BOSTON -- This year approximately 200,000 American women will be diagnosed with breast cancer, but when it comes to treating all of those individual patients, there are many options.

A cutting-edge test that examines the DNA of a breast tumor once it is surgically removed is helping doctors and patients alike decide when women need chemotherapy.

"I was on the fence back and forth," said Joyce Hanson, a 65-year-old mother and grandmother who was diagnosed with breast cancer last year. "It was very difficult."

After Hanson had surgery twice to remove the small tumor, the big question looming over her and her oncologists was what to do next. Would she need hormone treatments, radiation, or perhaps, chemotherapy?

"That is scary word for most people," said Hanson.

Like approximately half of all women who get breast cancer, the question of whether chemotherapy would help Hanson was not clear.

"Those are the most difficult visits we have with our patients," said Dr. Beverly Moy of Massachusetts General Hospital. "Because we basically say, 'These are the risks, these are the benefits, it's now up to you. It's very frustrating for patients and physicians."

Hanson fell into this category of cancer patients, and that's when Moy suggested Joyce have an oncotype test.

It's only appropriate for women whose tumor is estrogen-receptor positive, meaning it will respond to estrogen therapy, and whose cancer has not spread to the lymph nodes.

The results would give Hanson two critical answers: Would chemotherapy help her? And what are the odds her cancer will come back?

"I said that's exactly what I need to know."

Oncotype testing works like this: During surgery, the breast tumor is saved, preserved in paraffin wax and then shipped off to a lab.

Moy said, "They do DNA testing for these 21 genes through a process called RTPCR, and it gives you a recurrence score, low, intermediate or high. High score, yes, chemotherapy is beneficial. Low score, no, chemotherapy is not beneficial."

Hanson's recurrence score came back right in the middle, but the result gave her more confidence in her personal desire to skip chemotherapy, and its heavy emotional and physical costs.

Of all the cancer therapies, "The one that worries and distresses women the most is chemotherapy," according to Dr. Sue Troyan, a breast surgeon at Beth Israel Deaconess Medical Center.

Troyan said since it became available in 2004, oncotype has become a routine and reliable test for her and her patients.

"Now we're able to pick out some women, many women who do not need the chemotherapy and save them from having to go through that," Troyan said.

"I really felt it was huge huge help," said Hanson. "Having that piece of information really helped me."

An oncotype test costs about $3,500, or about the same as a single session of chemotherapy. Most of the time insurance will cover it. Experts feel this is just the tip of the iceberg and that soon, testing the DNA of tumors to unlock the best treatments for each particular patient could be commonplace.

Resource:

My Treatment Decision