New Study Suggests Some Breast Cancer Patients Can Skip Radiation
- Actress Joanna Kerns, 70, was diagnosed with stage zero breast cancer. She underwent a lumpectomy and a double mastectomy (removal of both breasts) to reduce her cancer risk.
- A new study presented at the annual San Antonio Breast Cancer Symposium suggests women with stage zero breast cancer (ductal carcinoma in situ) DCIS may be able to skip radiation after surgery.
- The study examined 171 early-stage breast cancer patients to see if their risk of cancer recurrence was impacted by skipping radiation. Patients deemed low-risk based on their Oncotype DX Breast test score found that only a small number experienced their cancer returning.
- Next-generation sequencing (NGS) is a specific type of technology used for molecular profiling. It helps doctors better understand breast cancer tumors, what makes them function, and possible treatments to eradicate them.
- NGS can be helpful for breast cancer patients at any stage, but it is critical for patients with late-stage or metastatic breast cancer.
Women like “Growing Pains” star Joanna Kerns, 70, who was diagnosed with non-invasive stage zero or Ductal Carcinoma in Situ (DCIS), may be able to safely bypass radiation after surgery, according to new research presented at the annual San Antonio Breast Cancer Symposium.
Dr. Seema Khan, the study’s lead author, highlighted results from the E4112 clinical trial that assessed the potential of bilateral MRI coupled with a DCIS gene profile to treat stage zero breast cancer patients.
Read MoreThe clinical trial followed 171 women who underwent a lumpectomy. This procedure is a surgery to remove a cancer or abnormal tissue from the breast. It’s also known as breast-conserving surgery because, unlike mastectomy, only the tumor and some of the surrounding tissue are removed. Women with early-stage breast cancer are typically treated with a lumpectomy and then given radiation to prevent a recurrence. However, the new data presented at SABCS suggests there’s another option for women with this diagnosis.
WATCH: Recovering from a lumpectomy.
During the study, the breast tissue from participants was subjected to the Oncotype DX Breast DCIS score. The test is a genetic test that profiles the tumors of women who have early-stage hormone receptor, HER2-negative breast cancer. The test’s main objective is to help doctors determine the likelihood of the breast cancer returning after initial treatment.
After surgery, a piece of the tumor is sent off to be tested. The result is a number otherwise known as the “Oncotype DX score.”
The score determines if a woman is at low, intermediate, or high risk of recurrence and, based on that result, whether a woman may benefit from the addition of chemotherapy before receiving hormonal therapy. In general, women who have a low score do not need chemotherapy. Women who have a high score may decrease the risk of the cancer coming back with the addition of chemotherapy.
Participants with an Oncotype DX score of 39 or higher were recommended to receive adjuvant radiotherapy, while women below 39 were considered low-risk and could skip radiation.
“75 of 82 patients with low-risk DCIS elected to skip adjuvant radiotherapy, and 84 of 89 patients with high-risk DCIS opted to undergo adjuvant radiotherapy.
After a median follow-up of five years after surgery, 5.1% of the 82 patients with low-risk DCIS and 4.5% of the 89 patients with high-risk DCIS experienced disease recurrence in the same breast as the primary DCIS,” the American Association for Cancer Research reports.
“Our results indicate that the Oncotype DX Breast DCIS Score was an effective tool to stratify patients for adjuvant radiotherapy following breast-conserving surgery. Women who skipped radiation based on this score did not experience an excess risk of recurrence in the same breast during the five-year follow-up period,” said Khan.
“These findings reveal a new approach to guide treatment decisions by determining which patients may benefit from radiotherapy and which patients may safely forego it,” Dr. Khan adds.
RELATED: Molecular Testing For Breast Cancer: What You Should Know
Helping Patients Cope with Early-Stage Breast Cancer
How Understanding Tumor Markers in Breast Cancer Helps
“Molecular profiling involves the use of various technologies to understand the underlying characteristics of the tumor found in your cancer by giving us specific information on the molecular and genetic makeup of that tumor,” Dr. Abdou explains.
These features or characteristics refer to DNA, RNA, or protein alterations or mutations in your tumor. Those changes can help give you and your doctor a better idea of the following:
- Whether you would benefit from certain treatments and targeted therapies.
- Suppose your cancer is likely to come back.
- Whether other family members may be at risk for certain kinds of cancer.
- Ask about potential clinical trials.
There are several tests you may encounter, depending on where you are getting treatment and what you are getting treatment for. Here are some of the common ones currently on the market:
- FoundationOne®CDx looks at 324 genes in solid tumors and says results can take up to 12 days. Test results include microsatellite instability (MSI) and tumor mutational burden (TMB) to help inform immunotherapy decisions.
- OmniSeq Insight provides comprehensive genomic and immune profiling for all solid tumors. It looks for 523 different genes. Test results include microsatellite instability (MSI) and tumor mutational burden (TMB), as well as PD-L1 by immunohistochemistry (IHC).
- Cobas EGFR Mutation Test v2 identifies 42 mutations in exons 18, 19, 20, and 21 of the epidermal growth factor receptor (EGFR) gene. It is designed to test tissue and plasma specimens with a single kit, allowing labs to run tissue and plasma simultaneously on the same plate.
WATCH: Next-Generation Sequencing in Breast Cancer
SurvivorNet experts recommend breast cancer patients diagnosed with early-stage breast cancer to ask about NGS testing. However, this is not considered standard-of-care for early-stage breast cancer. On the other hand, NGS is critical for patients with late-stage or metastatic breast cancer.
NGS test results in metastatic breast cancer look for additional DNA mutations that may have an effective targeted therapy.
“We usually recommend a repeat biopsy of the tumor from a spot where the cancer has spread. And that’s, of course, if it’s safe to biopsy that spot,” Dr. Abdou says. “Examples of such spots would be lung, liver, and bone. Those are examples of where we would obtain a biopsy in metastatic disease. The biopsy is really to confirm that the cancer is indeed metastatic breast cancer.”
RELATED: Metastatic Breast Cancer: Biomarkers and Mutations That Matter
Re-testing the tumor markers is also very important. Dr. Abdou continues:
“We also like to repeat the tumor markers, which are the receptors, including estrogen, progesterone, and HER2, because while in most circumstances the tumor markers remain the same as the primary tumor that started in the breast, in some circumstances, these markers change.”
Doing another biopsy and re-testing the tumor markers gives your doctor a better sense of how your cancer has evolved.
Joana’s Cancer Journey
Kerns told People she was diagnosed with non-invasive stage zero breast cancer in November 2016. The diagnosis came after she underwent a routine mammogram, which screens for breast cancer. She was surprised to learn she had cancer because she has no family history of the disease, and she receives regular screenings.
“I had been vigilant about screenings and exams, except this time I had missed a couple of years in there due to work and family issues, and suddenly I turn around, and it’s two years later, and I hadn’t done it, and I have cancer – it was quite shocking,” Kerns said.
Kerns underwent two lumpectomies and a double mastectomy to help reduce her cancer risk. During a lumpectomy, the cancer and an area of healthy tissue around it are removed. A double mastectomy is a procedure to remove both breasts. Sometimes, a mastectomy is performed to reduce a woman’s risk of developing cancer, especially if she is at high risk of cancer.
“Had I not caught my cancer this early on, I would have had to have a year of chemotherapy, and because of the reoccurrence and aggressiveness of this particular type of cancer, which was non-invasive HER2, I chose to do the mastectomy,” Kerns said.
A prophylactic, or preventative, mastectomy is an operation where the breast tissue is removed to prevent cancer from developing in the future.
“Risk-reducing mastectomies are an operation where we take women at, usually, very high-risk for getting breast cancer for genetic mutation carriers, who are the ones at the highest risk; there’s unfortunately only one way to actually prevent breast cancer,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet.
Some women decide to have their breasts reconstructed and have implants put in right after the mastectomy, while others don’t have reconstruction at all.
What To Ask Your Doctor
If you have been diagnosed with breast cancer, you may have questions about keeping your strength through treatment. Here are a few questions to help you begin the conversation with your doctor:
- What treatment will I be receiving?
- What side effects are associated with this treatment?
- Are there steps I can take daily to help minimize these side effects?
- What physical activity routine do you recommend for me during treatment?
- Do you have recommendations for someone who doesn’t particularly enjoy exercise?
- Can you recommend a dietician who can help me with healthy eating tips and weight maintenance?
- I’ve been having trouble sleeping. Do you have any treatment recommendations?
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