancer who had so-called “favorable disease.”  That is to say, their breast cancers were hormone receptor positive, HER-2 negative and with no spread to the lymph nodes. The physicians who piloted the study looked at a small portion of these women – only 1,626 women or 15.9% of all the enrolled women with breast cancer to be precise – who had low Oncotype DX scores. The low Oncotype DX score breast cancer patients were then treated with tamoxifen or an aromatase inhibitor such as anastrozole or both for 5 years – BUT with no chemotherapy.

Remarkably, 99.3% of those women with low risk, early stage breast cancer had no metastatic spread to other organs, like bone, brain, liver, or lung.  In a press release, Dr. Kathy Albain from the Loyola University Medical Center in Chicago, one of the lead doctors said, “There is outstanding survival with endocrine therapy alone. The test provides us with greater certainty of who can safely avoid chemotherapy.”

Just think, less than a decade ago, many of these women with breast cancer would have been treated with hormonal therapy AND chemotherapy. At that time, the medical oncologist’s decision was essentially based on anatomy; the size of the tumor was the most important feature of a woman’s breast cancer. But now it’s the biology of the breast cancer, the genetic changes in the tumor itself, that now takes center stage.

So What’s a Woman with Breast Cancer To Do?

Simply put, the Oncotype DX test has been used by breast cancer specialists for a decade without a confirmatory trial.  And now woman have confirmation from a well-run study of over 1,600 breast cancer patients. The Oncotype DX test is expensive, about $4000, but the test is covered by most insurance companies, including Medicare and Medicaid. And it is definitely cheaper than chemotherapy. Importantly, the Oncotype DX test isn’t a same day or next day test. In fact, the test takes about 2 weeks to get back results; plenty of time to recover from breast cancer surgery before making a decision about chemotherapy or hormonal therapy or both.

So I think it’s important for breast cancer surgeons, radiation oncologists, and medical oncologists to discuss the role of the Oncotype DX test before a woman finalizes her breast cancer treatment plan. Oncotype DX is one more step in the direction of “precision medicine” for women with breast cancer.

So keep in mind that the most important advances in breast cancer treatment are not only news to you, but also your well-meaning friends and family.

If you have any questions about your breast cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton1.