Want to learn about breast cancer genomic tests? Not genetics, genomics? We
will teach you all about it.
If you've been diagnosed recently with a small, early favorable breast cancer, for
some, there are sophisticated tests called genomic assays. These cutting-edge tests
can take a little deeper look into your cancer cells to give us a better idea
about how to best treat your unique breast cancer. They do not apply to all
but it's so important to know about them. In this lesson, I'm gonna tell you what
genomic assays are and the information that they provide. I'm also going to tell
you how genomic tests differ from genetic tests. There's a lot of confusion
there and I'm going to give you some clarity on that. I'm going to share with you who may
benefit from, or be eligible for a genomic assay for their breast cancer.
And I'm going to go over the most common genomic assays in breast cancer
available today. So let's get started. So what are genomic tests? Well, these new
cutting-edge tests are a leap forward in our ability to identify in early-stage
breast cancer whether or not you may or may not benefit from chemotherapy. These
genomic tests, in a few patients, can help us determine whether or not you might be
able to avoid radiation therapy after a lumpectomy for DCIS, which is a
precancerous condition. In a even smaller group of patients it can give us
some information of whether or not you can avoid ten years of hormonal therapy
for an invasive breast cancer and have only five years of hormonal therapy. So let me
tell you about pathology. It sounds boring but it's really important if you have
breast cancer. Whenever you are diagnosed with a breast cancer, after a
biopsy or you have the tumor removed the pathologist looks at your cancer
cells under the microscope and look at the "type" of breast cancer, they look at
the "grade", how angry each cell looks versus less angry. High grade or low grade. And tumor "receptors" which are critical information to guide us how to
best treat your cancer to keep it from coming back and threatening your life . Genomic assays takes this a step further it looks deeper into your cancer cells
looking at more genetic changes and RNA changes and protein changes and all kinds
of things to tell us whether your cancer is a higher risk for coming back and can
give us some information about how to treat your cancer that we otherwise
wouldn't know. Next, I'm going to talk to you a little bit about the difference
between genomic assays and genetic testing, and I'll get to that in just a
moment. So what is the difference between a genomic assay and genetic testing. Well,
medical terms are confusing and that's why we created the Breast Cancer School
for Patients. I've covered genomic tests a deeper look inside a tumor if you have
breast cancer. I'm now going to pivot and talk about "genetic testing," the "BRCA
mutation," the "breast cancer gene." These are terms for a broken copy of a gene. We
all are born with tens of thousands of genes but if you pick up a broken copy
of one of these genes, the BRCA mutation and there are other cancer-causing genes
that we can test for now. I'm gonna talk about the BRCA mutation. When you are
conceived, from either your mother or father you might pick up a copy a broken
copy, a mutated copy, of the BRCA gene. So if you pick up a broken copy, you pick up the BRCA
mutation. And men and women carry these mutations equally. We talk about it more
in women because it's really related to breast cancer. But if you pick up the
BRCA mutation that broken mutation is in every cell of your body, from birth all
the way into adulthood. If you carry that mutation, we then can predict that you
have a lifetime increased risk of developing breast cancer (up to 60-80 %) a
lifetime increased risk of developing ovarian cancer, lifetime risk of 20 to
40%. It's a really deadly one. If you're a woman you have an increased risk of
pancreatic cancer and melanoma if you're a man you have an increased risk of
breast cancer it's extremely rare in men but it can increase that risk in men to
about 8 or 10% in our lifetime increased risk of prostate cancer melanoma
pancreatic cancer so genetic testing is when we identify something that's
someone that has risks risk factors of red flags breast cancer early age strong
family history of breast and ovarian cancer or pancreatic cancer prostate
cancer take our video lesson at the breast cancer school for patients on
BRCA genetic testing our video is very thorough
we have great information and links to the best sites so genomic assays look
into your tumor if you have breast cancer
genetic testing identifying someone that may carry a broken genes been running in
their family possibly for thousands of years that identifies them as an
increased risk for developing breast cancer another
next I'm gonna tell you the specific situations in which today we use genomic
assays and you can see whether or not they may apply to you so will I benefit
from a genomic assay for my breast cancer it is important for me to share
with you that not all breast cancer specialists
embrace genomic assays in their practice of medicine genomic assays are becoming
more and more adopted nationwide integrated in to treatment guidelines
and they really are becoming commonplace but it is possible that you may qualify
for a Gemma genomic assay and your physicians never talk about it so this
is why we made this lesson for the breast cancer school for patients so you
can engage your breast cancer specialists to make sure that it is on
the table if it's appropriate for you so I'm gonna go through three common
scenarios I mentioned them earlier the most common scenario is if you are newly
diagnosed with an invasive breast cancer a small tumor generally no cancer in the
lymph nodes but in some situations these team these tests can be used if you have
a small amount of cancer in one to most importantly if your estrogen
receptor-positive it means your tumors responsive to hormonal therapy
80% of invasive breast cancers are and her2 negative which really still
suggests no chemotherapy so in this very favorable situation early stage breast
cancer genomic assays can look deeper into those cells and give us a little
bit more information to determine number one if you're at a much higher risk of
this cancer coming back and threatening your life and in that situation it might
help predict that you will benefit from chemotherapy even though everything else
doesn't suggest you it there to lessen the risk of that cancer to your life so
in some situations it can point to chemotherapy when you otherwise may not
be pursuing chemotherapy near treatment because you've had a genomic assay a
second common situation is that your tumor looks favorable and you do a
genomic assay to see whether it points to the chemotherapy or car and it the
majority of these situations point that your tumor is a generally low risk of
very very favorable - and you will benefit from hormonal therapy and
there's really no benefit from chemotherapy so it really confirms that
you can make a decision not to do chemotherapy in a the most definitive
way in today's world of breast cancer care there is a situation where you get
results sort of in the middle it's a piece of information but it doesn't
really point in one direction or the other and it's not uncommon so you just
need to be aware so that's the situation early stage
breast cancer invasive breast cancer DC is a pre cancer we usually treat it with
a lumpectomy take the tumor out good margins and generally most women will
have radiation to the breast to lessen the chance that anything grows back in
that breast maybe there's some DCI cells left in the breast although we tell you
we've got a mole that might grow in the future so radiation reduces that with
genomic assays can play a role and look deeper into the DCIS cells to kind of
get an idea whether those cells a little bit more aggressive and or less
aggressive and it's not used that often in this situation but more and more over
time and there other developing genomic assays for DCIS for this purpose that
will come out in the near future but if you FDCs have really really
really want to avoid radiation then a genomic assay can sometimes point
hey this tumor is at a higher risk of coming back and you really benefit from
radiation it can help you make that decision with your radiation oncologist
but if that genomic test comes back hey this is a very favorable tumor as far as
we can tell as a low risk of growing back then it gives you some information
that might point you in the direction in consultation with radiation oncologist
that you might be able to have a lumpectomy and no radiation and follow
the breast very care a third situation that's common
with genomic assays and breast cancer today is that most women with forma
undergo hormonal therapy for an invasive breast cancer early stage breast cancer
take the drug for ten years now but there's a genomic assay that might be
able to predict whether there's little benefit from beyond five years so take
it for you you're six seven eight nine and ten the way to think about that if
you're taking hormonal therapy after four up to four or five years and are
struggling with it's making life miserable you've done things with your
medical oncologist to try to ameliorate those symptoms and you really like I've
done with this drug at five years there's a genomic test that might point
to whether your breast cancer is a high risk for coming back if you stop you
know what excuse me stop hormonal therapy and that
might point you to continue taking those drugs because it really lessens the risk
of your cancer coming back right here life and dying of that breast cancer
at that test if you're struggling with those medications may say it's a low
risk you might be reassuring that you're willing to take that risk and stop the
drugs and go forward and improve the quality of life next I'm going to tell
you about the most common genomic assays today so what are the most common breast
cancer genomic assays available in the United States well the situation of
invasive breast cancer may be helping determine whether or not you benefit
from chemotherapy or not the most common genomic assay is an Oncotype DX assay
less use but also backed up by very good information and data is a ma'am
apprentice test and an endo predict genomic tells the situation where you
have DCIS and are trying to determine whether you might be able to avoid
radiation after a lumpectomy an Oncotype DCIS test is the most commonly utilized
test for this there are more tests coming available in the near future for
this purpose and in the situation where a patient's trying to determine with
their medical oncologists whether they can avoid the extra five years of ten
years of hormonal therapy the breast cancer index is an fda-approved test for
this purpose all of this information about genomic tests is available on our
website and links to all of the best sites to give you information about
genomic testing and where to find genomic testing is all available in the
breast cancer school for patients whereas cancer genomic assays are not
appropriate for everyone but may play a role in about 25 to 30 percent of newly
diagnosed patients with breast cancer these tests actually define what we call
personalized medicine which means giving you exactly the
treatments that you need not over treating you but also not under treating
you at the breast cancer school for patients we encourage you to engage your
breast cancer specialists to see whether or not a genomic asset may play a role
in your treatment decisions for your unique breast cancer we're here to help
you get the best possible breast cancer care in your community register on our
website to get our list of questions to prepare you for your next doctor visit
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