Over 212,920 new cases of breast cancer will be diagnosed this year in the United States. It is the most common type of cancer among women in this country (other than skin cancer), according to the National Cancer Institute.
Breast cancer is often classified as a local, regional and distant disease. Local disease is cancer that is confined to the breast and has not spread to the lymph nodes in the axilla (underarm area) or to other organs. Regional disease is cancer that originated in the breast and has spread the lymph nodes in the axilla. Lastly, distant disease is breast cancer that has spread to other areas or organs in the body.
Treatment for regional and distant disease will most likely benefit from the administration of chemotherapy along with other treatments, such as surgery and/or radiation therapy. However, the majority of women with local disease are also advised to receive chemotherapy in addition to radiation and hormonal therapy. Yet, research has not demonstrated that chemotherapy benefits all of them equally.
Up until recently, choosing whether or not a person with estrogen positive local disease should undergo chemotherapy often depended on age, size of the tumor and grade of the tumor. By following these criteria, the vast majority of patients would need to consider chemotherapy.
Recently, a new test called Oncotype DX became available to assist oncologists in making recommendations for treatment of patients with estrogen positive local disease. Only newly diagnosed patients with local disease (stage I and II), no positive lymph nodes and estrogen receptor disease are eligible for this testing.
The test results are reported as a recurrence score from 0 to 100. The higher the score the greater the risk of recurrence at 10 years. There are three risk categories for recurrence based on the test scores: low risk (0-17); intermediate risk (18-31); and high risk (32-100). For example, a woman with a recurrence score of 10 has a low risk of distant recurrence at 10 years. Tumors with low scores recurred at a rate of 6.8 percent in the 10 years after diagnosis; tumors with intermediate scores recurred at a rate of 14.3 percent; and those with high scores recurred at a rate of 30.5 percent, according to the National Breast Cancer Coalition.
The oncologist and patient can make a more informed decision based on this new information and the other clinical and pathological information.
Presently, a national clinical trial called TAILORX is under way to further examine whether genes that are frequently associated with risk of recurrence for women with local disease can be used to assign patients to the most appropriate and effective treatment. In this trial, Oncotype DX will be used to measure the activity of a set of genes in breast tumor tissue, to determine which women will receive adjuvant chemotherapy in addition to hormone therapy. This trial will hopefully provide the information needed for individualized plans of care for the treatment of breast cancer.
The Penn State Cancer Institute at Mount Nittany Medical Center presently offers this trial. Anyone with further questions regarding the Oncotype DX or the TAILORX trial is encouraged to call the cancer program at Mount Nittany Medical Center at 814.231.7005.
Tara Baney is the oncology clinical nurse specialist for the Penn State Cancer Institute at Mount Nittany Medical Center.