Genetic test could mean many women with breast cancer forgo chemotherapy

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A recent study shows most women with the most common form of early-stage breast cancer can now skip chemotherapy.

According to Dr. Schmidt, "By looking at different genes in the breast cancer, the oncotype test can predict if women are low risk, intermediate risk, or high risk or recurrence and what their benefit or lack thereof of chemotherapy might be".

There are several factors that determine whether or not a patient will, in fact, be able to forgo the chemo, most significant being if they score in the mid-range or lower for risk that their cancer will recur, as measured by a common genomic test.

For years doctors were unsure how to treat women who fell in the middle range of the scoring system.

TAILORx, a phase 3 clinical trial, opened in 2006 and was created to provide an evidence-based answer to the question of whether hormone therapy alone is not inferior to hormone therapy plus chemotherapy. At nine years, the rate was 83.3 percent for those with hormone therapy alone and 84.3 percent for the group that had both therapies. This confirms similar findings from earlier studies.

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The results of the trial suggest that up to 85 percent of women with early breast cancer can be spared chemotherapy - especially those over 50 years of age. The study confirmed that using a 21-gene analyzation to assess cancer recurrence risk can successfully indicate whether or not a woman needs to undergo invasive and unnecessary chemotherapy treatment. At the time of the study, doctors didn't know if chemotherapy would benefit women with intermediate risk.

There is one caveat to the new findings.

246 patients took part in the phase 3 PREOPANC-1 trial and were randomly assigned to receive either surgery immediately or chemoradiotherapy for 10 weeks followed by surgery. However, it is unclear if this benefit is due to the effect of chemotherapy or to endocrine suppression caused by chemotherapy-induced menopause. These come from small, early stage studies through to large randomised clinical trials. Since 1998, when the charity stamp was authorized by Congress and first issued by the United States Postal Service, more than $86 million has been raised for breast cancer research. The extra 6 cents went for research - 70 percent to the Cancer Institute and 30 percent to the Department of Defense.

The researchers said ongoing clinical trials are obtaining additional information on the clinical usefulness of the 21-gene assay in women with hormone receptor-positive breast cancer and positive axillary nodes, and evaluating the clinical usefulness of the 50-gene assay in this context.

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