Oncotype Tests Not Well Explained
Some of you are aware of the Oncotype DX test that is often used to help determine which women with early breast cancer would benefit from chemotherapy. It has been in use for a littlemore than five years and was initially only offered to women who had ER/PR positive (hormone positive), node negative disease. Over the course of a few years, it was expanded to sometimes include women who had positive node(s).
We have known for a long time that chemotherapy is often given to women who don't need it and/or who won't benefit from it. Determining the risk/benefit ratio and trying to better understand whose cancer is at higher risk for recurrence is a major challenge. A major direction of all cancer research is better targeting therapies and understanding who should get/who needs what treatment. As it stands now, for every 100 women with breast cancer who are given adjuvant chemotherapy, only a minority (depending on the stage and type, that number can vary from 3 or 4 to 20 or more) will benefit from it. The catch, of course, is that it is impossible to select those women at risk, and the reality of recurrent/metastatic breast cancer (meaning, not a local recurrence) is a disease that cannot be cured. Very high stakes.
I actually first learned of this test five years ago when my second breast cancer was diagnosed. For a range of specific reasons, including the fact that there was no way to know whether any axillary lymph nodes were involved because I had had an axillary node dissection 12 years earlier--voila, there were no nodes to be tested, I did have the Oncotype DX test done. The results returned in an intermediate risk range which confirmed the value of chemotherapy.
Here is a summary from Medpage about understanding these test results and then a link to find out more about the test itself:
Cancer Gene Test Results Often Not Well Explained
By Charles Bankhead, Staff Writer, MedPage Today
Discussions of genetic test results for breast cancer recurrence risk frequently miss the mark for patient comprehension, according to a survey of women with early-stage breast cancer.
A third of the survey respondents said they did not fully understand discussions with healthcare providers about results of genomic testing. The findings underscore the need to improve communication with patients about risk and treatment decision-making, investigators reported online in Cancer.
"Most women had high perceived understanding of what they discussed with physicians regarding their test results," Janice P. Tzeng, of the University of North Carolina in Chapel Hill, and colleagues wrote in conclusion. "However, a significant number of women did not fully understand discussions about their genomic-based recurrence risk, which presents the need to continue developing optimal ways to communicate and ensure both perceived and actual comprehension of genomic-based information.
"Finally," they wrote, "women with intermediate and high genomic-based recurrence risks deserve special attention, as they are more likely to suffer from worry about recurrence and distress regarding their result."
The findings came from a survey and medical-record review of 77 women with early-stage breast cancer. All the women had estrogen receptor-positive tumors and zero to three involved lymph nodes. They were evaluated by means of the Oncotype DX genomic test from 2004 to 2009. Complete data were available for 68 of the patients.
Half of the patients had test results indicating a low risk of recurrence, and another 37% had results indicating an intermediate risk. A quarter of the patients recalled having anxiety about their test results.
The authors found that 71% of the respondents accurately recalled the recurrence risk indicated by their test results. Two-thirds thought that they understood much of what they were told about the test results, leaving a third of the study group with incomplete or inadequate understanding of their results. When asked whether they would have the genomic test again, 96% of respondents said they would, and 95% said they would recommend the test to other women in the same situation.
Additionally, 95% of the women said the test results helped them better understand their treatment options' chances of success, 71% believed their test results were accurate, and 76% found the test useful because it could determine with certainty whether they had a high risk of recurrence. "Overall, results suggest that women are satisfied with genomic testing, given that they would recommend the test to other women and would have the test if they had to decide again," the authors wrote. "They also saw many benefits and few concerns about genomic testing."
Primary source: Cancer
Tzeng JP, et al "Women's experiences with genomic testing for breast cancer recurrence risk" Cancer 2010;
To learn more about the test itself: