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Assessing Recurrence Risk

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Ashok Bapat, MD, Virtua oncologist, describes the dilemma of treating post-surgical breast cancer patients, an issue the NCI-sponsored Trial Assigning Individualized Options for Treatment, or TAILORx, is now exploring. "In the trial, selected patients, deemed at low risk of cancer recurrence by the Oncotype DX ™ genetic test, receive only hormone therapy. Patients at high risk of recurrence receive chemotherapy plus hormone therapy. Those at moderate risk of recurrence are randomly assigned to either hormone therapy alone, or chemotherapy in addition to it. The end point is to determine the benefit of adding chemotherapy - or not - to moderaterisk patients.

"Oncotype DX , may offer a solution," explains Eric Miller, MD, Virtua surgeon. "It measures the expression levels of 21 genes which can help identify high-risk breast cancer patients, who potentially may not get adequate systemic therapy, versus average- or low-risk patients, who could receive more limited treatment." Currently, stage I-III breast cancers are risk assigned by tumor size, grade, nodal involvement, and ER-PR and HER2 status. Dr. Miller: "While the Oncotype DX test is expensive, it may be advantageous for lymph node negative, estrogen receptor positive, stage one breast cancer patients. The test could assist a physician to select the most appropriate treatment, prevent recurrence, and potentially lead to more appropriate treatment."

"Breast cancer is such a varied disease that selective treatment is the practical solution. It's important to treat people based on their individual risks and personal variables," Dr. Miller emphasizes.

"It's just too early to say if genetic tests should be adopted by physicians for every breast cancer patient," concludes Dr. Bapat

This Virtua Physician article was last updated: August 21, 2008